Animals ; Hepatopulmonary Syndrome ; diagnosis ; etiology ; therapy ; Humans ; Liver Transplantation

Blood Gas Analysis ; Hepatopulmonary Syndrome ; therapy ; Humans ; Male ; Middle Aged ; Portasystemic Shunt, Transjugular Intrahepatic ; Treatment Outcome

BACKGROUND: To determine the prevalence and prognostic impact of hepatopulmonary syndrome (HPS) in patients with unresectable hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). METHODS: Fifty-four patients with unresectable HCC undergoing TACE between December 2014 and December 2015 were prospectively screened for HPS and were followed up for a maximum of 2 years or until the end of this prospective study. RESULTS: Nineteen of the 54 (35.2%) patients were considered to have HPS, including one (5.3%) with severe HPS, nine (47.4%) with moderate HPS, and nine (47.4%) with mild HPS. The median overall survival (OS) was 10.1 (95% confidence interval [CI], 3.9-16.3) months for patients with HPS and 15.1 (95% CI, 7.3-22.9) months for patients without HPS, which is not a significant difference ( P  = 0.100). The median progression-free survival was also not significantly different between patients with and without HPS (5.2 [95% CI, 0-12.8] vs. 8.4 [95% CI, 3.6-13.1] months; P  = 0.537). In the multivariable Cox regression analyses, carbon monoxide diffusing capacity (hazard ratio [HR] = 1.033 [95% CI, 1.003-1.064]; P  = 0.028) and Child-Pugh class (HR = 1.815 [95% CI, 1.011-3.260]; P  = 0.046) were identified to be the independent prognostic factors of OS. CONCLUSION Mild or moderate HPS is common in patients with unresectable HCC undergoing TACE, but it does not seem to have a significant prognostic impact.
Humans ; Carcinoma, Hepatocellular/pathology* ; Chemoembolization, Therapeutic ; Prospective Studies ; Liver Neoplasms/pathology* ; Prognosis ; Hepatopulmonary Syndrome/therapy* ; Prevalence ; Treatment Outcome ; Retrospective Studies

Objective: To summarize the clinical features and prognosis of Budd-Chiari syndrome with hepatopulmonary syndrome (HPS) in children. Methods: The clinical data of a child who had Budd-Chiari syndrome with HPS treated at the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University in December 2016 was analyzed retrospectively. Taking "Budd-Chiari syndrome" and "hepatopulmonary syndrome" in Chinese or English as the keywords, literature was searched at CNKI, Wanfang, China Biomedical Literature Database and PubMed up to July 2023. Combined with this case, the clinical characteristics, diagnosis, treatment and prognosis of Budd-Chiari syndrome with HPS in children under the age of 18 were summarized. Results: A 13-year-old boy, presented with cyanosis and chest tightness after activities for 6 months, and yellow staining of the skin for 1 week. Physical examination at admission not only found mild yellow staining of the skin and sclera, but also found cyanosis of the lips, periocular skin, and extremities. Laboratory examination showed abnormal liver function with total bilirubin 53 μmol/L, direct bilirubin 14 μmol/L, and indirect bilirubin 39 μmol/L, and abnormal blood gas analysis with the partial pressure of oxygen of 54 mmHg (1 mmHg=0.133 kPa), the partial pressure of carbon dioxide of 31 mmHg, and the alveolar-arterial oxygen gradient of 57 mmHg. Hepatic vein-type Budd-Chiari syndrome, cirrhosis, and portal hypertension were indicated by abdominal CT venography. Contrast-enhanced transthoracic echocardiography (CE-TTE) was positive. After symptomatic and supportive treatment, this patient was discharged and received oxygen therapy outside the hospital. At follow-up until March 2023, there was no significant improvement in hypoxemia, accompanied by limited daily activities. Based on the literature, there were 3 reports in English while none in Chinese, 3 cases were reported. Among a total of 4 children, the chief complaints were dyspnea, cyanosis, or hypoxemia in 3 cases, and unknown in 1 case. There were 2 cases diagnosed with Budd-Chiari syndrome with HPS at the same time due to respiratory symptoms, and 2 cases developed HPS 1.5 years and 8.0 years after the diagnosis of Budd-Chiari syndrome respectively. CE-TTE was positive in 2 cases and pulmonary perfusion imaging was positive in 2 cases. Liver transplantation was performed in 2 cases and their respiratory function recovered well; 1 case received oxygen therapy, with no improvement in hypoxemia; 1 case was waiting for liver transplantation. Conclusions: The onset of Budd-Chiari syndrome with HPS is insidious. The most common clinical manifestations are dyspnea and cyanosis. It can reduce misdiagnosis to confirm intrapulmonary vascular dilatations with CE-TTE at an early stage. Liver transplantation is helpful in improving the prognosis.
Male ; Humans ; Child ; Adolescent ; Budd-Chiari Syndrome/therapy* ; Hepatopulmonary Syndrome/therapy* ; Retrospective Studies ; Hypoxia/complications* ; Oxygen ; Dyspnea/complications* ; Cyanosis/complications* ; Bilirubin

Although liver transplantation (LT) is the only effective treatment option for hepatopulmonary syndrome (HPS), the post-LT morbidity and mortality have been high for patients with severe HPS. We performed post-LT embolotherapy in a 10-year-old boy who had severe type I HPS preoperatively, but he failed to recover early from his hypoxemic symptoms after an LT. Multiple embolizations were then successfully performed on the major branches that formed the abnormal vascular structures. After the embolotherapy, the patient had symptomatic improvement and he was discharged without complications.
Child ; Combined Modality Therapy ; Echocardiography ; Embolization, Therapeutic/*methods ; Hepatopulmonary Syndrome/diagnosis/*therapy ; Humans ; *Liver Transplantation ; Male ; Oximetry ; Positron-Emission Tomography ; *Pulmonary Artery ; Tomography, X-Ray Computed

Blood Gas Analysis ; Echocardiography ; Hepatopulmonary Syndrome ; diagnosis ; physiopathology ; therapy ; Humans ; Hypoxia ; diagnosis ; etiology ; therapy ; Liver Cirrhosis ; complications ; Liver Transplantation ; Lung ; pathology ; physiopathology ; Oxygen ; therapeutic use ; Radiography, Thoracic ; Respiratory Function Tests

OBJECTIVETo study the protective effects of ofloxacin by reduction of endotoxin on lung in rats with hepatopulmonary syndrome (HPS).

METHODSRat models of HPS were induced by ligating the bile duct to result in the biliary cirrhosis. Thirty male SD rats were randomly divided into three groups with 10 animals in each one: sham operation group (the bile ducts were isolated and 2 ml NS was injected i.p), HPS model group (the bile ducts were ligated and 2 ml NS was injected i.p) and levofloxacin group (the bile ducts were did as the former group and 20 mg/kg ofloxacin injected i.p). After 6 weeks the portal pressure, ratios of dry weight to wet weight of lung (D/W), weight of spleen, plasma levels of endotoxin, MPO active and MDA contents in the lung. Plasma and lavage fluid of lung were examined. The results of the blood-gas analysis, the bacterial culture of blood, bile and ascites and the evaluation of pathologic change of lung be also investigated.

RESULTSIn levofloxacin group, portal pressure [(19.28 +/- 2.3) compare with (17.80 +/- 2.18)cm H2O, P<0.01], D/W [(5.1 +/- 0.7) compare with (4.9 +/- 0.7), P <0.01], plasma endotoxin levels [(59 +/- 6.2) compare with (268 +/- 35.6)ng/L, P<0.01], MPO active [(0.40 +/- 0.10) compare with (0.24 +/- 0.03)U, P<0.01] and MDA [(0.32 +/- 0.05) compare with (0.22 +/- 0.03) micromol/L, P<0.01] contents in the lung were significantly decreased compared with those in HPS group, and the inflammation of lung was also obviously alleviated.

CONCLUSIONReduction of endotoxin can attenuate the injury of lung in HPS rats.

Animals ; Anti-Bacterial Agents ; therapeutic use ; Bronchoalveolar Lavage Fluid ; chemistry ; Endotoxins ; blood ; Hepatopulmonary Syndrome ; blood ; drug therapy ; Levofloxacin ; Lung ; drug effects ; metabolism ; pathology ; Male ; Malondialdehyde ; metabolism ; Ofloxacin ; therapeutic use ; Portal Pressure ; drug effects ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo explore the mechanism of tanshinol on alleviate the inflammatory injury of lung tissue in rat hepatopulmonary syndrome (HPS).

METHODSSD rats were randomly divided into normal control group (n = 8), hepatopulmonary syndrome (HPS) group (n = 11) and tanshinol intervention group (n = 9). HE staining was used to observe the histopathology changes of pulmonary and hepatic tissues, and to count the number of macrophages in lung tissues. The activity of alanine transferase (ALT) and concentrations of endotoxin, tumor necrosis factor-a (TNF-alpha) and homocystein (Hcy) in plasma were detected. The concentrations of TNF-alpha, nitric oxide (NO) and malondialdehyde (MDA) and the activity of inducible nitric oxide synthase (iNOS) in the lung tissues were measured, respectively.

RESULTSThickened alveolar septum and increased macrophages were observed in lungs in HPS rat. After administered with tanshinol, the pulmonary pathological changes were alleviated and the number of macrophages in lung tissue was decreased compared with HPS group. The activity of ALT and the concentrations of endotoxin, TNF-alpha and Hcy in plasma ,and TNF-alpha, iNOS, NO and MDA in lung tissue in HPS group were higher than those of normal control group; meanwhile, those tanshinol group were less those that of HPS group.

CONCLUSIONTanshinol may play an important role in delaying the development of HPS through protecting liver or directly antagonizing the effect of intestinal endotoxemia so as to alleviate the inflammatory reaction in lung tissue.

Alanine Transaminase ; metabolism ; Animals ; Caffeic Acids ; pharmacology ; Disease Models, Animal ; Endotoxins ; blood ; Hepatopulmonary Syndrome ; drug therapy ; pathology ; Homocysteine ; blood ; Liver ; drug effects ; pathology ; Lung ; drug effects ; pathology ; Macrophages ; drug effects ; pathology ; Male ; Malondialdehyde ; metabolism ; Nitric Oxide ; metabolism ; Nitric Oxide Synthase Type II ; metabolism ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; blood