Hemodynamics ; Humans ; Hypertension, Portal ; physiopathology ; surgery ; Portal Vein ; physiopathology ; Portasystemic Shunt, Surgical ; methods

OBJECTIVETo examine the effect of different infusion volume on hemodynamics of portal hypertension (PHT) canines after hemorrhagic shock (HS).

METHODSPHT canine models were made by coarctating a half main portal vein with silk line chronic embolization. Two weeks later, the canine models were assigned to hemorrhagic shock by femoral artery venesection quickly. They were divided into two groups: large volume infusion group (n=6) and small volume infusion group (n=6). Hemodynamics indexes of PHT canines after HS were monitored continuously. We also examined the effect of different infusion volume on hemodynamics.

RESULTSPHT canines showed a series of hemodynamics changes in hemorrhagic shock stage, which aggravated hemodynamics disorder in PHT. After quick infusion, MAP, IVCP, PVP, PVPG, PVBF, HABF, and HBF increased significantly. These indexes in large volume infusion group were higher than those in small volume infusion group. PVR, SVR, HAR decreased significantly. PVP, PVPG, PVBF, HABF, and HBF showed a rebound increase above baseline values in large volume infusion group. The changes of PVP, PVPG, PVBF, HABF, and HBF were parallel with MAP and IVCP and without rebound increase in small volume infusion group. In large volume infusion group PVPG increased earlier and more significant than PVP and exceeded baseline by 13% (2.58 0.37) kPa, so the danger of rebleeding rose greatly. In small volume infusion group PVPG was over 22% (1.67 0.27) kPa lower than baseline, which infers that the danger of rebleeding reduced greatly. SVR and HAR were lower in large volume infusion group. PVP, PVPG, PVBF, HABF, and HBF showed a positive correlation with accumulated vein infusion volume. PVR showed a positive correlation with accumulated vein infusion volume in small volume infusion group. HAR showed a negative correlation with accumulated vein infusion volume in large volume infusion group.

CONCLUSIONSPHT canines after HS show a rebound increase of PVP, PVPG, PVBF, HABF, and HBF above baseline values in large volume infusion group. In small volume infusion group, however, no rebound increase is noticed. Large volume infusion may cause PVP, PVPG, PVBF, HABF, and HBF increase higher than small volume infusion.

Animals ; Dogs ; Hemodynamics ; Hypertension, Portal ; etiology ; physiopathology ; Portal Vein ; physiopathology ; Shock, Hemorrhagic ; complications

OBJECTIVETo explore the characteristics of the portal vein hemodynamics and the correlation with the portal vein pressure.

METHODSThere were 41 cases of hepatic cirrhosis complicating portal hypertension. The liver function was graded Child-Pugh A+B in 31 cases and Child-Pugh C in 10 cases. The inner-diameter and blood stream speed of the portal vein (PV), the spleen vein (SV) and the superior mesentery vein (SMV) were measured by the color Doppler ultrasonography. The vascular acreage and blood flow volume were calculated. The portal vein pressure was directly measured during the operation. Thirty-two healthy people and 26 patients with chronic hepatitis B (CHB) served as controls in this study.

RESULTSThe inner-diameter of the three veins was obviously wider and the blood flow speed was slower in two portal hypertension groups than in CHB and normal groups (P<0.01). In Child C group, the speed was the slowest. The speed of SV and SMV in two hypertension groups did not show any significant difference (P>0.05). In Child A+B group, the blood flow volume of the three veins was larger than that in normal and CHB groups (P<0.01 or P<0.05). The volume of PV was less in Child C group than Child A+B group (P<0.01), but the volume of SV and SMV was not obviously different (P>0.05). In Child A+B group, the portal vein pressure (Ppv) had a close correlation with the portal vein width, blood flow quantitation (Qpv), and blood stream volume (Qsv) of the spleen vein.

CONCLUSIONSThe Qpv in Child A+B grade can be measured by the color Doppler ultrasonography technique, and the portal vein pressure can be monitored easily by the equation of Ppv=1.8951+0.0011Qpv.

Adult ; Blood Flow Velocity ; Female ; Hemodynamics ; Humans ; Hypertension, Portal ; physiopathology ; Male ; Mesenteric Veins ; physiopathology ; Middle Aged ; Portal Pressure ; physiology ; Portal Vein ; physiopathology ; Splenic Vein ; physiopathology ; Ultrasonography, Doppler, Color

This study was to build a canine portal hypertension model by intra-portal administration of high polymer material polyurethane and organic solvent tetrahydrofuran mixed solutions in order to evaluate the effectiveness of the model. Twelve local crossbreed dogs were selected randomly, with intra-portal administration of 8% (weight/volume) polyurethane- tetrahydrofuran solutions through an incision in the upper abdomen to build the portal hypertension model. We measured the portal vein pressure before modeling, during modeling, and four-, eight-, and twelve- weeks after modeling, respectively. Then we evaluated the effectiveness of the model comparing values of data with those data obtained before modeling started, which were regarded as the normal values. The results showed that the portal vein pressure rose by 2. 5 times after the solution administrated instantly as much as that before modeling, and maintained at 1. 5 times after 4 weeks. This method presents an easy operation, low animal mortality and reliable model of portal hypertension. Its less abdominal adhesions and its ability in keeping normal anatomic structure specially make it suit for surgical research of portal hypertension.
Animals ; Disease Models, Animal ; Dogs ; Furans ; adverse effects ; Hypertension, Portal ; Polyurethanes ; adverse effects ; Portal Vein ; physiopathology

OBJECTIVETo compare the characteristics of esophageal gastric varices in portal hypertension patients with and without spontaneous shunts.

METHODSClinical data of 118 patients with esophageal gastric varices undergoing portal vein computed tomographic angiography (CTA) and gastroscopy between January 2012 and August 2015 was retrospectively reviewed.

RESULTSPortal vein CTA results showed that spleno-renal or gastro-renal shunts were detected in 24 out of 118 cases. The average portal vein diameters (PVD) of patients with and without spontaneous shunt were (12.48±2.79) mm and (13.58±3.46) mm, respectively (P>0.05). The average area of gastric veins in patients with spontaneous shunt was significantly larger than that of patients without shunt [294.00 (0.00~2400.00) mm2 vs. 26.00 (0.00~1620.00) mm2, respectively, (P<0.001]. Compared with patients without spontaneous shunt, the location of esophageal varices was lower and the degree was less serious in patients with spontaneous shunt (P<0.05). No matter with history of uppergastrointestinal bleeding, the average area of gastric veins in patients with spontaneous shunt was significantly larger than that of patients without shunt (P<0.05). For patients having no history of splenectomy, the average portal vein diameter (PVD) in those with spontaneous shunt was significantly smaller than that in those without shunt (P<0.05).

CONCLUSIONThe portal vein diameter of patients without splenectomy and with spontaneous shunts is shorter and their esophageal varices are less serious; the gastric veins are large and wriggly in patients with spontaneous shunts.

Angiography ; Esophageal and Gastric Varices ; physiopathology ; Gastroscopy ; Humans ; Hypertension, Portal ; physiopathology ; Portal Vein ; pathology ; Retrospective Studies ; Spleen ; Tomography, X-Ray Computed

OBJECTIVESTo investigate the changes in intrahepatic portal systemic shunt flow (IHSF) and their relationship with microspheres induced acute portal hypertension.

METHODSFollowing acute intrahepatic presinusoidal obstruction by intraportal injection of 15 microm diameter microspheres in male Wistar rats, functional hepatic blood flow (FHBF) and IHSF were determined by hepatic sorbitol uptake methods. The percentage of large shunts of diameter > 15 microm were estimated by intraportal injection of 51Cr labeled 15 mum diameter microspheres.

RESULTSIn normal control rats, hepatic sorbitol uptake was 97.9%+/-0.5% and IHSF was negligible, with FHBF equaling total hepatic blood flow [(2.52 +/- 0.23) ml/min x 100 g body weight-1]. Microsphere injection decreased sorbitol uptake to 12.8% +/- 4.3% and further to 4.1% +/- 0.7% when followed by hepatic arterial ligation. In the latter two groups, IHSF (1.46 +/- 0.15 and 1.16 +/- 0.19 ml/min x 100 g body weight-1, respectively) was not significantly different from portal venous flow [(1.36 +/- 0.20) and (1.20 +/- 0.20) ml/min x 100 g body weight-1, respectively; t = 2.013 and t = 2.116]. Portal venous flow remained at 70% of basal values and portal venous pressure only increased by 50% from baseline. 51Cr labeled microsphere shunt fraction through large shunts (> 15 microm) was less than 1.0%.

CONCLUSIONIntrahepatic portasystemic shunts in the normal rat liver predominantly have diameters less than 15 microm and, when activated by intraportal injection of microspheres, they divert up to 70% of portal venous blood flow away from hepatic sinusoids and thereby they reduce acute increases in portal venous pressure.

Animals ; Hepatic Artery ; physiopathology ; Hepatic Veins ; physiopathology ; Hypertension, Portal ; chemically induced ; physiopathology ; Microspheres ; Portal Vein ; physiopathology ; Random Allocation ; Rats ; Rats, Wistar

Esophageal and Gastric Varices ; etiology ; therapy ; Hemodynamics ; Humans ; Hypertension, Portal ; complications ; therapy ; Liver Cirrhosis ; complications ; therapy ; Portal Vein ; physiopathology

Portal hypertension is a common physiopathological change in liver cirrhosis. In this study, rabbits were used and the model of pre-hepatic portal hypertension (PHT) was induced by partial ligation of portal vein in two steps. We measured the diameters of portal vein and small mesenteric vein at different time-points. Then we detected the stress forces induced by blood flow in varicose veins and in portal vein; such forces included hydrostatic pressure, shear stress and circumferential stress. With the increase of the diameter of varicose small mesenteric vein, the hydrostatic pressure and circumferential stress gradually elevated and shear stress descended markedly in both the portal vein and the small mesenteric vein of PHT rabbits, between which there was a positive linear correlation. The findings in our study indicate that the complications of PHT are partially attributable to the environment of lower shear stress and higher circumferential stress in which the blood vessels of portal venous system live.
Animals ; Hemodynamics ; Hypertension, Portal ; etiology ; pathology ; physiopathology ; Mesenteric Veins ; pathology ; physiopathology ; Portal Vein ; pathology ; physiopathology ; Rabbits ; Stress, Mechanical ; Vascular Resistance ; physiology ; Venous Pressure

Ceftriaxone-induced immune haemolytic anemia is rare but severe complication of this type of antibiotics. In this article, we present a 43-year old patient who suffered from ceftriaxone-induced haemolysis complicated with acute portal vein thrombosis. After successful salvage and transfusion, we underwent thrombolysis via superior mesenteric artery route. Totally recanaliztion achieved. Repeated CT venography showed portal vein still patent with 6 months oral anti coagulation treatment.
Adult ; Ceftriaxone ; adverse effects ; Female ; Hemolysis ; drug effects ; Humans ; Portal Vein ; pathology ; Venous Thrombosis ; physiopathology

We retrospectively collected the ultrasound imaging data of 152 patients with cirrhosis, the gallbladder wall thickness (GBWT) and portal hemodynamics parameters (portal vein diameter, portal vein mean flow velocity, portal vein blood flow) were recorded,and SPSS 11.0 software was used to analyze the correlation between them. The results revealed that there was good correlation between portal vein diameter and the degree of gallbladder wall thickening (r 0.944, P < 0.05). Portal vein mean velocity and portal vein blood flow were both negatively correlated with gallbladder wall thickness (r = -0.939 or r = -0.950, respectively; both P < or = 0.005). These indicate that gallbladder wall thickening is closely related to hemodynamic parameters. It is feasible to predict the degree of portal hypertension through the observation of gallbladder wall thickening in patients with liver cirrhosis.
Adult ; Aged ; Aged, 80 and over ; Female ; Gallbladder ; pathology ; Hemodynamics ; Humans ; Liver Cirrhosis ; pathology ; physiopathology ; Male ; Middle Aged ; Portal Vein ; physiopathology