Hepatic Veins ; physiopathology ; Humans ; Hypertension, Portal ; physiopathology ; Portal Pressure

Arteriovenous Fistula ; Humans ; Hypertension, Portal

The performance of transjugular intrahepatic portosystemic shunt (TIPS) has two key procedures: (1) portal vein branch puncturing, and (2) the correct judgment of the safety of the puncture site. The portal vein branch puncturing is the most important and difficult step for a successful TIPS procedure. Therefore, to find and to establish an proper access to the portal vein is critical. Nowadays, in clinical practice several imaging techniques have been used to localize the portal vein, such as magnetic resonance imaging, sonography, fluoroscopy, arteriography and computed tomography. This article aims to make a general review on these invasive and non - invasive localization techniques when a successful performance of TIPS is expected.

Objective To assess the clinical value of laparoscopic colorectal resection combined with simultaneous radiofrequency ablation for liver metastases.Methods Twenty-two patients with colorectal cancer and synchronous liver metastases were treated by laparoscopie colorectal resection and simultaneous radiofrequency ablation(RFA)in Third People's Hospital of Chengdu from December 2001 to July 2006.Areas of colliquative necrosis were detected by contrast-enhanced computed tomography postoperatively.The outcomes were analyzed by chi-square test.Results Of all patients,8 had muhiple liver metastases,16 had complications.Thirty-one liver metastases were treated by RFA,and no complication oecurred.The mean postoperative hospital stay was(14±5)days,and there was no perioperative death.Five of the 22 patients were identified as incomplete ablation of the tumor,and the RFA was reperformed.The recurrence of liver metastases in the RFA necrotic zone was observed in 4 patients,and RFA was reperformed on 2 of them.Six patients died,and 2 of them died of liver metastases recurrence in the RFA necrotic zone.The recurrence rate of liver metastases and mortality was 18%(4/22)and 27%(6/22),respectively.The recurrence rate of patients with the diameter of the metastatic lession≥2.0 cm was significantly higher than those with the diameter of the metastatic lession＜2.0 cm(x2=5.867,P＜0.05).Conclusions Laparoseopie colorectal resection combined with simultaneous RFA provide a curative opportunity for colorectal cancer patients who are old and have multiple liver metastases,complications,poor tolerance of operation,and for patients whose tumors are difficult to resect.

Liver failure is a clinical syndrome with severe disorders of liver cells for biosynthesis, detoxication, excretion, and biological transformation, which presents with coagulation disorders, jaundice, hepatic encephalopathy, and ascites. Liver failure progresses rapidly, so the prediction of clinical outcome is significant for the diagnosis and treatment. In recent years, there have been numerous reports on the prediction of clinical outcome in patients with liver failure. The study and application of serological and comprehensive models are reviewed, which provides a reference for the rational therapy for liver failure patients.

OBJECTIVETo evaluate the agreement and correlation between hepatic vein pressure gradient (HVPG) and portal vein pressure (PVP) in patients with portal hypertension,and explore their clinical value.

METHODSA total of 46 patients with portal hypertension were directly measured the free hepatic pressure, wedged hepatic pressure, portal vein pressure before and after TIPS therapy. The agreement and correlation of HVPG and PVP were analyzed, and explore their clinical value.

RESULTSThere is no significant agreement or correlation between HVPG and PVP in 5 patients, whose third hilar have large communicating branches between portal vein and Inferior vena cava, or with obvious umbilical vein opened. The HVPGs were significantly agreed with portal vein pressure in other 41 patients. There is no significant difference of HVPG or PVP between earlyTIPS and not early-TIPS groups. In addition, the portal vein pressures after TIPS were significantly decreased compared with that before TIPS.

CONCLUSIONThe HVPG can well show the PVP except these with obvious communicating branches between portal vein and Inferior vena cava in third hilar, and TIPS can effectively decrease the portal vein pressure in patients with portal hypertension.

Hepatic Veins ; Humans ; Hypertension, Portal ; Portal Vein ; Vena Cava, Inferior ; Venous Pressure

OBJECTIVE: To investigate the function of bone marrow mesenchymal stem cells (BMSCs) with over-expressed matrix metalloproteinase 1 (MMP1) on liver fibrosis. METHODS: Fifty SD male rats were randomly divided into 4 groups: recombinant adenovirus Adhuman MMP-1(hMMP-1)-enhanced green fluorescent protein (EGFP) transfected BMSCs group (Group A, n=10), Ad-EGFP transfected BMSCs group (Group B, n=10), liver fibrosis group (Group C, n=15), and a normal group (Group D, n=15). The liver fibrosis model was formed by subcutaneous injection of the mixed liquor of carbon tetrachloride (CCL4) and vegetable oil. After 10 weeks, the model of liver fibrosis was formed. Group A and B were administered the transfected BMSCs via the tail veins, while Group C and D were administered normal saline. After 3 weeks, the rats were sacrificed. The body weight, liver weight, liver function, liver fibrosis indexes and liver pathological changes were tested. RESULTS: Compared with the control group, the rats administered BMSCs with over-expressed MMP1 showed a significant improvement in the body weight, liver weight and plasma albumin (ALB) (P<0.05), and a significant reduction in the plasma alanine aminotransferase, total bilirubin, hyaluronic acid, laminin and procollagen III (P<0.05). Hematoxylin-eosin staining confirmed that the degree of liver fibrosis was significantly ameliorated under average visual fields (P<0.05). CONCLUSION The repair ability of BMSCs on liver fibrosis can be enhanced by over-expression of hMMP-1.
Adenoviridae ; Animals ; Carbon Tetrachloride ; Green Fluorescent Proteins ; Hematopoietic Stem Cells ; cytology ; Liver Cirrhosis ; chemically induced ; therapy ; Male ; Matrix Metalloproteinase 1 ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Transfection

【Objective】 To evaluate the safety and efficacy of long-term indwelling of Allium ureteral stent in the treatment of ureteral stricture. 【Methods】 The clinical data of patients who underwent endoscopic Allium ureteral stent implantation for ureteral stricture in our hospital during Aug.2020 and Dec.2022 were retrospectively analyzed, and the surgical conditions and adverse events were recorded. The data of serum creatinine, blood urea nitrogen, glomerular filtration rate (GFR) and renal pelvis width under ultrasound were compared before surgery and 1, 3, 6 and 12 months after surgery. 【Results】 A total of 52 patients with ureteral stricture of 1.1 (0.7, 2.0)cm were included. All operations were successful. The operation time was 82.5 (70, 114)min, intraoperative blood loss 20 (10, 20)mL, and postoperative hospitalization stay 1 (1, 2) day. During the follow-up of (13.2±7.8) months, 14 patients had stent displacement, 5 had stone obstruction of stent tubes, 7 had occasional hematuria after movement, 9 had intermittent lumbar and abdominal pain, and 1 had recurrent urinary tract infection. The serum creatinine, blood urea nitrogen and renal pelvis width of 1 month, 3, 6 and 12 months after surgery were significantly decreased, while GFR was significantly increased. 【Conclusion】 Long-term indwelling of Allium ureteral stent is effective in the treatment of ureteral stricture, but the high incidence of stent displacement should arouse attention.

BACKGROUNDOrthotopic liver transplantation (OLT) has become the therapeutic option of choice for end-stage liver disease. The aim of this study was to investigate the changes of splenic morphology, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), apparent diffusion coefficient (ADC) values and explore their value in evaluating the therapeutic effects of orthotopic liver transplantation (OLT) on portal hypertension at 1.5 Tesla MRI.

METHODSTwenty patients with portal hypertension undergoing OLT were included in this study. Conventional MRI and diffusion-weighted image (DWI) (b value = 600 s/mm(2)) sequences were applied on each patient before and after OLT, and these patients were referred to as the preoperative and postoperative groups. Twenty healthy individuals were selected as the normal group. After image acquisition, the splenic width (W), thickness (T), length (L), the diameter of the portal vein (PD) and splenic vein (SD) were measured and the splenic volume (V) was calculated. The SNR and CNR were measured on T2WI. The ADC maps were calculated using the b600 in DWIs and the ADC values were measured.

RESULTSCompared with the preoperative group, the splenic V, PD and SD decreased significantly in the postoperative group (P < 0.05). All splenic morphological values were significantly different between preoperative and normal groups (P < 0.05). The splenic L and V were significantly different (P < 0.05) between postoperative and normal groups. The SNR and CNR values were 17.66 ± 4.62 and 13.18 ± 3.12, 11.50 ± 1.64 and 7.44 ± 4.32, 4.24 ± 1.24 and 3.03 ± 2.41 in the preoperative, postoperative and normal groups, respectively. Both SNR and CNR decreased after OLT, but they was still higher than the normal values. The SNR was significantly different between any two groups (P < 0.05). The CNR was significantly different (P < 0.05) between the preoperative and postoperative groups, preoperative and normal groups. The splenic ADC values were (1.339 ± 0.482) × 10(-3) mm(2)/s, (1.120 ± 0.254) × 10(-3) mm(2)/s and (0.997 ± 0.447) × 10(-3) mm(2)/s in the preoperative, postoperative and normal groups, respectively. The difference of ADC values were significant (P < 0.05) between the preoperative and postoperative groups, and the preoperative and normal groups.

CONCLUSIONSOLT is an effective method of treatment for portal hypertension. In addition to dramatically decreasing the splenic V, it can also decrease the splenic SNR, CNR and ADC values in patients with portal hypertension. The changes of splenic SNR, CNR and ADC after OLT may be helpful in providing noninvasive supplementary information in assessing the therapeutic effect of OLT on portal hypertension.

Adult ; Aged ; Female ; Humans ; Hypertension, Portal ; diagnosis ; surgery ; Liver Transplantation ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Retrospective Studies ; Splenomegaly ; diagnosis ; surgery