OBJECTIVETo study the clinical value of total hemihepatic vascular exclusion (THHVE) in liver resection for patients with hepatocellular carcinoma (HCC) and impaired liver function.

METHODSThe data of 70 patients who underwent liver resection for HCC with impaired liver function between January 2009 and October 2011 were analyzed retrospectively. THHVE was applied in 38 patients (THHVE group), Pringle maneuver in 25 patients (Pringle group) and no vascular occlusion in 7 patients. In the THHVE group, 36 patients were male, 2 were female, average age was (54 ± 9) years. And in Pringle group, 23 patients were male, 2 were female, average age was (53 ± 10) years. Total intraoperative blood loss, blood transfusion rate, clamping time, postoperative complication rate, postoperative hospital stay and postoperative liver function were compared between the THHVE and Pringle group.

RESULTSTotal blood loss ((317 ± 186) ml vs. (506 ± 274) ml, t = -3.025, P = 0.004) and transfusion rate (10.5% vs. 32.0%, χ(2) = 4.509, P = 0.034) were significantly lower in the THHVE group than in the Pringle group. Although the clamping time was longer ((21 ± 5) minutes vs. (17 ± 5) minutes, t = 3.209, P = 0.002), the total bilirubin levels on postoperative day 3 and 7 and ALT levels on postoperative day 1, 3, 7 were significantly lower in the THHVE group than in the Pringle group, and the pre-albumin level on postoperative day 7 was higher in the THHVE group than in the Pringle group. Total complication rate (26.3% vs. 52.0%, χ(2) = 4.291, P = 0.038) and major complication rate (7.9% vs. 28.0%, χ(2) = 4.565, P = 0.033) were lower in the THHVE group than in the Pringle group. And postoperative hospital stay duration was shorter in the THHVE group than in the Pringle group ((14.0 ± 2.6) d vs. (16.4 ± 4.0) d, t = -2.625, P = 0.012).

CONCLUSIONSTHHVE is a safe and effective technique in liver resection for patients with HCC and impaired liver function. It is associated with less blood loss, lower transfusion requirements, better postoperative liver function recovery, lower postoperative complication rate and shorter postoperative hospital stay.

Adult ; Aged ; Carcinoma, Hepatocellular ; blood supply ; surgery ; Female ; Hepatectomy ; methods ; Humans ; Liver ; blood supply ; physiopathology ; Liver Neoplasms ; blood supply ; surgery ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo investigate the influence of myocardial inhibition on injury to liver, kidney and intestine and blood perfusion at early stage in rat with severe burn.

METHODSThirty-two healthy male Wistar rats were enrolled in the study and randomly divided into sham scald, propranolol, scald control and scald + propranolol groups, with 8 rats in each group. After intraperitoneal injection of 10 g/L pentobarbital sodium for anesthesia, rats of the former two groups were sham scalded in a water bath of 37 degrees C for 18 s, while the latter two groups were inflicted with 30% TBSA full-thickness scald in a 97 degrees C water bath for 18 s. Rats were resuscitated with Ringer's lactate solution (4 mL x kg(-1) x 1% TBSA(-1), i. p.) following the Parkland formula 30 mins after the injury. At the same time, rats in propranolol and scald + propranolol groups received propranolol 0.75 mg/kg intravenously. After 6 hours, parameters of myocardiac mechanics (SBP, DBP, MAP, LVSP, LVEDP, +/- dp/dt max) were recorded by the multiple channel physiological signal collecting and processing system; blood flow of liver, kidney and intestine were detected with the laser doppler flowmetry; the serum contents of cTnI, TBA, beta2-MG and DAO were determined for reflecting injuries to the heart, liver, kidney and intestine, respectively.

RESULTSMyocardiac mechanics parameters, with the exception of LVEDP, were decreased in propranolol group as compared with those in sham group (P <.05). All myocardiac mechanics parameters in burn control group were lower than those in sham group and higher than those in burn + propranolol group (P < 0.05). Blood flow of organs showed similar changes in above-mentioned 3 groups (P < 0.05). Organ damages as shown in burn control group [cTnI (4.86 +/- 0.29) microg/L, TBA (83.6 +/- 18.2) micromol/L, beta2-MG (2.75 +/- 0.19) mg/L, DAO (1.45 +/- 0.09) x 10(3) U/L] were more serious than those in sham control group [cTnI (1.73 +/- 0.09) microg/L, TBA (24.5 +/- 2.4) micromol/L, beta2-MG (1.15 +/- 0.18) mg/L, DAO (0.87 +/- 0.13) x 10(3) U/L], and less serious than those in scald + propranolol group [cTnI 5.95 +/- 0.42 microg/L, TBA 125.8 +/- 21.3 micromol/L, beta2-MG 3.25 +/- 0.17 mg/L, DAO (1.83 +/- 0.13) x 10(3) U/L] (P < 0.05).

CONCLUSIONSPropranolol can aggravate injury to the liver, kidney and intestine at early stage in rat with severe burn, suggesting that "shock heart" may be one of initial factors in lowering blood flow to the organs, thus inducing injury to them.

Animals ; Blood Pressure ; Burns ; metabolism ; physiopathology ; Intestines ; blood supply ; Kidney ; blood supply ; Liver ; blood supply ; Male ; Myocardium ; metabolism ; Propranolol ; adverse effects ; Rats ; Rats, Wistar ; Shock

OBJECTIVETo investigate the instigating effect of "shock heart" on injury to liver, kidney and intestine at early stage of severe burn in rat.

METHODSFifty-six healthy male Wistar rats were enrolled in the study and randomly divided into normal control (n=8, without treatment, NC) and burn (n=48, inflicted with 30% TBSA full-thickness scald, B) groups. The rats in B group were intraperitoneally injected with Ringer's lactate solution (4 ml x kg(-1) x 1% TBSA(-1) 30 minutes after burn following the Parkland formula, and they were observed at 0.5, 1.0, 3.0, 6.0, 12.0, 24.0 post-burn hour (PBH), with 8 rats at each time point. The parameters concerning myocardial mechanics, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure( LVEDP), +/-dp/dt max were recorded. The volume of blood flow in liver, kidney and intestine were detected. The serum contents of cTnI, TBA, 32-MG, DAO were determined.

RESULTSIn B group, LVSP and +/- dp/dt max decreased at 1.0 PBH, SBP, DBP and MAP decreased at 3.0 PBH ,all parameters of myocardial mechanics, decreased at 6.0 PBH and still lower than those in NC group at 24.0 PBH (P < 0.01). The volume of blood flow in liver, kidney and intestine in B group were markedly decreased at 1.0 PBH, and gradually decreased during 1.0-12.0 PBH, which were still lower than those in NC group at 24.0 PBH (P < 0.05 or P < 0.01). Compared with that in NC group (1.71 +/- 0.07 microg/L), the serum content of cTnI in B group were increased at 0.5 PBH (2.22 +/- 0.08 microg/ L, P < 0.01), and peaked at 12.0 PBH (7.07 +/- 0.44 microg/L), and persisted at high level (4.57 +/- 0.30 microg/L) at 24.0 PBH. The serum contents of TBA at 3.0 PBH, beta2-MG at 1.0 PBH, DAO at 1.0 PBH was obviously higher than those in NC group (P < 0.05 or P < 0.01), which all showed ascending tendency during 1.0-12.0 PBH.

CONCLUSIONMyocardial damage is earlier than other organs after severe burn, which is significantly correlated with the parameters of other organs damage and their blood flow volume. Shock heart may be one initiate factor to induce the damage of liver, kidney and intestine and decrease of their blood flow volume after severe burn.

Animals ; Blood Pressure ; Burns ; blood ; physiopathology ; Cardiomyopathies ; etiology ; Kidney ; blood supply ; Liver ; blood supply ; Male ; Random Allocation ; Rats ; Rats, Wistar ; Shock ; physiopathology ; Ventricular Function

Spontaneous regression of hepatocellular carcinoma is extremely rare, and the exact pathogenesis leading to this remarkable phenomenon remains unclear. We describe a case of spontaneous regression of an incidentally discovered hepatocellular carcinoma in a 63-year-old man with hepatitis C cirrhosis. The regression followed a series of events, in particular, an upper gastrointestinal haemorrhage. Ischaemic insult may be a major pathway leading to tumour regression. As limited data is available in the literature, knowledge and recognition of this rare event will have implications for patient management and may alter treatment. Further, data may be useful to assess if these patients have an altered prognosis with improved survival.
Carcinoma, Hepatocellular ; blood supply ; complications ; pathology ; physiopathology ; Gastrointestinal Hemorrhage ; etiology ; physiopathology ; Humans ; Incidental Findings ; Liver Cirrhosis ; complications ; pathology ; physiopathology ; Liver Neoplasms ; blood supply ; complications ; pathology ; physiopathology ; Male ; Middle Aged ; Neoplasm Regression, Spontaneous ; pathology ; physiopathology ; Tomography, X-Ray Computed

Carcinoma, Hepatocellular ; blood supply ; diagnostic imaging ; Hepatic Artery ; physiopathology ; Humans ; Liver Neoplasms ; blood supply ; diagnostic imaging ; Portal Vein ; physiopathology ; Tomography, Spiral Computed ; methods

OBJECTIVETo evaluate the influence of extended hepatic pedicle occlusion (HPO) on hepatic ischemic/reperfusion (I/R) injury and intraoperative blood loss in major hepatectomy for primary liver cancer (PLC).

METHODSBetween June 2001 and December 2005, a total number of 843 patients with PLC had been operated on. Those whose hepatic pedicle were occluded continuously for or longer than 30 min during hepatectomy were retrospectively reviewed (continuous HPO group) and compared to the patients whose hepatic pedicle were occluded for the same length of time but intermittently (intermittent HPO group). The amount of intraoperative blood loss, the percentage of the patients who needed blood transfusion and postoperative liver biochemical tests were compared between the two groups.

RESULTSThere were 35 cases in continuous HPO group and 38 cases in intermittent HPO group with occlusion time between 30 min and 45 min. The two groups were matched for underlying liver disease ,preoperative liver function, tumor size and location, major intrahepatic vessel involvements and the types and extensions of the hepatectomies. The mean intraoperative blood loss in continuous HPO group was significantly less than that in intermittent HPO group (660 ml vs. 1054 ml, P < 0.05); accordingly, the percentage of patients who need blood transfusion in continuous HPO group was significantly lower than that in intermittent HPO group (48.6% vs. 78.9%, P < 0.01). Patients in both of the groups were recovered smoothly after operation, with no occurrence of liver failure.

CONCLUSIONSThe hepatic pedicle can be continuously occluded for 3045 min in cirrhotic patients with well compensated liver function, and when compared to routine intermittent HPO, continuous HPO significantly decreases the intraoperative blood loss and reduces the need for transfusion. Meanwhile it does not increase the hepatic I/R injury.

Adult ; Aged ; Blood Loss, Surgical ; prevention & control ; Female ; Hepatectomy ; methods ; Humans ; Liver ; blood supply ; physiopathology ; Liver Neoplasms ; physiopathology ; surgery ; Male ; Middle Aged ; Retrospective Studies

Adult ; Blood Circulation ; Blood Flow Velocity ; Blood Pressure ; Female ; Heart Rate ; Hemodynamics ; physiology ; Humans ; Hypertension, Portal ; etiology ; physiopathology ; Liver ; blood supply ; physiopathology ; Liver Cirrhosis ; etiology ; physiopathology ; Male ; Middle Aged ; Ventricular Dysfunction ; physiopathology

OBJECTIVETo analyze the value of time-signal intensity curve (TIC) in dynamic contrast-enhanced magnetic resonance imaging (DEC-MRI) in the evaluation of liver fibrosis.

METHODSThirty-six consecutive patients and healthy volunteers were divided into 4 groups according to the stages of fibrosis, namely the normal group (n=9), mild fibrosis group (n=5), moderate to severe fibrosis group (n=7), and liver cirrhosis group (n=15). All the subjects underwent conventional and DEC-MRI, and the TIC was generated automatically to evaluate the peak height, TTP, MSI and MSD. The correlations between the TIC parameters and the stage of fibrosis were assessed. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the value of the TIC parameters in the evaluation of fibrosis stage.

RESULTSModerate but significant inverse correlations of the peak height, MSI, and to fibrosis stage were noted in these patients (P<0.05); the peak time was positively correlated to the fibrosis stage (P<0.05). In patients with a fibrosis stage ≥1, the AUC of the measured TIC parameters ranged from 0.747 to 0.783, with the MSD of the spleen had the highest AUC (0.783). For a fibrosis stage ≥3, the AUC of the indices ranged between 0.728 and 0.877, highest for liver MSI of the arterial phase, followed by the portal vein MSI, liver MSI of portal venous phase, liver MSD, splenic MSI of arterial phase and splenic MSD. In the diagnosis of liver cirrhosis, the AUC (range 0.742-0.821) decreased in the order of liver MSI of the portal venous phase, liver MSD, liver MSI of the arterial phase, the portal vein MSI, splenic MSI of the arterial phase and splenic MSD.

CONCLUSIONTIC of DEC-MRI can be used to evaluate hemodynamic changes in the liver, and may serve as a practical non-invasive functional imaging modality for assessing the severity of liver fibrosis.

Adolescent ; Adult ; Aged ; Contrast Media ; Female ; Gadolinium DTPA ; Hemodynamics ; physiology ; Humans ; Liver ; blood supply ; physiopathology ; Liver Cirrhosis ; diagnosis ; physiopathology ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Young Adult

BACKGROUNDA fatal complication after liver transplantation is anastomotic embolization of the hepatic artery. In order to solve this problem, the portal venous arterialization (PVA) is used to reconstruct the hepatic arterial blood flow. The purpose of this study was to investigate the influence of PVA on rats with acute occlusion of hepatic artery.

METHODSRat PVA models were established and then randomly divided into Group 1 (control group), Group 2 (jaundice group), Group 3 (bile duct recanalization group), and Group 4 (portal vein arterilization group). Recanalization of the common bile duct and PVA were performed 5 days after bile duct ligation in the rats. The influence of the PVA on general conditions, hepatic changes of structure and function, portal vein pressure and hepatic micrangium were observed for one month.

RESULTSFive days after common bile duct ligation the serum bilirubin, transaminase and alkaline phosphatase levels were significantly increased. Compared with group 1, there was a statistically significant difference (P < 0.01). These rats then underwent bile duct recanalization and PVA. After a month, the liver functions and microscopic structures completely returned to normal and, compared with group 1, there was no statistically significant difference in portal vein pressure (P > 0.05). Vascular casting samples showed that hepatic sinusoids were slightly thicker and more filled than normal ones and although they had some deformations, the hepatic sinusoids were still distributed around the central vein in radial form.

CONCLUSIONWithin a month after operation, bile duct recanalization and PVA do not show obvious adverse effects on liver hemodynamics and hepatic micrangium, and the liver function and microscopic structure can return to normal.

Animals ; Arterial Occlusive Diseases ; physiopathology ; surgery ; Arteriovenous Shunt, Surgical ; methods ; Blood Pressure ; Hepatic Artery ; physiopathology ; surgery ; Liver ; blood supply ; pathology ; physiopathology ; Liver Circulation ; Male ; Portal Vein ; physiopathology ; surgery ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo evaluate the correlation between the mean of time blood flow velocity (TVmean) of feeding artery around hepatocellular carcinoma (HCC) and the microvessel density (MVD) in relation to tumor cell differentiation, and to evaluate the usefulness of TVmean as a noninvasive preoperative marker of biologic characteristic of HCC.

METHODSTo measure TVmean of feeding arteries around the HCC in 45 patients before operation and TVmean of minute arteries in hepatic tissue in 45 normal subjects by ultrasonographic examination. Tumor cell differentiation grade was determined by routine histopathological staining. Tumor MVD was measured by immunohistochemical staining with monoclonal antibodies against F VIII RAg of excised HCC. Correlationship between TVmean of feeding arteries and MVD of HCC was studied.

RESULTSA linear correlation between TVmean of feeding arteries around the tumors of HCC and MVD of HCC tissue (r = 0.794, y = 18.2764 + 1.5544x) was obtained. With TVmean > or = 21.3 cm/s, the positive and negative predictive values of poorly differentiated HCC were 97.4% and 87.5%, respectively. With TVmean < 21.3 cm/s, those of well differentiated HCC were 88.5% and 97.3%, respectively. The degree of reliability of calculating HCC cell differentiation according to TVmean was 89.5%.

CONCLUSIONTumor growth and cellular differentiation, the two major factors affecting prognosis of HCC, may be evaluated by TVmean of feeding arteries around the tumor. It offers a useful preoperative information for predicting prognosis of HCC patients.

Adult ; Aged ; Arterioles ; pathology ; Blood Flow Velocity ; Capillaries ; pathology ; Carcinoma, Hepatocellular ; blood supply ; pathology ; physiopathology ; Female ; Humans ; Liver Neoplasms ; blood supply ; pathology ; physiopathology ; Male ; Middle Aged ; Neovascularization, Pathologic ; pathology