OBJECTIVETo compare the effect of ablations with pulsed and continuous high-intensity focused ultrasound (HIFU) on the target area containing large blood vessels in isolated perfused porcine liver.

METHODSAn isolated perfused liver model was established by perfusing the isolated porcine liver with autologous blood through the portal vein and hepatic artery using an cardiopulmonary bypass machine. With B-mode ultrasound guidance, a blood vessel about 4 mm in diameter was selected, and pulsed and continuous HIFU ablation at the same dose was delivered along the blood vessel at 3 mm to the vascular wall. After the ablation, the damages of the blood vessels as the acoustic channel and the target area were inspected, and the tissues at the interface of target volume and blood vessels were sampled for pathological examination.

RESULTSNeither pulsed nor continuous HIFU caused noticeable injuries of the acoustic channel vessels, but the volume of necrotic tissues in the target area differed significantly between the two groups (P<0.05). HE staining and vessel staining did not show any injuries of the blood vessels in the pathway of ultrasound ablation in neither of the groups (P>0.05).

CONCLUSIONWhen the target area contains large blood vessels in the pathway of ultrasound ablation, pulsed HIFU can have better therapeutic efficiency to effectively induce tissue damages without affecting the blood vessels.

Animals ; Disease Models, Animal ; Extracorporeal Circulation ; Hepatic Artery ; pathology ; Hepatic Veins ; pathology ; High-Intensity Focused Ultrasound Ablation ; adverse effects ; methods ; Liver ; pathology ; Swine

Focal fatty change of the liver is a nodular lesion which is a rarely described and poorly characterized entity. The hepatic nodule measured 1.4cm at its maximum diameter, was subcapsular in location and occurred adjacent to the falciform ligament. Microscopically it was composed of hepatic tissue with a preserved lobular architecture. The central venous structures and portal tracts with their triads were regularly placed. The cytoplasm of almost all of the hepatocytes within the nodule was replaced by macrovesicular fat vacuoles with the nuclei displaced. Several large abnormal vessels were found at the margin of the nodule. The nodule was discovered incidentally on postmortem examination of a female infant who proved, at autopsy, to have multiple cardiac anomalies and bronchopneumonia. The possible inadequate local tissue perfusion due to abnormal intrahepatic vessels at this particular location could be augmented by multiple cardiac anomalies culminating in focal ischemia and focal fatty change. When encountered in surgery or on gross examination, it could be confused with other space occupying lesions such as liver cell adenoma, abscess and metastatic lesions.
Fatty Liver/complications ; Fatty Liver/pathology* ; Female ; Heart Defects, Congenital/complications ; Hepatic Artery/abnormalities ; Human ; Infant

Liver transplantation is the only solution for end-stage liver diseases. The common hepatic artery (CHA) arises from the coeliac trunk (CT), and the right (RHA) and left hepatic (LHA) arteries are its terminal branches. An abnormal arterial pattern would influence the surgical outcome. The anterior layer of the lesser omentum of a female cadaver was cleaned to identify the CHA, which was traced backwards for its origin and toward the porta hepatis for its terminal branches. In this case, the replaced RHA originated from the CT and ran posterior to the portal vein and the common bile duct. The replaced LHA arose from the left gastric artery. The CHA originated from the CT and branched out as the middle hepatic and gastroduodenal arteries. The replaced RHA and LHA with alteration in relation to the neighbouring structures is a complex and rare variant. Knowledge of this uncommon arterial anomaly is beneficial for hepatobiliary surgeons.
Cadaver ; Education, Medical ; Female ; Hepatic Artery ; anatomy & histology ; pathology ; Humans ; Liver ; blood supply ; surgery ; Models, Anatomic

OBJECTIVESTo classify the courses of the abnormal hepatic arteries originated from superior mesenteric artery in patients with gastric cancer, and to define its application in the D2 radical gastrectomy in those patients.

METHODSEighty-six patients with gastric cancer who had received D2 radical gastrectomy by the same surgeon between January 2008 and June 2010 were included in this study. All patients received the preoperative multislice spiral computed tomoangiography (MSCTA) to classify the abnormal hepatic artery originated from the superior mesenteric artery, which was verified during the surgery. Postoperative immunohistochemistry of the lymphoid tissues around the abnormal hepatic artery was performed by recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen (CEA) to verify the micrometastasis.

RESULTSIn this group, the abnormal hepatic artery originated from the superior mesenteric artery were found with MSCTA and verified by operation in 14 patients, including 12 men and 2 women. The mean age was 62 years. Of the 14 cases with abnormal hepatic artery, 3 cases were found with abnormal common hepatic artery and 11 cases with abnormal right hepatic artery. The total mutation rate is 16.3%. In those patients, the hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 13 cases. It was difficult to dissect the abnormal hepatic artery, especially for the post-pancreas type in D2 lymphadenectomy, for fear of damaging the abnormal blood vessel and pancreas. The operation time in cases with abnormal hepatic artery was significantly longer than that in patients with normal hepatic artery [(218.8 ± 23.9) min vs. (179.6 ± 18.5) min]. Immunohistochemical analysis revealed no metastasis in the lymphoid tissues surrounding the abnormal artery.

CONCLUSIONSAbnormal hepatic arteries originated from the superior mesenteric artery can be classified into pre-pancreas type and post-pancreas type. The dissection of the abnormal hepatic artery is not advocated in D2 radical gastrectomy for no lymph node metastasis is found around the abnormal hepatic artery in this study.

Aged ; Female ; Gastrectomy ; Hepatic Artery ; pathology ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Mesenteric Artery, Superior ; pathology ; Middle Aged ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVE: We wished to evaluate the effect of the Pringle maneuver (occlusion of both the hepatic artery and portal vein) on the pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone in rabbit livers. MATERIALS AND METHODS: Radiofrequency (RF) ablation zones were created in the livers of 24 rabbits in vivo by using a 50-W, 480-kHz monopolar RF generator and a 15-gauge expandable electrode with four sharp prongs for 7 mins. The tips of the electrodes were placed in the liver parenchyma near the porta hepatis with the distal 1 cm of their prongs deployed. Radiofrequency ablation was performed in the groups with (n=12 rabbits) and without (n=12 rabbits) the Pringle maneuver. Three animals of each group were sacrificed immediately, three days (the acute phase), seven days (the early subacute phase) and two weeks (the late subacute phase) after RF ablation. The ablation zones were excised and serial pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone were evaluated. RESULTS: With the Pringle maneuver, portal vein thrombosis was found in three cases (in the immediate [n=2] and acute phase [n=1]), bile duct dilatation adjacent to the ablation zone was found in one case (in the late subacute phase [n=1]), infarction adjacent to the ablation zone was found in three cases (in the early subacute [n=2] and late subacute [n=1] phases). None of the above changes was found in the livers ablated without the Pringle maneuver. On the microscopic findings, centrilobular congestion, sinusoidal congestion, sinusoidal platelet and neutrophilic adhesion, and hepatocyte vacuolar and ballooning changes in liver ablated with Pringle maneuver showed more significant changes than in those livers ablated without the Pringle maneuver (p < 0.05) CONCLUSION: Radiofrequency ablation with the Pringle maneuver created more severe pathologic changes in the portal vein, bile ducts and liver parenchyma surrounding the ablation zone compared with RF ablation without the Pringle maneuver. Therefore, we suggest that RF ablation with the Pringle maneuver should be performed with great caution in order to avoid unwanted thermal injury.
Animals ; Bile Ducts/*pathology/surgery ; *Catheter Ablation ; Disease Models, Animal ; Hepatic Artery/*pathology/surgery ; Liver/*blood supply/pathology/*surgery ; Male ; Necrosis ; Portal Vein/pathology ; Rabbits

Bile Duct Diseases ; etiology ; pathology ; Diagnosis, Differential ; Graft Rejection ; etiology ; pathology ; Hepatic Artery ; pathology ; Humans ; Liver Transplantation ; adverse effects ; Thrombosis ; etiology ; pathology

Bile Duct Neoplasms ; pathology ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; pathology ; surgery ; Hepatectomy ; methods ; Hepatic Artery ; pathology ; surgery ; Humans ; Lymph Node Excision ; methods ; Portal Vein ; pathology ; surgery

Hemobilia, in patients with the diagnosis of polyarteritis nodosa, is rare at clinical presentation and has a grave prognosis. We describe a case of massive hemobilia, due to aneurysmal rupture, in a patient with polyarteritis nodosa. A 39-year-old man was admitted to the hospital with upper abdominal pain. The patient had a history of partial small bowel resection, for intestinal infarction, about 5 years prior to this presentation. Abdominal computed tomography demonstrated multiple high attenuation areas in the bile duct and gallbladder. Hemobilia with blood seepage was visualized on endoscopic retrograde cholangiopancreatography; this bleeding stopped spontaneously. The following day, the patient developed a massive gastrointestinal bleed with resultant hypovolemic shock. Emergent hepatic angiogram revealed multiple microaneurysms; a communication was identified between a branch of the left hepatic artery and the bile duct. Hepatic arterial embolization was successfully performed. The underlying disease, polyarteritis nodosa, was managed with prednisolone and cyclophosphamide.
Rupture/*complications ; Polyarteritis Nodosa/*physiopathology ; Male ; Humans ; Hepatic Artery/*pathology ; Hemobilia/diagnosis/*etiology ; *Embolization, Therapeutic ; Aneurysm, Ruptured/*complications/therapy ; Adult

OBJECTIVETo study the effect of hepatic artery embolization on the microwave coagulated area, an in vivo animal experiment.

METHODSTwenty-four suitable hepatic lobes of ten dogs were divided into two groups: microwave coagulation alone 12 lobes (control group) and hepatic artery occlusion with iodized oil and gelatin sponge particles followed by microwave coagulation 12 (experiment group). Microwave coagulation was delivered with an output of 50 W for 300 or 400 seconds with thermal needles introduced parallel to and 5 approximately 20 mm from the puncture needle. After sacrifice of the dogs, their hepatic lobes were sectioned along the puncture line. Then, the appearance and size of the coagulated area were recorded. The tissue specimens were fixed in formalin for light microscopic evaluation.

RESULTSA decline in temperature gradient was detected from the center to the periphery of the affected tissue after the application of microwave coagulation, which was sharper in the control group than in the experimental group. Single polar microwave coagulation at 50 W for 300 seconds produced a necrotic volume of 25 approximately 33 mm in longitudinal diameter and 13 approximately 22 mm in transverse diameter in control group, 33 approximately 44 mm and 24 approximately 32 mm in the experimental group. The coagulation area was slightly bigger when the duration of coagulation was 400 seconds than 300 seconds, without significant difference.

CONCLUSIONHepatic artery occlusion, inhibiting the heat loss caused by hepatic arterial blood flow, is able to significantly enlarge the necrotic volume of microwave coagulation.

Animals ; Dogs ; Electrocoagulation ; Embolization, Therapeutic ; Female ; Hepatic Artery ; Liver ; pathology ; Liver Neoplasms ; therapy ; Male ; Microwaves ; therapeutic use

Animals ; Dexamethasone ; therapeutic use ; Female ; Ginsenosides ; therapeutic use ; Hepatic Artery ; pathology ; Ischemia ; therapy ; Liver Diseases ; therapy ; Rats ; Rats, Sprague-Dawley