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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.
PLoS One ; 15(1): e0221544, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31986149

RESUMO

BACKGROUND: Computed tomography (CT) images of livers may show a hypo-attenuated structure alongside the falciform ligament, which can be a focal fatty pseudolesion and can mimic a malignancy. The preferred location is on the right parafissural site, ventral in segment IVa/b. The etiology is not clear, nor is it known how the histology of this location develops. These are evaluated in this study. METHODS: 40 adult cadavers with autopsy and / or postmortem CT in a university hospital and a forensic center were included. Liver biopsies were taken at the left side of the falciform ligament as control, and at the right side as the possible precursor of a pseudolesion; these were examined for collagen and fat content. Cadavers with steatotic (>5% fat) or fibrotic (>2% collagen) control samples were excluded. RESULTS: Significantly more collagen was present in the right parafissural liver parenchyma: median 0.68% (IQR: 0.32-1.17%), compared to the left side 0.48% (IQR: 0.21-0.75%) (p 0.008), with equal fat content and CT attenuation values. The etiophysiology goes back to the demise of the umbilical venes in the early embryonic and neonatal period. CONCLUSIONS: The right parafissural area contains more collagen and an equal amount of fat compared to the control left side. This supports the hypothesis of delayed, 'third' inflow: the postnatal change in blood supply from umbilical to portal leaves the downstream parafissural area hypoperfused leading to hypoxia which in turn results in collagen accumulation and the persistence of paraumbilical veins of Sappey.


Assuntos
Colágeno/metabolismo , Diagnóstico Diferencial , Fígado Gorduroso/diagnóstico , Neoplasias Hepáticas/diagnóstico , Fígado/diagnóstico por imagem , Adulto , Autopsia , Biópsia , Cadáver , Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/patologia , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/patologia , Fígado/metabolismo , Fígado/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Mesentério/diagnóstico por imagem , Mesentério/patologia , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Umbigo/diagnóstico por imagem , Umbigo/patologia
3.
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
4.
Kathmandu Univ Med J (KUMJ) ; 17(65): 30-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734675

RESUMO

Background Extra hepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in the developing countries (up to 30% of all variceal bleeders) and is second to cirrhosis in the West (up to 5-10%). Our understanding of the disease is poor compared with other illnesses. Objective To undertake a retrospective study of the clinicoepidemiological profile of Extra hepatic portal vein obstruction in a tertiary care hospital in eastern Nepal. Method All consecutive adult patients whose features were consistent with the diagnosis of extra hepatic portal vein obstruction from June 2014 to June 2016 were retrospectively analyzed to explore the various clinico-epidemiological parameters. Result A total of 58 patients were enrolled in the study with a median age of 24 years (20.5- 40). Portal vein thrombosis was the most common cause of extrahepatic portal vein obstruction. Hematemesis followed by melena were the most common presenting symptoms. All patients had splenomegaly on examination. None of the patients had clinical, biochemical or radiological evidence of chronic liver disease. Conclusion The diagnosis of extra hepatic portal venous obstruction and differentiation from cirrhosis can be easily made by characteristic clinical features, normal liver function tests and doppler ultrasound. Portal vein thrombosis (PVT) is the predominant cause of extra hepatic portal vein obstruction in Nepali patients, as seen at this tertiary care hospital in Nepal.


Assuntos
Veia Porta/patologia , Doenças Vasculares/patologia , Trombose Venosa/etiologia , Adulto , Feminino , Humanos , Hipertensão Portal/etiologia , Fígado/irrigação sanguínea , Cirrose Hepática , Masculino , Melena , Nepal , Estudos Retrospectivos , Esplenomegalia , Centros de Atenção Terciária , Doenças Vasculares/complicações , Doenças Vasculares/epidemiologia , Doenças Vasculares/etiologia , Adulto Jovem
5.
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
6.
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
7.
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
8.
Khirurgiia (Mosk) ; (9): 93-98, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532174

RESUMO

OBJECTIVE: To improve short- and long-term outcomes of locally advanced pancreatic body-tail cancer followed by major vessels invasion. MATERIAL AND METHODS: A case report of pure laparoscopic DP-CAR procedure with portal vein resection for locally advanced pancreatic body-tail cancer followed by severe abdominal pain in a 49-year-old patient is presented. RESULTS: Liver or stomach ischemia was not observed. Portal wall resection wasn't associated with any complication and resulted R0-resection. Postoperative period was complicated by Grade B pancreatic fistula. Preoperative abdominal pain completely disappeared after surgery. Surgery time was 330 min, intraoperative blood loss - 300 ml. The patient is currently undergoing FOLFIRINOX adjuvant chemotherapy. CT in 90 days after surgery confirmed no progression of disease or liver/stomach blood supply congestion. CONCLUSION: Modern technologies provide the opportunity to perform pure laparoscopic advanced surgical procedures with major vessels resection. Pure laparoscopic DP-CAR procedure with portal vein resection is effective and safe procedure that can be performed with all principles of open surgery and is associated with acceptable short- and long-term results.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Artéria Celíaca/cirurgia , Laparoscopia/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Veia Porta/cirurgia , Antineoplásicos/administração & dosagem , Fluoruracila/administração & dosagem , Humanos , Irinotecano/administração & dosagem , Leucovorina/administração & dosagem , Pessoa de Meia-Idade , Invasividade Neoplásica , Oxaliplatina/administração & dosagem , Pancreatectomia/efeitos adversos , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/patologia , Veia Porta/patologia
9.
BMJ Case Rep ; 12(9)2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31551317

RESUMO

Mesenteric ischaemia represents an uncommon complication of splanchnic vein thrombosis which requires a high level of suspicion to diagnose in a timely manner. This report discusses a case of portal, splenic and superior mesenteric vein thrombosis leading to mesenteric ischaemia and infarct in a 79-year-old man. The diagnosis of acute mesenteric ischaemia and splanchnic vein thrombosis remains difficult due to the non-specific symptoms of these conditions. As diagnosis does continue to improve, treatment of acute mesenteric ischaemia using medical management has become increasingly possible before ischaemia advances to the point at which surgical resection is required.


Assuntos
Isquemia Mesentérica/etiologia , Veias Mesentéricas/patologia , Veia Porta/patologia , Veia Esplênica/patologia , Trombose Venosa/complicações , Dor Abdominal , Idoso , Diagnóstico Diferencial , Humanos , Jejuno/cirurgia , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Veia Esplênica/diagnóstico por imagem , Tomógrafos Computadorizados , Trombose Venosa/diagnóstico por imagem
10.
JNMA J Nepal Med Assoc ; 57(216): 130-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31477949

RESUMO

Extra Hepatic Portal Vein Obstruction in individual with solitary left kidney is rare occurence. Though there is no etiological association between Extra Hepatic Portal Vein Obstruction and solitary left kidney but the solitary left kidney decides the modality of treatment. Eighteen year lady referred to our institute with menorrhagia for 5 years and ultrasonography finding of splenomegaly and atretic right kidney. Investigations revealed Extra Hepatic Portal Vein Obstruction with multiple cavernoma formation with oesophagogastric varices with right renal agenesis. She successfully underwent splenectomy with devascularisation. Patient with Extra Hepatic Portal Vein Obstruction present mainly with recurrent episodes of variceal bleeding, splenomegaly and hypersplenism. Splenectomy and esophagogastric devascularisation is an effective modality of treatment for patient with Extra Hepatic Portal Vein Obstruction with solitary kidney. Keywords: cavernoma; modified Hassab's operation; Portal vein; unilateral renal agenesis.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico , Veia Porta/patologia , Rim Único/fisiopatologia , Adolescente , Anormalidades Congênitas/diagnóstico , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Rim/anormalidades , Nefropatias/congênito , Nefropatias/diagnóstico , Esplenectomia/métodos
11.
World J Gastroenterol ; 25(31): 4437-4451, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496623

RESUMO

Portal vein thrombosis (PVT) represents a well-known complication during the natural course of liver cirrhosis (LC), ranging from asymptomatic cases to life-threating conditions related to portal hypertension and hepatic decompensation. Portal flow stasis, complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT development. However, PVT occurrence remains unpredictable and many issues regarding its natural history, prognostic significance and treatment are still elusive. In particular although spontaneous resolution or disease stability occur in most cases of PVT, factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as yet. Moreover, PVT impact on LC outcome is still debated, as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction progression. Anticoagulation and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases, even if the safer therapeutic option and the optimal therapy duration are still unknown. Nevertheless, their impact on mortality rates should be addressed more extensively. In this review we present the most debated questions regarding PVT, whose answers should come from prospective cohort studies and large sample-size randomized trials.


Assuntos
Anticoagulantes/administração & dosagem , Hipertensão Portal/terapia , Cirrose Hepática/complicações , Derivação Portossistêmica Transjugular Intra-Hepática , Trombose Venosa/terapia , Administração Oral , Anticoagulantes/efeitos adversos , Progressão da Doença , Feminino , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/mortalidade , Cirrose Hepática/mortalidade , Cirrose Hepática/terapia , Seleção de Pacientes , Veia Porta/patologia , Prognóstico , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/etiologia , Trombose Venosa/mortalidade
12.
In Vivo ; 33(5): 1697-1702, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471426

RESUMO

BACKGROUND/AIM: Chemotherapy is often halted due to abnormal liver function resembling hepatitis. But the cause can be extrahepatic portal venous obstruction (EHPVO) with hepatic enzyme elevation rather than being an adverse effect of chemotherapy. We investigated EHPVO with hepatic enzyme elevation in patients with cancer. PATIENTS AND METHODS: Data of these hospitalized patients with solid tumors between January 2013 and September 2017 were collected. The criteria for study inclusion were: (i) Extrahepatic malignancy; (ii) computed tomographic scans showing a tumor with external compression of the extrahepatic portal vein; and (iii) serum aminotransferase (AST) or alanine transaminase (ALT) level three times above the normal value. RESULTS: Thirteen out of 377 (3%) patients developed EHPVO with hepatic enzyme elevation, as demonstrated from computed tomographic scan. Four cases (31%) also had vascular thrombosis (three portal vein and one inferior vena cava). Serum AST increased from 34±11 to 169±94 U/l. ALT increased from 9±38 to 177±104 U/l. There was no relationship of EHPVO with viral markers and cirrhosis. Six cases received chemotherapy with liver function improvement. CONCLUSION: EHPVO occurred in patients with metastatic cancer, leading to hepatic enzyme elevation resembling hepatitis without hepatitis risk factors and cirrhosis. Before withholding chemotherapy due to hepatic enzyme elevation, the possibility of EHPVO should firstly be excluded.


Assuntos
Constrição Patológica/diagnóstico , Hepatite/complicações , Hepatite/diagnóstico , Neoplasias/complicações , Veia Porta/patologia , Doenças Vasculares/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Constrição Patológica/etiologia , Feminino , Hepatite/sangue , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Tomografia Computadorizada por Raios X , Doenças Vasculares/etiologia
13.
Anticancer Res ; 39(9): 5019-5026, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519609

RESUMO

BACKGROUND: Portal vein thrombosis (PVT) is a life-threatening complication after hepatectomy. However, the relationship between postoperative PVT and morphometric features of the PV has not been fully elucidated yet. PATIENTS AND METHODS: A total of 81 patients who underwent hepatectomy for perihilar cholangio-carcinoma (PHCC) were studied. We investigated the diameters and angles of PV using pre- and postoperative computed tomography (CT) reconstructed by SYNAPSE VINCENT®. RESULTS: The incidence of PVT after hepatectomy was 11.1%. There were significant differences with respect to the remnant liver PV diameter (p=0.015), the diameter ratio (p=0.001), and the postoperative PV angle (p=0.001) between patients with and without PVT. Multivariate analysis revealed that a postoperative PV angle of less than 90° (p=0.008) and a diameter ratio of less than 45% (p=0.041) were independent risk factors for PVT. CONCLUSION: A postoperative PV angle of less than 90° and diameter ratio of less than 45% eventually lead to PVT after hepatectomy for PHCC.


Assuntos
Hepatectomia/efeitos adversos , Tumor de Klatskin/complicações , Tumor de Klatskin/cirurgia , Veia Porta/patologia , Complicações Pós-Operatórias , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Gerenciamento Clínico , Feminino , Hepatectomia/métodos , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Veia Porta/anatomia & histologia , Veia Porta/diagnóstico por imagem , Período Pós-Operatório , Prognóstico , Tomografia Computadorizada por Raios X
14.
World J Gastroenterol ; 25(31): 4360-4382, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496618

RESUMO

Hepatocellular carcinoma is one of the most frequent malignant tumors worldwide: Portal vein tumor thrombosis (PVTT) occurs in about 35%-50% of patients and represents a strong negative prognostic factor, due to the increased risk of tumor spread into the bloodstream, leading to a high recurrence risk. For this reason, it is a contraindication to liver transplantation and in several prognostic scores sorafenib represents its standard of care, due to its antiangiogenetic action, although it can grant only a poor prolongation of life expectancy. Recent scientific evidences lead to consider PVTT as a complex anatomical and clinical condition, including a wide range of patients with different prognosis and new treatment possibilities according to the degree of portal system involvement, tumor biological aggressiveness, complications caused by portal hypertension, patient's clinical features and tolerance to antineoplastic treatments. The median survival has been reported to range between 2.7 and 4 mo in absence of therapy, but it can vary from 5 mo to 5 years, thus depicting an extremely variable scenario. For this reason, it is extremely important to focus on the most adequate strategy to be applied to each group of PVTT patients.


Assuntos
Carcinoma Hepatocelular/terapia , Hipertensão Portal/terapia , Neoplasias Hepáticas/terapia , Recidiva Local de Neoplasia/epidemiologia , Trombose Venosa/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/métodos , Meios de Contraste/administração & dosagem , Intervalo Livre de Doença , Hepatectomia , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/mortalidade , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Transplante de Fígado , Terapia Neoadjuvante/métodos , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Seleção de Pacientes , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Prognóstico , Análise de Sobrevida , Trombectomia , Fatores de Tempo , Ultrassonografia/métodos , Trombose Venosa/etiologia , Trombose Venosa/mortalidade
15.
Prensa méd. argent ; 105(8): 427-430, sept 2019. fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1023136

RESUMO

The aim of this study was to analyse a patient dignosed in our hospital as having pylephlebitis. The patient is a 29 years old male, and we must consider that pylophlebitis refers to the septic thrombosis of the portal venous system, associated to some kind of infectious process. Can occur related to acute appendicitis, colonic diverticulitis and cholangitis, among others. Is a rare but close to a significant morbidity and mortality, since it can develop to an abdominal sepsis. The management review of the case reported, is presented (AU)


Assuntos
Humanos , Masculino , Adulto , Apendicite/complicações , Sistema Porta , Veia Porta/patologia , Tomografia Computadorizada por Raios X , Sepse , Tromboembolia Venosa/complicações
16.
World J Gastroenterol ; 25(28): 3798-3807, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391774

RESUMO

BACKGROUND: Cirrhosis is a major risk factor for the development of hepatocellular carcinoma (HCC). Portal vein thrombosis is not uncommon after splenectomy in cirrhotic patients, and many such patients take oral anticoagulants including aspirin. However, the long-term impact of postoperative aspirin on cirrhotic patients after splenectomy remains unknown. AIM: The main purpose of this study was to investigate the effect of postoperative long-term low-dose aspirin administration on the development of HCC and long-term survival of cirrhotic patients after splenectomy. METHODS: The clinical data of 264 adult patients with viral hepatitis-related cirrhosis who underwent splenectomy at the First Affiliated Hospital of Xi'an Jiaotong University from January 2000 to December 2014 were analyzed retrospectively. Among these patients, 59 who started taking 100 mg/d aspirin within seven days were enrolled in the aspirin group. The incidence of HCC and overall survival were analyzed. RESULTS: During follow-up, 41 (15.53%) patients developed HCC and 37 (14.02%) died due to end-stage liver diseases or other serious complications. Postoperative long-term low-dose aspirin therapy reduced the incidence of HCC from 19.02% to 3.40% after splenectomy (log-rank test, P = 0.028). Univariate and multivariate analyses showed that not undertaking postoperative long-term low-dose aspirin therapy [odds ratio (OR) = 6.211, 95% confidence interval (CI): 1.142-27.324, P = 0.016] was the only independent risk factor for the development of HCC. Similarly, patients in the aspirin group survived longer than those in the control group (log-rank test, P = 0.041). Univariate and multivariate analyses showed that the only factor that independently associated with improved overall survival was postoperative long-term low-dose aspirin therapy [OR = 0.218, 95%CI: 0.049-0.960, P = 0.044]. CONCLUSION: In patients with viral hepatitis-related cirrhosis, long-term post-splenectomy administration of low-dose aspirin reduces the incidence of HCC and improves the long-term overall survival.


Assuntos
Aspirina/administração & dosagem , Carcinoma Hepatocelular/epidemiologia , Cirrose Hepática/complicações , Neoplasias Hepáticas/epidemiologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/prevenção & controle , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Hiperesplenismo/etiologia , Hiperesplenismo/cirurgia , Hipertensão Portal/etiologia , Hipertensão Portal/cirurgia , Incidência , Cirrose Hepática/mortalidade , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/prevenção & controle , Masculino , Pessoa de Meia-Idade , Veia Porta/patologia , Prognóstico , Estudos Retrospectivos , Esplenectomia/efeitos adversos , Fatores de Tempo , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle , Adulto Jovem
17.
Indian J Med Res ; 149(4): 468-478, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31411170

RESUMO

In India, an unexplained enteropathy is present in a majority of non-cirrhotic intrahepatic portal hypertension (NCIPH) patients. Small intestinal bacterial contamination and tropical enteropathy could trigger inflammatory stimuli and activate the endothelium in the portal venous system. Groundwater contaminated with arsenic is an environmental factor of epidemic proportions in large areas of India which has similar consequences. Von Willebrand factor (a sticky protein) expressed by activated endothelium may promote formation of platelet microthrombi and occlusion of intrahepatic portal vein branches leading to NCIPH. Environmental factors linked to suboptimal hygiene and sanitation, which enter through the gastrointestinal (GI) tract, predispose to platelet plugging onto activated endothelium in portal microcirculation. Thus, NCIPH, an example of poverty linked thrombophilia, is a disease mainly affecting the lower socio-economic strata of Indian population. Public health measures to improve sanitation, provide clean drinking water and eliminate arsenic contamination of drinking water are urgently needed. Till such time as these environmental factors are addressed, NCIPH is likely to remain 'an Indian disease'.


Assuntos
Hipertensão Portal/epidemiologia , Fígado/patologia , Veia Porta/patologia , Trombofilia/epidemiologia , Arsênico/toxicidade , Plaquetas/efeitos dos fármacos , Endotélio/efeitos dos fármacos , Meio Ambiente , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/patologia , Índia/epidemiologia , Fígado/efeitos dos fármacos , Cirrose Hepática/epidemiologia , Cirrose Hepática/patologia , Pobreza , Trombofilia/etiologia , Trombofilia/patologia
18.
Eur J Radiol ; 119: 108633, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31437747

RESUMO

PURPOSE: To conduct an intraindividual comparison of the enhancement pattern of hepatocellular adenoma (HCA) on dynamic MRI study obtained following the injection of Gadoxetic acid (Gd-EOB-DTPA) and other gadolinium-based contrast agents (GBCAs). METHOD: This is a retrospective, Institutional Review Board-approved study conducted in a single institution. A search of medical records between 2008 and 2017 revealed 17 patients (all females) with at least one pathologically-proven HCA who underwent liver MRI with Gd-EOB-DTPA and another GBCA within 1 year. Enhancement of each lesion on hepatic arterial (HAP), portal venous (PVP), 2 min and 4-5 minutes phases was subjectively evaluated by two abdominal radiologists. Lesions were categorized as hyper-, iso- or hypointense compared to the surrounding liver parenchyma. The presence of a peripheral pseudocapsule was also recorded. The differences in lesion enhancement were assessed using the McNemar Test. A p-value <0.05 was considered statistically significant. RESULTS: The final population included 35 HCAs (83% inflammatory subtype). There was no significant difference in lesion size (P = 0.708) and enhancement on HAP (P = 0.625) or PVP (P = 0.125). HCAs showed more frequently hypointensity on 2 min (13/35 vs. 1/35, P < 0.001) and 4-5 minutes (P < 0.001) images obtained after injection of Gd-EOB-DTPA compared to those obtained after other GBCAs. A pseudocapsule was more frequently noted after administration of Gd-EOB-DTPA (13/35 vs 1/35, P = 0.002). CONCLUSIONS: Enhancement pattern of HCA differs significantly after the injection of Gd-EOB-DTPA compared to other GBCAs. Lesion hypointensity on 2 min and 4-5 minutes images is more frequent when using Gd-EOB-DTPA.


Assuntos
Adenoma de Células Hepáticas/patologia , Meios de Contraste , Gadolínio DTPA , Neoplasias Hepáticas/patologia , Adulto , Idoso , Meios de Contraste/administração & dosagem , Feminino , Artéria Hepática/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Veia Porta/patologia , Estudos Retrospectivos
19.
Eur J Radiol ; 118: 88-95, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439264

RESUMO

PURPOSE: To evaluate MR imaging parameters including quantitative multiphasic post-contrast enhancement with subtraction and qualitative diffusion weighted imaging (DWI) in differentiating benign versus malignant portal venous thrombosis (PVT) in patients with hepatocellular carcinoma (HCC). METHOD: Radiology reports over a 6-year period ending February 2016 were searched for key words indicating presence of both HCC and PVT on abdominal MRI. 39 patients were identified with PVT characterized as benign or malignant based on pathologic data or serial imaging growth criteria. Image review was performed by two subspecialized radiologists blinded to the diagnosis and medical chart. Signal intensity for regions of interest were recorded within the portal vein thrombus as well as the portal vein on pre-contrast and dynamic post-contrast phases without and with subtraction. Qualitative parameters for DWI and presence of PV expansion were also evaluated. RESULTS: Percent enhancement generated high area under the curve (AUC) for both readers on all non-subtraction phases: arterial (0.95/0.98), portal venous (0.97/0.97) and delayed phase (0.96/0.99) and subtraction phases: arterial (0.91/0.96), portal venous (0.94/0.99) and delayed phases (0.96/0.97). Statistically significant differences were observed between benign and malignant PVT for both readers for PV expansion (p= <0.001/0.006). No qualitative DWI parameter reached statistical significance for both readers. CONCLUSIONS: Post-contrast and subtraction MRI can reliably distinguish malignant from benign PVT in patients with HCC using subtracted or non-subtracted images and at arterial, portal venous, or delayed phase timing.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Veia Porta/patologia , Trombose Venosa/patologia , Adulto , Idoso , Área Sob a Curva , Artérias/patologia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Ann Surg Oncol ; 26(11): 3709-3710, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407182

RESUMO

BACKGROUND: Solid pseudopapillary tumors (SPPTs) are low malignant potential entities found mainly in young females.1,2 Pancreatectomy without tumor rupture is the treatment of choice, and the laparoscopic approach is indicated.3,4 Limited pancreatectomy is possible due to the low risk of malignancy (< 10%) based on the low risk of lymph node invasion or true vascular invasion.1,2 Centrally located large SPPTs can be treated by extended central pancreatectomy with or without vascular resection to avoid pancreatoduodenectomy or distal pancreatectomy. METHODS: A 24-year-old woman was admitted with abdominal pain. A 6-cm SPPT was discovered at the neck-body junction in close contact with the anterior aspect of the mesentericoportal vein (MPV) and the splenic vessels, with signs of segmental portal hypertension. To avoid an extended pancreatectomy for this young patient, an extended central pancreatectomy was performed, with resection of the splenic vessels, and the MPV was freed from the tumor under clamping for 10 min, with no need for vascular reconstruction. The duration of the surgery was 260 min, with 200 ml of blood loss and no transfusion. RESULTS: The woman's postoperative course was uneventful, with a hospital stay of 16 days. Histology confirmed the diagnosis of a 6-cm SPPT tumor (R0 and N0). The patient was asymptomatic 1 year later, with no tumor recurrence and no pancreatic insufficiency. Between 2011 and 2018 the authors performed 72 laparoscopic central pancreatectomies, with SPPT performed for 13 patients (18%). Laparoscopic central pancreatectomy was extended (n = 5) or standard (n = 8) with no conversion, no recurrence, and no pancreatic insufficiency. CONCLUSION: An SPPT tumor is a good indication for the laparoscopic approach because this entity is found in young patients with a low risk of malignancy. Large centrally located tumors can be treated by extended central pancreatectomy to avoid a large pancreatectomy with greater early and long-term disadvantages.


Assuntos
Carcinoma Papilar/cirurgia , Laparoscopia/métodos , Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/cirurgia , Veia Porta/cirurgia , Baço/cirurgia , Adulto , Carcinoma Papilar/patologia , Feminino , Humanos , Veias Mesentéricas/patologia , Neoplasias Pancreáticas/patologia , Veia Porta/patologia , Prognóstico , Baço/patologia , Instrumentos Cirúrgicos , Adulto Jovem
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