Ultrasonographic localisation of thrombi in the caudal vena cava and hepatic veins in a heifer.
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Animals↗
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Results for “HEPATIC VEIN THROMBOSIS”
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[Mechanism of decline in the liver's relative storage capacity for bromsulphalein with advancing age. I. Significance of the storage capacity of isolated hepatocytes and of the volume of hepatic storage mass].
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Aging↗
Therapeutic efficacy of multimodal combination therapy using transcatheter arterial infusion of epirubicin and cisplatin, systemic infusion of 5-fluorouracil, and additional percutaneous ethanol injection for unresectable hepatocellular carcinoma.
PURPOSE: Previous studies have shown that a treatment regimen using epirubicin, cisplatin, and 5-fluorouracil (5-FU) (ECF) has a survival benefit for gastric cancer patients. Based on these results and the hypothesis that a combination modality has a better therapeutic advantage over a single mode of therapy, the efficacy of multimodal combination therapy using a transarterial infusion of epirubicin and cisplatin, systemic infusion of 5-FU, and additional percutaneous ethanol injection (PEI) for unresectable hepatocellular carcinoma (HCC) was investigated in this study in comparison with conventional transarterial chemoembolization (TACE). PATIENTS AND METHODS: From July 1997 to September 1998, a total of 52 patients with unresectable HCC who underwent at least two cycles of transarterial chemotherapy were enrolled in this study. Among the 52 patients, 30 (ECF group) received a multimodal combination therapy comprising transarterial infusion of epirubicin (50 mg/m2) and cisplatin(60 mg/m2), systemic infusion of 5-FU (200 mg/m2), and additional PEI every 4 weeks, and the remaining 22(ADR group) received conventional TACE using Adriamycin (ADR, 50 mg) and Gelfoam every 8 weeks. RESULTS: During the follow-up period (mean 13.8 +/ -8.5 months), the objective tumor response of the ECF group was significantly higher than that of the ADR group (53.3 vs 22.7%, P=0.044). The median survival time was 13.5 months for the ECF group and 10.5 months for the ADR group (P=0.026). The cumulative survival rates at 6, 12, 18, and 24 months,respectively, were 90, 57, 27, and 17% for the ECF group and 73, 37, 7, and 0% for the ADR group. Uni-variate analysis showed five prognostic factors including tumor number, tumor morphology, portal vein thrombosis, Child-Pugh classification, and tumor response. With multivariate analysis, portal vein thrombosis and tumor response were identified as the two independent f actors for survival. No serious adverse effect was observed in the ECF group, while there was a higher tendency for hepatic complications in the ADR group. CONCLUSIONS: Combination therapy comprising transarterial infusion of epirubicin and cisplatin, systemic infusion of 5-FU, and additional PEI appears to be feasible and promising as a multimodal approach for unresectable HCC. Furthermore, it may provide a survival benefit for patients with more advanced disease.
Administration, Cutaneous↗
Pregnancy in hepatitis B antigen positive cirrhosis.
Two pregnant women with chronic active viral hepatitis (HBs Ag+) and cirrhosis are described. In the first patient, maternal death occurred postpartum due to bleeding esophageal varices and liver and renal failure. Postmortem examination revealed advanced nodular cirrhosis and thrombosis of the splenic and portal veins. The infant was premature but did well and did not become infected despite the detection of HBsAg in the cord blood. Nine members of the patient's immediate family were tested; the blood of one sibling of the patient was found to be HBsAg+ and samples from 5 other members were found to be anti-HBs+. In the second patient, death due to liver failure occurred in the seventh month of pregnancy and postmortem examination revealed advanced nodular cirrhosis. Examination of multiple fluids from the mother and fetus were negative for HBsAg. In contrast to the apparent lack of effect of pregnancy on cirrhosis of the liver in general, the possibility of an adverse effect in this particular type(HBs Ag+) should be considered.
Adult↗
Immunohistochemical patterns of human liver sinusoids under different conditions of pathologic perfusion.
This study reports the effects of altered hepatic perfusion on the sinusoidal bed and the phenotypic characteristics of sinusoidal endothelial cells (SECs). Sinusoids were studied by the application of endothelial cell markers (CD31, CD34, CD105, and ATZ 11) in lesions with localized increased perfusion (liver cell adenoma, focal nodular hyperplasia, and macroregenerative nodule), in chronic congestion, in decreased portovenous inflow (portal vein thrombosis), and in decreased arteriohepatic perfusion (obliterative arteriopathy in chronic allograft rejection). SECs react in a sensitive and uniform way to all investigated conditions of different pathologic liver perfusion: expression of CD31, CD34, and ATZ 11 by SEC is found in inflow areas, CD105-positive SECs are found at the end of the sinusoidal blood stream. This blood flow-orientated phenotypic shift of SECs was accompanied by a perisinusoidal accumulation of activated hepatic stellate cells and collagen IV. These findings are helpful in liver biopsies and provide new insights into the angioarchitecture of benign nodular lesions.
Adenoma↗
[Histopathological investigation of the transjugular intrahepatic portocaval shunt (TIPS)].
The aim of the study was to investigate the histological structure of the artificial channel connecting one of the portal vein branches with the hepatic vein, as an effect of the transjugular intrahepatic portosystemic shunt (TIPS). The livers of six patients were investigated. In 4 of them recurrent variceal bleedings were an indication for TIPS, in the remaining 2 patients--intractable ascites. In all cases portal hypertension was due to liver cirrhosis. All patients were estimated as Child-Pugh group C. The period from the stent implantation to the moment of investigation ranged from 1 to 7 months. 2 livers were removed at the time of liver transplantation, 4 were procured at the autopsy. All shunts were patent and in none of the 6 cases dislocation of the stent occurred. The wall of the intrahepatic shunts was lined by a granulation tissue (pseudointima) covered with a layer of endothelial cells. No thrombosis, mechanical damage of the stent or extensive hypertrophy of pseudointima were found.
Adult↗
[Application of percutaneous transluminal angioplasty and stent placement at the third hepatic porta in treatment of Budd-Chiari syndrome].
OBJECTIVE: To evaluate percutaneous transluminal angioplasty (PTA) and stent placement at the third hepatic porta in treatment of Budd-Chiari syndrome (BCS). METHODS: Twenty patients with BCS, 12 males and 8 females, aged 17 to 53, with the main clinical symptom of abdominal distention and mild abdominal pain, were treated with PTA and stent placement: after the identification of the target vessel percutaneous puncture was performed at femoral or jugular vein and rendezvous procedure was used so as to conduct PTA or place a stent. Follow-up was made for 3 - 54 months. RESULTS: Operation was succeeded in all patients without severe complication with a clinical effective rate of 85%. Symptoms were gradually relieved in 17 cases. Restenosis occurred in 2 cases. One patient died from severe gastric bleeding and one formed thrombosis in the stent. CONCLUSION: A safe and effective new method for diagnosing and treating BCS, PTA and stent placement at the third hepatic porta has the same treatment value for BCS just as the operation at the second hepatic porta.
Adolescent↗
Imaging of the ductus venosus in neonates: from patency to closure.
OBJECTIVE: To familiarize the radiologist with the variable sonographic appearance of the involuting ductus venosus in neonates. METHODS: Five sick neonates ranging in age from 24 to 42 weeks had abdominal sonographic examinations to check for intra-abdominal diseases. RESULTS: Doppler sonography showed a patent ductus venosus in 3 neonates and a ductus venosus with thrombosis in 2 neonates. The ductus venosus was identified in the liver between the left portal vein and the inferior vena cava. In 2 patients, follow-up sonography showed that the ductus venosus progressively had thrombosis and then disappeared. CONCLUSIONS: The ductus venosus in a neonate has a variable sonographic appearance depending on its stage of involution. Its detection in a sick neonate can lead to inadvertent diagnosis of a hepatic varix, an abscess, or a tumor.
Heart Defects, Congenital↗
[A Technic of re-using a thrombosed hepatic artery in hepatic intra-arterial chemotherapy].
Nowadays the palliative treatment of hepatic metastasis very often uses the hepatic arterial chemotherapy in subcutaneous injection cavity. Unfortunately in about ten per cent of the cases, the thrombosis of hepatic artery limits the lasting quality of use of the catheters which last about twelve months (more or less four). As mentioned in our observation, if the patient "answers" the chemotherapy, we propose reusing this thrombosized artery by means of an original technical artifice. In this observation, in fact, we grafted a small segment of submesenteric vein on the hepatic disobstructed artery. We think that this artifice could also be used in case of anatomic variations of the hepatic artery like trifurcation.
Aged↗
[Bisection of the liver for transplantation. Simplification of the method].
Blind bipartition of a whole liver to obtain two transplants is problematic, because of frequent vasculo-biliary duplications, especially arterial (mainly on the left) and biliary (mainly on the right) duplications. Arteriography and cholangiography on the back table are necessary to obtain a map of the arterial and biliary distributions without injuring the vessels of the biliary ducts enclosed in the vasculo-biliary sheaths. The surgeon may use three special maneuvers: resection of segment IV when the arterio-biliary duplication involves segment IV; attribution of the common hepatic artery on the side of the arterial duplication (frequent on the left); attribution of a short segment of the common hepatic duct on the side of a biliary duplication (frequent on the right). In an anatomical study of 93 vasculo-biliary casts, the following results were obtained: in 4 cases: bipartition not possible; in 22 cases: "ideal" bipartition (no duplication); in 57 cases: partition right-left livers: in 37 cases 1 maneuver, in 19 cases 2 maneuvers, in 1 case 3 maneuvers; in 10 cases: partition right liver-left lobe: in 2 cases 1 maneuver, in 8 cases 2 maneuvers. We report 8 bipartitions and 16 transplantations (10 children and 6 adults). The duplications we noted do not differ statistically from those reported in our former anatomical study. Survival of the patients (100% in usual cases, 66% in case of extreme emergency or terminal hepatic insufficiency) and survival of the transplants (68,75%) do not differ either from those noted in other transplantation methods. Complications, especially arterial thrombosis, were within the same statistical ranges.(ABSTRACT TRUNCATED AT 250 WORDS)
Dissection↗
FVIIa corrects the coagulopathy of fulminant hepatic failure but may be associated with thrombosis: a report of four cases.
PURPOSE: During liver transplantation, excessive blood losses are correlated with increased morbidity and mortality. Blood losses are particularly high in the case of urgent liver transplantation for fulminant hepatic failure (FHF). Recombinant activated factor VII (rFVIIa) has shown promise in treating the coagulopathy of liver disease. We review our experience with the use of rFVIIa in treating the coagulopathy of FHF during urgent liver transplantation. CLINICAL FEATURES: We report four patients with FHF who met King's College criteria for liver transplantation and in whom rFVIIa was used after conventional means for treating the associated coagulopathy had failed. In all patients, the coagulation defect was corrected by rFVIIa. However, thrombotic complications occurred in two patients (myocardial ischemia and portal vein thrombosis) and the implication of rFVIIa cannot be excluded. CONCLUSION: We conclude that rFVIIa is effective in the correction of the coagulopathy associated with FHF. However, thrombotic events are of concern and therefore, further studies are warranted to define the safety of rFVIIa in that setting.
Adult↗
Portal vein thrombosis during antineoplastic chemotherapy in children: report of five cases and review of the literature.
We report five paediatric cases of portal vein thrombosis (PVT) occurring during chemotherapy, observed in two institutions over an 8-year time period. These children aged 2.5-15 years were treated for Burkitt's lymphoma, Ewing's tumour, small cell bone tumour or medulloblastoma. PVT was diagnosed on colour Doppler ultrasonography (US). In four patients, thrombosis occurred 2-45 days after severe hepatic veno-occlusive disease (HVOD) secondary to intensive chemotherapy containing busulfan. In one case, PVT occurred in the absence of HVOD in a patient with pre-existing periportal lymphomatous infiltration. Four patients experienced persistent portal hypertension, which resulted in death in one. PVT during chemotherapy in children is a rare event and appears to be closely related to intensive chemotherapy containing busulfan and to be associated with HVOD.
Adolescent↗
Liver transplantation for fulminant hepatic failure and late-onset hepatic failure in children.
The mortality rate of fulminant hepatic failure (FHF) and late-onset hepatic failure (LOHF) in childhood has remained between 70 and 95 per cent despite recent improvements in medical therapy. Liver transplantation has become an important therapeutic option in adults with this condition but has been performed infrequently in children. Between March 1988 and August 1991, 12 children aged between 1 month and 14 years with FHF or LOHF received 13 liver transplants. The aetiology was viral hepatitis in eight children (non-A non-B in six, A in two), drug hepatotoxicity (carbamazepine) in two, autoimmune hepatitis in one and congenital haemochromatosis in one. Reduced-size livers were used for ten of the 13 transplants. Morbidity after operation included infective complications and abdominal bleeding. Two patients died from graft versus host disease, one from brain aspergillosis and another from graft infarction after portal vein thrombosis. Eight patients survive after a median follow-up of 18 months. Liver transplantation should be the therapeutic choice for children with FHF and LOHF for whom the chances of recovery are poor.
Adolescent↗
Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis.
PURPOSE: Despite the absence of conclusive data, portal vein (PV) thrombosis is considered a contraindication to transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC). The purpose of our study was to establish the safety of TACE in such patients and identify key prognostic factors and survival. MATERIALS AND METHODS: Data were prospectively collected from 32 consecutive patients with unresectable HCC and PV thrombosis who underwent treatment with TACE. History and physical examination, relevant laboratory values, and contrast material-enhanced magnetic resonance (MR) images were obtained before each TACE procedure. Repeated TACE was performed every 6 weeks unless patients developed a contraindication or MR imaging showed complete response. RESULTS: Median overall survival was 9.5 months (range, 3-50 months). Child-Pugh numerical disease stage was the prognostic factor most strongly related to survival. The 30-day mortality rate was zero and there was no evidence of TACE-related hepatic infarction or acute liver failure. The 6-, 9-, 12-, and 18-month survival rates were 60%, 47%, 25%, and 12.5%, respectively. CONCLUSIONS: PV thrombosis should not be considered a contraindication to TACE. Compared with historical control subjects who received traditional forms of treatment, the patients in the present study had extended survival. However, prospective randomized trials are necessary to show this conclusively and to show which subgroups benefit.
Aged↗
Direct thrombin inhibitors for treatment of heparin induced thrombocytopenia, deep vein thrombosis and atrial fibrillation.
Thrombin is a central enzyme in hemostasis, exerting potent procoagulant effects and activating platelets. Recently, several small molecule direct thrombin inhibitors (DTI's) with important clinical applications have been developed. Both lepirudin and argatroban are effective in treatment of heparin-induced thrombocytopenia resulting in rapid normalization of platelet counts and a reduction in thrombotic events. Because of differences in clearance mechanisms, argatroban is preferable in patients with renal insufficiency and lepirudin if there is hepatic impairment. DTI's have also been evaluated in treatment of venous thromboembolism. Small studies with recombinant hirudin have shown promise. Ximelagatran is a new DTI in late-stage clinical trials with advantages for treatment of venous thromboembolism including oral administration and fixed dosing, making it convenient for long-term treatment. A Phase III trial demonstrated that ximelagatran was superior to placebo for preventing recurrent thrombosis in patients who had undergone six months of standard anticoagulant therapy for venous thromboembolism. Another large trial compared ximelagatran to standard treatment with enoxaparin and warfarin for treatment of symptomatic deep vein thrombosis in a Phase III trial of 2,528 patients. The results showed that ximelagatran administered twice daily was as effective as standard treatment in preventing recurrence with no increase in bleeding complications. Ximelagatran has also been evaluated in two Phase III trials in patients with atrial fibrillation. The primary analysis of both showed that ximelagatran was non-inferior to warfarin for preventing stroke and other embolic events with no increase in bleeding complications. Unexpectedly, elevated serum transaminase levels were observed in 5-10% of patients receiving ximelagatran for over 1 month, and routine monitoring may be necessary. The introduction of DTIs represents an important advance in treatment of heparin-induced thrombocytopenia. The oral direct thrombin inhibitor, ximelagatran, shows promise in providing simplified, effective therapy for venous thromboembolism and atrial fibrillation.
Animals↗
One-year morbidity after donor right hepatectomy.
Live donors are becoming an increasingly important source of donor organs in liver transplantation; however, long-term functional aspects of recovery from donor right hepatectomy are unknown. We analyzed donor outcomes at 1-year follow-up. We performed a single-center retrospective analysis of 70 right hepatectomy donors. Six-week and 1-year postoperative follow-up results were compared to preoperative baseline values. Ultrasonography was performed in all donors at 6 weeks and as clinically indicated. All donors were alive and well at the end of the study period. Of 66 right hepatic donors, only 22 (32%) were fully compliant with a 1-year follow-up visit. All those not compliant were contacted by phone. All complications except 1 (late finding of portal vein thrombosis) occurred in the perioperative (90-day) period. The incidence of bile leak was 4.3%, incisional hernia 20%, and autologous transfusion 1.0%. There were no aborted procedures. In those compliant with full 1-year follow-up, total bilirubin, aspartate aminotransferase, and alanine aminotransferase were normal in 97%. A total of 5 donors were noted to have persistence of asymptomatic thrombocytopenia beyond the perioperative period (90 days). These were investigated with Doppler sonography. Sonography was unremarkable in 3 of the 5, while 2 had abnormal findings: splenomegaly alone in 1, and splenomegaly with portal vein thrombosis in the other. Magnetic resonance angiography was performed in both, and the patient with portal vein thrombosis underwent endoscopy, which failed to reveal varices. Neither has clinical portal hypertension. Both remain asymptomatic albeit with stable thrombocytopenia. In conclusion, the majority of complications after donor right hepatectomy occur in the perioperative period. Later findings may include asymptomatic thrombocytopenia, with an incidence possibly as high as 23%, though the significance of this finding remains uncertain. Larger-scale studies are needed to confirm the true incidence and clinical significance of persistent thrombocytopenia in the donor hepatectomy population. Strategies to improve compliance with 1-year follow-up visits need to be developed.
Adult↗
Vascular complications of superior mesenteric artery infusion with pitressin in treatment of bleeding esophageal varices.
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Catheterization↗
Reversal of hepatic encephalopathy after occlusion of total portasystemic shunts.
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Adult↗