Hepatic Blood Research Articles

Liver pathology algorithms for the non-specialist: diffuse liver pathology

Pathological lesions occur in the liver in primary hepatic disorders and in extrahepatic/ systemic diseases with hepatic involvement. Diseases may have acute or chronic manifestations. Comorbidities may exist. Pattern recognition is the mainstay of liver biopsy interpretation. A kaleidoscope of morphological patterns exists. One pattern can be caused by more than one etiology. One etiology can produce more than one pattern. Histopathological findings evolve with disease progression or resolution. Therapy may modify the picture. A 3-step algorithmic approach to liver biopsy reporting is presented. To avoid bias, biopsies are analysed blind initially to arrive at a morphological diagnosis based solely on descriptive histological findings. Differential clinical diagnoses are then prioritized according to ones area of practice. The final diagnosis is rendered after close clinicopathological correlation. The basic morphological patterns are: portal hepatitis; periportal (interface) hepatitis; lobular hepatitis; cholestasis/cholestatic hepatitis; steatosis/steatohepatitis; granulomas/ granulomatous hepatitis; necrosis; fibrosis/cirrhosis; and minimal change. Helpful features include abnormalities in hepatocytes, bile ducts, Kupffer cells, hepatic stellate cells, sinusoids and blood vessels; various pigments; viral inclusions and organisms; and aberrant cells. An exclusionary diagnosis may be just as useful as a definitive one to aid decision-making and further patient management. Best practice depends on dedicated hepatology teamwork.

Community-acquired primary liver abscess due to klebsiella pneumoniae in a type 2 diabetic patient

Klebsiella pneumonia (KPLA) liver abscess is a cause of morbidity and mortality in especially diabetic patients. Early case reports have been from the Southeast Asia, also been found in other parts of the world. Diagnosis is usually by culture of hepatic aspirate and/or blood culture and treatment by drainage of abscess and administration of appropriate antibiotics. This is a case of KPLA in a 52-year old man treated and responded to antibiotics. KPLA is an entity that should be sought for especially in poorly controlled diabetic patients when they present with clinical features of liver abscess. Blood culture must always be done especially when aspiration or drainage proves difficult. Use of appropriate antibiotics alone may be successful in treating them if surgical drainage is unsuccessful.

The relationship between liver hemodynamic changes and liver tumor growth of different lobes of rat after partial portal vein ligation

Objective To discuss the relationship between liver hemodynamic changes and tumor growth of different lobes of rat with hepatocellular carcinoma,after the partial portal vein ligation.Methods Eighteen male rats with liver cancer were randomly divided into group A and B,portal vein ligation (PVL)was performed in group A,and group B served as a control (sham operations).At different time points after surgery,hepatic artery and portal vein blood flow velocity of the ligated and non-ligated lobes were measured with doppler ultrasound measurement,tumor volume of the ligation and non-ligated lobes were measured with positron emission tomography (PET-CT),and the correlation between liver hemodynamic changes and tumor growth of different lobes were analyzed using SPSS.Results Liver artery blood flow velocity of the ligated lobe in group A was significantly higher than that in group B [(4.34 ±0.53) ml/min vs (2.07 ± 0.04) ml/min,P ＜ 0.05],and there was a positive correlation between liver artery blood flow velocity and tumor volume of the ligated lobe (r =0.908,P ＜ 0.05).Conclusion Increased artery blood flow to the ligated lobe after the hepatic portal vein ligation is one of the promote factors to accelerate liver tumor growth of ligated lobe. Key words: Portal vein ligation; Hepatocellular carcinoma; Hepatic artery blood flow

Using pathomorphological diagnostics of changes in the hepatic and small intestinal blood vessels of nonlinear immunocompromised mice with the ehrlichia infection in forensic medicine

The paper presents materials with the use of the pathomorphologic diagnostics of changes in the vessels of the liver and small intestine of nonlinear immunocompromised mice with the Ehrlichia infection in forensic medicine.

Postoperative arterial hemorrhage after pancreatoduodenectomy: Report of five cases

s / Pancreatology 13 (2013) S1–S80 S67 retrospectively analyzed our cases to clarify the effectiveness and limitations on our treatment for the intra-abdominal arterial hemorrhage after PD. Methods: Between March 2000 and April 2013, five of 254 patients (2.0%) developed intra-abdominal hemorrhage in perioperative period after PD. All patients were managed by transcatheter arterial embolization (TAE). The patients can be divided into two groups according to the site of bleeding. Namely, Hepatic Artery (HA) group (4 patients); stump of GDA, RHA and CHA (2patients), and Superior Mesenteric Artery (SMA) group; (1 patient), a branch of jejunal artery of elevated-jejunum for hepaticojejunostomy. Results: All patients had complete hemostasis by single TAE. There was no mortality. The onset of bleeding was on 8th to 14th (median 12th) post-operative day (POD). In 2 of 5 patients, massive bleeding was preceded by minor bleeding 6 to 7 days before. In HA group, 3 patients had past history of upper abdominal surgery (gasterectomy:2, partial resection of duodenectomy:1). In HA group, coil embolization of CHA was performed in all patients. No patients had arterial variation. After embolization the elevation of s-AST/ALT were slight (AST:32-194, ALT:36233) and no hepatic failure was occurred. But liver abscesses were detected in 2 patients 36 and 146 days after embolization. In SMA group the embolization was performed with gelatin, and no complication was observed. The period of hospital stay after TAE was 36 to 146 (median 56) days. Conclusions: Interventional radiology for the arterial hemorrhage after PD was done successfully. A past-history of upper abdominal surgery may be a risk factor of arterial bleeding after PD. In the HA group, it could be useful to employ a metallic covered stent to keep hepatic arterial blood flow and avoid liver abscess formation.

Intermittent negative pressure external drainage of the pancreatic duct reduces pancreatic fistula after pancreaticojejunostomy in the patients with soft pancreas

s / Pancreatology 13 (2013) S1–S80 S67 retrospectively analyzed our cases to clarify the effectiveness and limitations on our treatment for the intra-abdominal arterial hemorrhage after PD. Methods: Between March 2000 and April 2013, five of 254 patients (2.0%) developed intra-abdominal hemorrhage in perioperative period after PD. All patients were managed by transcatheter arterial embolization (TAE). The patients can be divided into two groups according to the site of bleeding. Namely, Hepatic Artery (HA) group (4 patients); stump of GDA, RHA and CHA (2patients), and Superior Mesenteric Artery (SMA) group; (1 patient), a branch of jejunal artery of elevated-jejunum for hepaticojejunostomy. Results: All patients had complete hemostasis by single TAE. There was no mortality. The onset of bleeding was on 8th to 14th (median 12th) post-operative day (POD). In 2 of 5 patients, massive bleeding was preceded by minor bleeding 6 to 7 days before. In HA group, 3 patients had past history of upper abdominal surgery (gasterectomy:2, partial resection of duodenectomy:1). In HA group, coil embolization of CHA was performed in all patients. No patients had arterial variation. After embolization the elevation of s-AST/ALT were slight (AST:32-194, ALT:36233) and no hepatic failure was occurred. But liver abscesses were detected in 2 patients 36 and 146 days after embolization. In SMA group the embolization was performed with gelatin, and no complication was observed. The period of hospital stay after TAE was 36 to 146 (median 56) days. Conclusions: Interventional radiology for the arterial hemorrhage after PD was done successfully. A past-history of upper abdominal surgery may be a risk factor of arterial bleeding after PD. In the HA group, it could be useful to employ a metallic covered stent to keep hepatic arterial blood flow and avoid liver abscess formation.

226 LONG-TERM ANTIBIOTIC AND PROTON-PUMP INHIBITOR USE ARE STRONG PREDICTORS OF RECURRENT INFECTIONS IN CIRRHOSIS: A PROSPECTIVE MULTI-CENTER STUDY FROM NACSELD

(type V collagen), C6M (type VI collagen), BGM (Biglycan), ELM (Elastin), and CRPM (CRP)), and ECM formation markers (P3NP (type III collagen) and P4NP7S (type IV collagen)) were measured. Results: The markers measured in hepatic venous blood correlated to the level measured in arterial blood (R=0.89–0.98; p < 0.0001). In hepatic venous blood, all markers correlated directly to Child Score and MELD, and inversely to ICG clearance and serum albumin, strongest with P3NP (R=0.46, 0.48, −0.53, and −0.46; respectively, p < 0.0001). All markers except ELM were inversely correlated to hematocrit and to hemoglobin, especially C4M and C1M showed strongest correlations (R = −0.31; −0.40; respectively, p = 0.001p < 0.0001). In both arterial and hepatic venous blood all markers except CRPM correlated to HVPG (e.g. P3NP for both sites R =0.47, p < 0.0001). A multiple regression analysis including P3NP, C6M and MELD improved the correlation (R =0.62, p < 0.0001). P3NP could clearly separate controls from HVPG levels <10mmHg (p < 0.01) and those with HVPG<10mmHg from those with HVPG levels ≥10mmHg (p < 0.0001). C4M, C5M, and ELM were all significantly higher in patients with HVPG levels ≥12mmHg compared to lower HVPG levels (p < 0.01–0.0001). Conclusion: The Protein Fingerprint markers reflect liver function and stage of disease. A strong correlation between the markers measured in hepatic venous and arterial blood was observed. A multimarker model in combination with clinical scores predicted HVPG and separated clinical relevant HVPG thresholds noninvasively. Therefore these markers and their models are suitable for non-invasive evaluation of portal hypertension in cirrhosis.

Different Contribution of Splanchnic Organs to Hyperlactatemia in Fecal Peritonitis and Cardiac Tamponade

Background. Changes in hepatosplanchnic lactate exchange are likely to contribute to hyperlactatemia in sepsis. We hypothesized that septic and cardiogenic shock have different effects on hepatosplanchnic lactate exchange and its contribution to hyperlactatemia. Materials and Methods. 24 anesthetized pigs were randomized to fecal peritonitis (P), cardiac tamponade (CT), and to controls (n = 8 per group). Oxygen transport and lactate exchange were calculated during 24 hours. Results. While hepatic lactate influx increased in P and in CT, hepatic lactate uptake remained unchanged in P and decreased in CT. Hepatic lactate efflux contributed 20% (P) and 33% (CT), respectively, to whole body venous efflux. Despite maintained hepatic arterial blood flow, hepatic oxygen extraction did not increase in CT. Conclusions. Whole body venous lactate efflux is of similar magnitude in hyperdynamic sepsis and in cardiogenic shock. Although jejunal mucosal pCO2 gradients are increased, enhanced lactate production from other tissues is more relevant to the increased arterial lactate. Nevertheless, the liver fails to increase hepatic lactate extraction in response to rising hepatic lactate influx, despite maintained hepatic oxygen consumption. In cardiac tamponade, regional, extrasplanchnic lactate production is accompanied by hepatic failure to increase oxygen extraction and net hepatic lactate output, despite maintained hepatic arterial perfusion.

Contrast-enhanced ultrasound in the splenic artery steal syndrome of liver transplantation

Objective To investigate the utilization of contrast-enhanced ultrasound (CEUS) for the detection of splenic artery steal syndrome (SASS) after orthotropic liver transplantation (OLT).Methods Color Doppler flow imaging (CDFI) were performed at various time points post-operatively.CEUS and celiac angiography were conducted in patients suspected of SASS.Results 9 patients were suspected of SASS by slim or undetectable hepatic arterial Doppler blood signals by CDFI at various time points postoperatively.CEUS in 9 patients showed a delayed and weak contrast-enhanced blood signal in the hepatic artery associated with a rapid and intense enhancement of portal venous blood.No narrowing of a hyperintense signal was observed in the hepatic artery by CEUS.The 9 diagnoses of SASS were proven by celiac angiography.Conclusions SASS is identified as a sluggish and weak hyperintense blood signal in the hepatic artery without the narrowing and interruption of hypeintense signal in CEUS.CEUS is an effective imaging modality for detection of SASS following OLT. Key words: Ultrasonography; Microbubbles; Liver transplantation; Splenic artery steal syndrome

Selective occlusion of the portal vein while maintaining hepatic artery blood flow during partial hepatectomy: a new method for preventing ischemia-reperfusion injury?

DOI of original article: 10.1016/j.jss.2012.0 * Corresponding author. Department of Obst Tel.: þþ49-89-5160-4111; fax: þþ49-89-5160E-mail address: ioannis.mylonas@med.un 0022-4804/$ e see front matter a 2013 Elsev http://dx.doi.org/10.1016/j.jss.2012.09.010 The liver is an essential multifunctional organ with diverse Severalmethods have been developed to control blood flow vital functions in nutrient metabolism, blood and bile formation, detoxification, and hormone production. Liver function can be impaired by drug and alcohol abuse, food and environmental toxins, metabolic disorders, viral infections, and congenital defects. Primary liver cancer and liver metastases, primarily from colorectal cancer, can also cause life-threatening damage to the liver [1]. Depending on comorbidities, tumor size, and the segmental distribution of tumors in the liver, the techniques of ablation, resection, or liver transplantation remain the most important and successful treatment modalities for primary and secondary liver cancer [2,3]. Because the liver is a highly vascularized and blood-rich organ, bleeding from the liver is one of the most feared complications of liver surgery. Indeed, intraoperative bleeding and the need for perioperative blood transfusion are negative predictors of mortality and longterm outcomes [4e6]. Bleeding from the liver may also cause the surgeon to convert from laparoscopic liver surgery to laparotomy [7].

Influence of bypass angles on extracardiac Fontan connections: a numerical study

The extracardiac Fontan connection (EFC) is an effective treatment for congenital single ventricle heart defects. Numerous studies have sought to optimize the EFC design. However, the optimal design of EFC remains uncertain. This study aims to examine the influence of bypass angles between the inferior vena cava (IVC) and right pulmonary artery (RPA), and the angles between the IVC and superior vena cava (SVC), on hemodynamics. Furthermore, this study demonstrates a methodology for cardiovascular surgical planning. First, a three-dimensional anatomical geometry was reconstructed from the medical images of a patient with single ventricle heart defects. Second, based on haptic deformations, six computational models were virtually generated. Third, numerical simulations were conducted using computational fluid dynamics through the finite volume method. Finally, hemodynamic parameters were obtained and evaluated. The hemodynamic parameters, including the flow patterns, streamlines, and swirling flow, were obtained. Meanwhile, the energy loss and flow distributions of vena cava blood were calculated. First, the hepatic artery blood distribution to two lungs and the flow ratio of the left pulmonary artery to RPA are sensitive to the angle between the IVC and RPA and not to that between the IVC and SVC. Second, energy dissipation is mainly sensitive to the angle between the IVC and SVC and not to that between the IVC and RPA. Third, an appropriate increase in the angle between the IVC and RPA or that between the IVC and SVC may lead to optimal options. This study is useful for surgeons in evaluating optimal Fontan options.

PD-0020 Pharmacokinetic Analysis of Percutaneous Hepatic Perfusion (PHP) of Melphalan in Patients with Hepatic Metastases from Melanoma

ABSTRACT Introduction PHP (Delcath Systems Inc., New York, NY) is a non-invasive regional therapy that isolates the liver using a series of catheters, allowing infusion of high doses of chemotherapy directly into the hepatic artery. Systemic toxicity is minimized by extracorporeal hemofiltration of effluent hepatic venous blood, which is then returned to the systemic circulation. A randomized phase III study was conducted to compare PHP of high-dose melphalan with best alternative care in patients with ocular or cutaneous melanoma metastatic to the liver. A pharmacokinetic analysis, including an evaluation of filter extraction efficiency, was performed in a subset of patients from this study. Methods Melphalan was perfused into the liver over 30 minutes via PHP at a maximum dose of 3.0 mg/kg of ideal body weight (maximum 220 mg/treatment). Extracorporeal hemofiltration was performed during and for 30 minutes after melphalan infusion. PHP was performed with patients under general anesthesia. Blood samples (7 mL) were collected during the first cycle of PHP melphalan simultaneously from the periphery (arterial line) and extracorporeal circuit (both pre- and post-filter). Sample collections were made at: baseline (peripheral only); 15 minutes after the start of the infusion; immediately post-infusion; 5, 10, 15, and 30 minutes post-infusion. Plasma concentrations of melphalan were determined by high-pressure liquid chromatography with ultraviolet detection. Data were analyzed using a non-compartmental approach with WinNonlin v5.2 (Pharsight Corporation, Mountain View, CA). Concentration-time profiles were constructed for each sampling location (i.e. three profiles/patient). Pharmacokinetic parameters were: maximum plasma concentration (Cmax); area under the concentration-time curve from time zero to final sample (AUClast) calculated using the linear trapezoidal method; and filter efficiency [defined as: (pre-filter AUClast) minus (post-filter AUClast) divided by (pre-filter AUClast)]. Download : Download full-size image Figure . Individual AUC by site, alter 3 0 mg/Kg (ideal body weight) melphalan Horizontal bars represent mean and 95% Cls Results Plasma samples were available from 48 patients, of which 40 were evaluable. Mean absolute melphalan dose was 191 mg (range, 137–220 mg) and duration of perfusion was 30 minutes (range, 16–52 minutes). Mean prefilter, postfilter and systemic Cmax values were 8726 ng/mL, 2330 ng/mL and 1429 ng/mL, respectively. Mean prefilter AUClast was 264,652 min*ng/mL, mean postfilter AUClast was 74,146 min*ng/mL and mean systemic AUClast was 50,777 min*ng/mL; individual patient data for AUClast are shown in the Figure. Mean filter extraction efficiency was 71.2% ± 10.4%. Filter efficiency did not change significantly with absolute melphalan dose (p = 0.86, Spearman) or theoretical rate of perfusion (p = 0.064, Spearman). Conclusion The mean filter extraction efficiency of the PHP filtration system is 71%, and results appear to be consistent across patients (narrow 95% CI intervals). These findings indicate that the filter removes most of the melphalan administered via PHP.

OC-097 The novel gastrin/CCK2 receptor antagonist YF476 induces clinical responses and is well tolerated in patients with type I gastric neuroendocrine tumours

IntroductionAutoimmune chronic atrophic gastritis causes loss of gastric parietal cells and results in achlorhydria, increased antral gastrin production and hypergastrinaemia. In some patients this hypergastrinaemia induces hyperplasia of enterochromaffin-like (ECL)...

Percutaneous hepatic perfusion (PHP or ChemoSat) with melphalan versus best alternative care (BAC) in patients (pts) with hepatic metastases from melanoma: A post hoc analysis of PHP-randomized versus BAC-to-PHP crossover versus BAC-only pts.

8570 Background: PHP (Chemosat, Delcath Systems Inc, New York, NY) allows repeated delivery of high dose chemotherapy to the liver while limiting unwanted systemic exposure by extracorporeal filtration of hepatic venous blood. A prospective randomized multicenter study compared melphalan PHP versus BAC in pts with unresectable hepatic metastases from ocular or cutaneous melanoma and showed a highly significant advantage for PHP in terms of the primary endpoint, hepatic PFS, and multiple secondary endpoints. We present an exploratory post-hoc analysis of pts assigned to BAC who crossed over to PHP after disease progression (BAC-to-PHP crossover) versus those who did not (BAC-only) versus PHP-randomized pts. Methods: 93 pts were randomized to PHP (n=44) or BAC (n=49). In the BAC group, crossover to PHP with melphalan was permitted after hepatic disease progression. Up to 6 PHP treatments with melphalan 3.0 mg/kg ideal body weight were given every 4–8 weeks. Results: In the BAC group, 28 of 49 pts crossed over to PHP. Updated efficacy findings (investigator) as of 31 March 2011 are shown in the table. Independent Review Committee results were similar to investigator-assessed efficacy. Safety in BAC-to-PHP crossover pts was similar to that seen in PHP-randomized pts. The most common toxicities in BAC-to-PHP crossover pts were hematological: peri-procedural thrombocytopenia (71%) and anemia (57%), and melphalan-related neutropenia (82%) and thrombocytopenia (79%). Conclusions: Efficacy of melphalan PHP in BAC-to-PHP crossover pts was consistent with that seen in PHP-randomized pts with hepatic metastases from melanoma. Crossover from BAC to PHP after hepatic disease progression led to a median 11-month survival advantage vs BAC alone. [Table: see text]

Post hoc analysis of relationship between baseline white blood cell count and renal and hepatic function and response in a randomized phase III trial of decitabine in patients age 65 or older with acute myeloid leukemia.

6632 Background: A phase III trial (NCT00260832) in patients (N=485) ≥65y with newly diagnosed acute myeloid leukemia (AML) was conducted (Kantarjian, JCO; in press). Every 4 wk, patients received decitabine (DAC) 20 mg/m2 (1-h intravenous infusion, 5 successive days) or treatment choice (TC) with either supportive care or cytarabine (20 mg/m2 subcutaneous injection daily, 10 successive days). This post hoc analysis examined whether baseline (BL) renal and hepatic function and white blood cell (WBC) counts were associated with response to DAC or TC. Methods: For patients with available data, BL WBC count and markers of renal function (blood urea nitrogen [BUN], creatinine) and liver function (ALT, AST, albumin) were tabulated for patients with/without a response to DAC or TC. Response was defined as morphologic complete remission (CR), CR with incomplete blood count recovery (CRi), or partial remission (PR). Results: Nonresponders had a higher mean BL creatinine vs responders (86.78 vs 80.23 mmol/L, respectively; P=.005); with no differences in BL BUN levels. There were no other between-group differences. Conclusions: This analysis suggests that there is no relationship between BL WBC or hepatic function and response to treatment with DAC or TC. Although there was no difference in BL BUN, higher mean creatinine levels in nonresponders may suggest a prognostic relationship but further studies are needed to clarify. [Table: see text]

Liver functional magnetic resonance imaging analysis using a latent variables approach

The liver is a highly vascular organ with a dual blood supply, and it performs a remarkable number of vital functions. Here, we show, through measurement of blood oxygen level-dependent (BOLD) signal, that liver arterial and hepatic portal blood supplies can be modulated through hyperoxia exposure and by consumption of a standardized meal, respectively. As such, we suggest that hyperoxia modulates the hepatic arterial BOLD signal, whereas a controlled meal changes predominantly the hepatic portal BOLD signal. The hemodynamics of the dual liver blood supplies in response to the aforementioned challenges are complex and variable across subjects, making a general linear model-based analysis difficult. Therefore, we present the application of two local (at each voxel) hemodynamic response-independent techniques—principal component analysis and partial least squares—to observe the hypothesized reduction in BOLD contrast during cycles of hyperoxic breathing, when comparing preprandial versus postprandial states in a normally functioning liver. We illustrate the ability of our techniques to differentiate between healthy and diseased livers with an analysis of 17 subjects—11 with normal livers and 6 with liver disease (hepatitis or cirrhosis). Our local analysis can correctly classify all of the subjects. Copyright © 2012 John Wiley & Sons, Ltd.

Abstract 3558: A pilot clinical study of limonene in women with early stage breast cancer: Effects of short-term treatment on tissue limonene disposition and serum markers

Abstract Background: Limonene is a highly lipophilic monoterpene found in citrus peel oil that has demonstrated anticancer properties in preclinical studies. The purpose of this study was to evaluate whether limonene and its primary metabolite perillic acid (PA) would distribute extensively to the breast tissue and reach an effective drug concentration. Secondary endpoints included evaluation of changes in cancer-related biomarkers in plasma and tissue. Methods: Participants (N = 40) with newly diagnosed stage 0 - 2 breast cancer took 2 grams daily of oral limonene for 2 - 6 weeks (21.5 ± 8.8 days) prior to planned surgical tumor resection. Blood was drawn pre/post intervention for measurement of serum concentration of limonene, PA, and protein biomarkers, as well as to assess toxicity profiles. A small piece of breast tissue adjacent to the tumor mass was also collected for analysis of limonene and PA levels. Limonene and PA levels in tissue and serum were analyzed using specific chromatography-based assays. Results: Limonene was found to preferentially concentrate in breast tissue (332.3 + 336.1 uM) versus plasma (0.49 + 0.67 uM) with tissue-to-plasma concentration ratio (TPCR) of 1,667 + 312.5 (P&amp;lt;0.001). PA did not concentrate in breast tissue (5.73 + 10.28 uM) versus plasma (3.89 + 6.81 uM) with TPCR of 1.4 + 0.56. Post-intervention serum levels of leptin, adiponectin, TGF-beta1, IGFBP-3 and IL-6 were unchanged from baseline. There was a small but statistically significant post-intervention increase in IGF-1, however the change was no longer significant after adjustment for number of days on agent. Possibly or probably related adverse events were primarily GI-related and were not dose-limiting. No clinically significant changes in complete blood count, renal, hepatic or other blood chemistry studies were noted. Analysis of the intervention effects on tissue biomarkers of proliferation, apoptosis, and cell cycle regulation is ongoing. Discussion: Oral limonene preferentially concentrates in the breast tissue and has a favorable side effect profile. PA does not readily concentrate in breast tissue when administered as oral limonene. Short-term limonene intervention resulted in minimal changes in systemic biomarkers. Further clinical trials with a longer intervention are necessary to establish limonene's potential role as a chemopreventive agent in breast cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3558. doi:1538-7445.AM2012-3558

1008 SUSTAINED VIROLOGIC RESPONSE TO INTERFERON PREVENTS THE LETHAL CONSEQUENCE OF CLINICAL DECOMPENSATION IN PATIENTS WHO DEVELOP A HEPATOCELLULAR CARCINOMA POST ANTIVIRAL-TREATMENT

reduction in tumor perfusion, but with still arterialised tumor areas was classified as partial response (PR) whereas no change in tumor perfusion after TACE was considered nonresponder (NR). Follow-up CT/MRT/angiography (mean, 3 months) represented the goldstandard. Additionally, the quality of both techniques with respect to quantification of tumor perfusion was assessed using approved software programs. Results: 19 out of 25 HCC-patients could be evaluated with both techniques. In 6 patients, one of the imaging modalities (VPCT ×2, CEUS ×4) failed to detect the malignant lesions. With respect to therapy response evaluation, results of both methods differed only in 1 case where VPCT proved correct and CEUS was false-negative. Differences in the detection of residual tumor vitality after TACE were not significant. Quantification of tumor perfusion was possible in 7 patients using CEUS and in all 19 patients by means of VPCT. Conclusions: Both CEUS and VPCT allow for reliable evaluation of TACE-results. For detection and especially, perfusion measurements and thus tumor characterisation, VPCT proved superior to CEUS. The latter, enables furthermore quantification of hepatic arterial blood flow and volume both in the tumor and the cirrhotic liver parenchyma which makes it more confident for detection of even low vascularized HCC and differentiation from nodular liver parenchymal regeneration. Moreover, VPCT accurately quantifies TACE-related transitory or persistent liver parenchymal perfusion damage.

Effect of time duration of ruminal urea infusions on ruminal ammonia concentrations and portal-drained visceral extraction of arterial urea-N in lactating Holstein cows

The effects of a 6 versus 24h ruminal urea infusion in lactating dairy cows fed a basal diet deficient in N on ruminal ammonia concentration, arterial urea-N concentration, net portal-drained viscera (PDV) urea-N flux, arterial urea-N extraction across the PDV, and renal urea-N kinetics were investigated. Three Danish Holstein cows fitted with ruminal cannulas and permanent indwelling catheters in major splanchnic blood vessels were randomly allocated to a 3 × 3 Latin square design with 21-d periods. Treatments were ventral ruminal infusion of water for 24h (water INF), 24-h infusion of 15g of urea/kg of dry matter intake (DMI; 24-h INF), and 6-h infusion of 15g of urea/kg of DMI (6-h INF). The 6-h INF was initiated 0.5h after the afternoon feeding, and ran until 2230h. Eight sample sets of arterial, portal, and hepatic blood, ruminal fluid, and urine were obtained at 0.5h before the morning feeding and 0.5, 1.5, 2.5, 3.5, 4.5, 5.5, and 6.5h after feeding (i.e., 9 to 15.5h after the 6h infusion was terminated). A substantial decrease in DMI for 6-h INF compared with 24-h INF and water INF was observed, and it has to be recognized that DMI may have confounding effects. However, the experimental setting plan was met (i.e., to cause changes in the daily pattern of ruminal ammonia and blood urea-N concentrations). The arterial urea-N concentration for 24-h INF and 6-h INF were greater than the arterial urea-N concentration with water INF throughout the sampling window. However, the arterial urea-N concentration for 6-h INF decreased steadily with sampling time reflecting a carryover effect from the ruminal urea infusion. The ruminal ammonia concentration and net portal flux of ammonia for 6-h INF were not different from water INF; hence, no carryover effect on ruminal ammonia concentration was observed. The portal flux of urea-N was not affected by treatment (i.e., even the combination of low ruminal ammonia and high arterial urea-N concentration with 6-h INF was not used by the cow to increase the uptake of urea-N across the PDV). Arterial urea-N extraction across the PDV was increased with water INF especially from 0.5 to 3.5h postprandial relative to the urea infusion treatments, reflecting increased epithelial permeability for urea-N. This indicates that daily ruminal peak of ammonia or blood urea-N concentrations overruled potential signals from low ruminal ammonia concentration observed during the sampling window. In conclusion, dairy cows appear unable to increase transport of urea-N from blood to gut in periods with low ruminal ammonia concentrations, even in a situation with infrequent N supply and apparent carryover effects on blood urea-N. It is speculated that mechanisms responsible for downregulation of epithelial urea-N transport based on daily maximum concentrations of ammonia in the rumen or urea-N in the blood suppresses any short-term signal from low ruminal ammonia during periods with low ruminal N supply.

Percutaneous Recanalization of an Occluded Hepatic Vein in a Difficult Subset of Pediatric Budd-Chiari Syndrome

We present a 3-year-old child with Budd Chiari syndrome having idiopathic complete occlusion of all three major hepatic veins and small hepatic venules. Adequate antegrade flow in right hepatic vein was established by transfemoral balloon angioplasty followed by stenting of the same. Long term antiplatelet therapy was instituted. Medium term follow up reveals satisfactory antegrade flow and regression of symptoms. This strategy highlights an effective nonsurgical approach of restoring physiological pattern of hepatic sinusoidal blood flow in Budd Chiari syndrome.