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PubMed2000

[Abdominal ultrasound diagnosis].

The doppler sonography is an important tool in the diagnosis of liver diseases, even by using new techniques like the power doppler. There are a lot of indications for the evaluation of the hepatic vessels. Apart from the diagnosis of portal hypertension in liver cirrhosis a portal vein thrombosis should be detected or excluded in cases of new or refractory ascites. The Budd-Chiari syndrome is another important indication. Focal liver lesions can have characteristic findings in doppler sonography, but an exact differentiation of liver tumors is not possible. But doppler sonography even using the power doppler technique is be used more and more in hepatocellular carcinoma to evaluate the response to treatment with chemoembolization, radiofrequency thermoablation or percutaneous ethanol injection. The accuracy is compatible to angiography and computer-tomography.

Carcinoma, Hepatocellular↗
PubMed1991

Sequential observation of pathomorphological alterations in liver of experimental murine schistosomiasis mansoni.

Fifty CFI female mice were experimentally infected with schistosomiasis mansoni (50 cercariae per mouse). This study was designed to follow the stages of structural changes that may take place in the liver of patients infected by this parasite. Histological examination of liver tissue samples were carried out weekly for ten weeks after infection with schistosomiasis mansoni cercariae. The present study suggests that the development of hepatic schistosomiasis mansoni in mice is biphasis with a first or granulomatous phase in which the morphological changes are mild and a second aggressive fibrotic phase, when hepatic collagen synthesis increases rapidly and leads to fibrotic morphological changes that are characteristic of this infection. Gross and microscopic portal fibrosis and portal vascular lesions resembled those in hepatosplenic schistosomiasis in man. The rapid production of severe hepatic fibrosis without the use of hepatotoxic compound makes this model of interest for the study of liver fibrosis and its therapy.

Animals↗
PubMed2006

[Septic thrombosis of the axillary vein with unilateral pulmonary abscess. Variation of Lemierre's syndrome].

HISTORY: A man aged 62 was hospitalized for treatment of an axillary abscesses originating from a suppurative hidradenitis. INVESTIGATIONS: Microbiological tests revealed peptostreptococcus and staphylococci. Hepatic enzymes were moderately elevated in association with a mild hyperbilirubinemia. RESULTS: After surgical intervention the patient developed a severe septic illness together with a unilateral pulmonary infection and abscess formation, requiring a thoracotomy. Preoperative serology ruled out active hepatitis as well as atypical pneumonia. The detection of a unilateral septic axillary thrombosis led to the correct diagnosis. Antibiotics and anticoagulation brought about a complete cure. CONCLUSION: In cases of septicemia of uncertain origin septic venous thromboses should be considered in the differential diagnosis.

Anti-Bacterial Agents↗
PubMed2006

Agenesis of gallbladder and multiple anomalies of the biliary tree in a patient with portal thrombosis: a case report.

A 55-year-old male patient was admitted to hospital because of splenomegaly. Abdominal ultrasonography and computed tomography failed to demonstrate the gallbladder. The diagnosis of right portal vein thrombosis was established by Doppler ultrasonography, splenoportography and computed tomography angiography. To investigate the biliary tree and evaluate the effect on the biliary tree of portal changes, endoscopic retrograde cholangiopancreatography was performed. Endoscopic retrograde cholangiopancreatography study revealed the absence of gallbladder, cystic duct and common bile duct together with the junction of the right and left hepatic ducts at the pancreatic head, with predominant left hepatic duct. To our knowledge, this is the first reported case of multiple congenital anomalies of the extrahepatic biliary tree associated with right portal vein thrombosis. The presence of these rare pathologies in two viscera running together in a patient with right portal vein thrombosis is a very rare condition.

Abnormalities, Multiple↗
PubMed1994

Patterns of portal vein occlusion and their aetiological significance.

Clinical and angiographic findings in 53 patients with portal vein occlusion were reviewed to determine the relationship between the pattern of venous occlusion and its aetiology. Five major patterns were identified. Group 1 comprised three children with idiopathic intrahepatic portal vein occlusion alone (hepatoportal sclerosis). Those in group 2 (25 patients), with occlusion of the main portal vein, accounted for almost half the total number and for most of those with a probable congenital aetiology. The ten patients in group 3 had angiographic occlusion and collateralization of the main portal and superior mesenteric veins. Intra-abdominal sepsis, other than that from pancreatic disease, was associated with this pattern of venous occlusion in which the splenic vein is spared. No patients with isolated portal and splenic vein occlusion (group 4) were recorded. Widespread thrombosis throughout the portal venous system (group 5; 15 patients) had a multifactorial aetiology but was typically observed in hypercoagulable states that were also associated with hepatic vein occlusion or other deep vein thromboses.

Adolescent↗
PubMed1990

[Protein C deficiency with recurrent infarct of the small intestine].

Protein C and antithrombin III represent main inhibitors of the plasmatic coagulation system. Due to the lack of practicable assays the clinical importance of protein C was only established during the last six years. In familial protein C deficiency 77% of patients present with recurrent venous thromboses, half of them below the age of 30. In addition to recurrent superficial thrombophlebitis more serious manifestations like deep vein thrombosis and pulmonary embolism have been described. Mesenteric vein thrombosis has been reported in only 5 cases all of which could be controlled by conservative treatment. In our patient protein C deficiency was discovered 10 years after the angiographic diagnosis of portal and mesenteric vein thrombosis. Thereafter, the patient complained of recurrent abdominal discomfort. Intestinal ischaemia due to mesenteric vein thrombosis required segmental resection twice. Postoperatively the patient was heparinized. After excluding a secondary protein C deficiency due to a lack in vitamin K, hepatic disease, or disseminated intravascular coagulation, long-term anticoagulation by dicumarol was implemented as therapy of first choice.

Female↗
PubMed2000

Contrast-enhanced color Doppler US in malignant portal vein thrombosis.

PURPOSE: To assess the role of contrast-enhanced color Doppler US in the differential diagnosis of benign and malignant portal vein thrombosis. MATERIAL AND METHODS: Fifty-six patients with portal vein thrombosis underwent color and power Doppler US examination before and after i.v. injection of galactose-palmitic acid suspension. The criterion for diagnosing the presence and extension of thrombosis was the lack of visualization of portal vein flow in a segment of the portal vein. The criterion for diagnosing malignant portal vein thrombosis was the detection of pulsatile arterial flow, either hepatopetal or hepatofugal, in the thrombus. The US data were correlated with the types of portal vein thrombosis. RESULTS: Among the 56 patients, there were 40 benign and 16 malignant portal thromboses. Unenhanced Doppler US detected continuous blood flow in 24 benign thromboses and pulsatile in 3 malignant thromboses. No flow, either continuous or pulsatile, was detected in 16 cases with benign thrombosis and in 13 cases with malignant thrombosis. Contrast-enhanced Doppler US allowed to assess pulsatile flow in 15 cases with malignant thrombosis (94%). The use of pulsatile flow as diagnostic criterion of malignant thrombosis yielded a sensitivity of 57% and a specificity of 95% with conventional Doppler US, whereas contrast-enhanced US achieved a sensitivity of 94% and a specificity of 100%. CONCLUSION: Contrast-enhanced Doppler US is a reliable diagnostic tool for assessing malignant portal vein thrombosis.

Aged↗
PubMed1971

The Australia (hepatitis-associated) antigen in fibrinogen and other fractions of human plasma.

Human plasma containing the Australia (hepatitis-associated) antigen was fractionated by the cold ethanol method of Cohn, Strong, Hughes, Mulford, Ashworth, Melin, and Taylor (1946) and small aliquots were examined for the presence of this antigen by immunodiffusion and by electron microscopy. The findings were in general agreement with the postulated risk of transmitting hepatitis by blood derivatives. The Australia (hepatitis-associated) antigen was detected in fibrinogen, thrombin, and antihaemophilic globulin as well as in other fractions. The antigen was not found in gamma globulin (immunoglobulin fraction) nor in albumin.The use of radioiodinated fibrinogen for the diagnosis of deep vein thrombosis is discussed and it is concluded that the use of fibrinogen for diagnostic procedures should be assessed against the possible risk of hepatitis.

Factor VIII↗
PubMed1997

[Hepatocellular carcinoma in Germany. Epidemiology, etiology, clinical aspects and prognosis in 100 consecutive patients of a university clinic].

Chronic hepatitis C and B are the main causes of hepatocellular carcinoma (HCC) worldwide. Little is known about the etiology of HCC in Germany which is regarded as a low-prevalence area for viral hepatitis C (HCV) and B (HBV). To assess the etiologic factors of HCC in Germany we have retrospectively analyzed the records of 100 consecutive patients with hepatocellular carcinoma in our clinic. HCC-patients with documented status on HCV/HBV-infection and daily alcohol intake (n = 55) had HCV antibodies in 53%, HBs-Ag in 20%, isolated chronic alcohol abuse in 11% and genetic hemochromatosis in 2%. In 13% of the HCC-patients no risk factor could be identified. Coinfections with HCV and HBV were not observed. Liver cirrhosis was present in 90% of the HCC-patients. In histologically confirmed HCC (n = 71) serum alpha-fetoprotein level was normal (< 8.5 ng/ml) in 20%, moderately elevated (8.5-300 ng/ml) in 48% and considerably elevated (> 300 ng/ml) in 32% of the patients. Only 31% of all patients presented with small single lesions (< or = 5 cm) without evidence for extrahepatic metastases or portal vein thrombosis. Only 30% of the HCC-patients could be treated with a curative intention (28 hepatic resections, one orthotopic liver transplantation). Patients who underwent resection had cumulative 6-month, 1-year, 2-year and 3-year survival rates of 83.8%, 65.9%, 54.3% and 24.8% respectively. Median survival time after resection was 24.8 months compared with 5.8 months in symptomatically treated patients with unresectable HCC (n = 39). Patients with hepatitis C-associated HCC were significantly older than patients with hepatitis B-associated HCC (mean values: 63.2 vs. 54.2 years). Frequency of cirrhosis, tumor stage, alpha-fetoprotein level and prognosis did not differ between groups. In conclusion hepatocellular carcinoma was predominantly associated with chronic HCV-infection. Most patients presented with normal or moderately elevated serum AFP-levels. Prognosis was poor even after hepatic resection.

Adolescent↗
PubMedDate not supplied

Impact of double helical CT and three-dimensional CT arteriography on surgical planning for hepatic transplantation.

BACKGROUND: To assess the impact of preliver transplant double helical computed tomography (DHCT) and three-dimensional computed tomography arteriography (3D-CTA) on surgical planning for hepatic transplantation. METHODS: Vascular findings detected on DHCT/3D-CTAs of 80 patients were shown to the transplant surgeon in a blinded fashion. These findings included hepatic arterial anatomy, diameters of the major vessels that supplied the liver, celiac axis stenosis, splenic artery (SA) aneurysms, and portal vein thrombosis (PVT). The surgeon was asked to state the "planned" surgical approach for each case based on scan findings. These results were subsequently compared with what "actually" occurred at transplantation by review of surgical records. RESULTS: Fifty-five patients had conventional and 25 patients had nonconventional hepatic arterial anatomy. Three patients had PVT, three patients had celiac axis stenosis, and three patients had SA aneurysms. Correlation between the "actual surgical technique" and the "planned surgical approach" was seen in 50/55 (91%) patients with conventional and in 23/25 (92%) patients with nonconventional anatomy. Five patients requiring aortohepatic interposition grafts for arterial anastomoses had either severe celiac axis stenoses or arterial inflow vessels that were 3 mm or smaller. Three patients with PVT underwent successful surgical resection of the thrombosed segment and standard PV anastomoses as planned. Patients with complete replacement of hepatic arterial supply to the superior mesenteric artery required alteration of the sequence of the vascular anastomoses. Patients with SA aneurysms had surgical ligation of the splenic artery. CONCLUSIONS: DHCT/3D-CTA provides noninvasive means to identify findings that have significant impact on surgical planning for hepatic transplantation including celiac axis stenosis, diameter of inflow arterial vessel </= 3 mm, complete replacement of hepatic arterial supply, PVT, and SA aneurysms.

Hepatic Artery↗
PubMedDate not supplied

Implantable Doppler probe for continuous monitoring of blood flow after liver transplantation.

BACKGROUND/AIMS: Hepatic artery and portal vein thromboses after liver transplantation remain significant causes of graft loss. Doppler ultrasonography is useful for detecting the thrombosis early. Doppler examination requires specialized equipment and training. However the results depend on the skill of the operator. METHODOLOGY: We developed a new Doppler probe that can be implanted in the abdominal cavity. The probe was used for 48 hours in 10 living donor liver transplantation patients. RESULTS: In all recipients, hepatic arterial and portal flows were monitored continuously. The medical staff could easily operate the ultrasonography system at the bedside. CONCLUSIONS: The technique was useful for detecting hepatic blood flow for 48 hours after liver transplantation.

Adult↗
PubMed2001

Radiological features of hepatocellular carcinoma in Southern Pakistan.

We describe the radiological features of 201 patients diagnosed as having hepatocellular carcinoma (HCC) in Southern Pakistan. The cases of biopsy-proven HCC were analysed retrospectively for years 1994-1998. Age, sex, underlying cirrhosis, hepatitis markers, and radiological description were recorded. The mean age was 56 years. There were 149 males and 52 females. 82% patients had underlying cirrhosis. The tumour size was measured in at least two dimensions, and the maximum mean tumour size at the time of diagnosis was 8.3 +/- 4.0 cm. Of the tumours 79.5% were more than 5 cm; 56% of primary HCC were multifocal; 51% involved the right lobe only; 15% involved the left lobe; 34% involved both lobes of liver. Portal vein thrombosis was detectable in 17%. There were no significant differences in the radiological patterns amongst patients who had hepatitis B virus related and hepatitis C virus-related HCC except for age.

Adult↗
PubMed2005

[The efficacy of hepatic arterial infusion therapy for advanced hepatocellular carcinoma according to extrahepatic collateral feeding vessels].

BACKGROUND/AIMS: Despite the poor response rate of 20-30%, hepatic arterial infusion therapy (HAIT) has been often tried for advanced hepatocellular carcinoma with portal vein tumor thrombosis or ineffective response to other treatments. The factors that predict treatment response to HAIT remain unclear. This study ascertained the response rate to HAIT based on the existence of extrahepatic collateral feeding vessels or anatomical variants. METHODS: Forty one patients received repeated HAIT using an implanted drug delivery system. Of the 41 patients, 18 patients were treated with 5-FU, epirubicin and mytomycin-C; 17 patients were treated with 5-FU and cisplatin; and 6 patients were treated with 5-FU, cisplatin and leucovorin. The patients were divided into two groups according to the existence of extrahepatic collateral feeding vessels or anatomical variants. RESULTS: Of the 41 patients, 10 patients (24.4%) showed a complete response (CR) or partial response (PR). Of 41 patients, 22 patients (group A) did not have extrahepatic collateral feeding vessel or an anatomical variant, but 19 patients (group B) did. In group A, 10 patients (45.5%) had a treatment response (CR+PR). However, only one patient (5.3%) had a treatment response (CR+PR) in group B. The response rate in group A was significantly higher than that in group B (45.5 vs. 5.3%; P=0.005). The median survival of group A was significantly longer than that of group B (10.8 vs 3.4 months, P=0.031). CONCLUSIONS: Hepatic arterial infusion therapy may be useful therapeutic option for patients with advanced HCC, especially in those that do not have extrahepatic collateral feeding vessel or anatomical variant.

Adult↗
PubMed2004

Treatment of cutaneous sarcoidosis with thalidomide.

BACKGROUND: Although systemic corticosteroids are effective against cutaneous sarcoidosis, alternative therapies are needed. OBJECTIVE: We sought to assess the efficacy and tolerance of thalidomide for cutaneous sarcoidosis. METHODS: We performed a retrospective evaluation of thalidomide (100-200 mg/d) in 12 consecutive patients with cutaneous sarcoidosis treated in a university hospital between 2000 and 2002. RESULTS: Cutaneous lesions regressed within 1 to 5 months, with an average time of 2 to 3 months for 10 patients. In all, 4 patients achieved complete responses, 6 had partial responses, and 2 had no regression. Nasopharyngeal, pulmonary neurologic, and hepatic symptoms were also attenuated. Thalidomide was well tolerated. The main adverse effect was deep vein thrombosis in 1 patient. CONCLUSION: Thalidomide efficacy and tolerance in patients with cutaneous sarcoidosis merits further evaluation in a controlled trial.

Adult↗
PubMed1993

Imaging of pregnancy-related complications.

Thirty-six cases of pregnancy-related complications were studied with plain radiography, ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging alone or in combination. Among the complications diagnosed with these various techniques were venous thromboembolic disorders, deep vein thrombosis, ovarian vein thrombosis, endometritis and pyometra, HELLP syndrome (hemolysis, elevated liver enzyme levels, and low platelet counts), hepatic hematoma and rupture, fatty liver, uterine rupture, various hematomas and a foreign body, tubo-ovarian abscess, cerebral venous thrombosis, cerebral ischemia, and cerebral edema. Prompt detection and appropriate management of many of these complications could result in decreased maternal and fetal mortality and morbidity. Although US should be considered first because it can be performed bedside, does not require use of ionizing radiation, and is cost-effective, CT is superior in demonstrating the extent of the abnormality and MR imaging is best for detection of neurologic complications of pregnancy. The radiologist should select the best available method and tailor the examination according to the presumptive clinical diagnosis and the individual problem to be solved.

Adult↗