Influence Of Portal Hypertension Research Articles

Influence of portal hypertension on the postoperative outcome after liver resection for hepatocellular carcinoma: a meta-analysis of matched cohorts and prospective studies

Influence of portal hypertension on the postoperative outcome after liver resection for hepatocellular carcinoma: a meta-analysis of matched cohorts and prospective studies

Influence of portal hypertension on the state of the hemomicrocirculatory level of rat skin: morphological study

The effect of portal hypertension on the condition of the hemomicrocirculatory tract of the skin male white nonlinear rats was studied. Hypertension was simulated by applying a ligature to the portal vein according to the conventional method. After 30, 60 and 90 days, skin biopsies were taken from the anterior abdominal wall for optical microscopy examination, which was subjected to routine histological processing. In animals of the control group, which underwent sham surgery, the skin remained unchanged. In rats of the experimental group after 30 days in the basal layer of the epidermis there were cells with signs of degenerative changes. The basement membrane of the epidermis had small areas with thinning and thickening, which in both cases were accompanied by the formation of small and massive leukocyte infiltrates. Its edema was noted, which extended to the papillary and reticular layer of the dermis. Elastic fibers were unchanged. Only 50% of the microvessels looked intact, 20% microvessels were narrowed, and 30% had signs of stagnant hyperemia due to dilatation. After 60 days the epidermis was thinned, in the basal layer the cells with picnotized and displaced to the periphery nucleus were detected. In all studied layers of epidermis, besides reticular layer, expansion of arterioles, venules and capillary loops was observed. After 90 days the epidermis was represented by 3-6 layers of cells, its general refinement was observed due to the reduction of the thickness of the spinous and granular layers with simultaneous thickening of the horny layer. In the papillary layer of the dermis, the number of thin-walled blood vessels was increased. The average diameter of the arterioles of the hypodermis decreased relative to the values on the 60th day. The mean diameter of the arterioles of the subdermal network on the border of the papillary and reticular layers and capillary loops under the basal membrane was reduced what can be a sign of sclerotic changes in the microvessels. The venules diameter remained increased. In arterioles and venules, stasis of the microvessels, edema of their walls, microaneurysm, and venous sacculation were detected. Thus, we believe that the changes in the microvessels of the skin, which are observed in portal hypertension, are the result of hemodynamic disturbances in the tissue, which is a complex chain of hemomicrocirculatory flow to the direct action of hypertension in the portal vein and is a secondary response to systemic vascular damage.

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Early HVPG measurement and TIPS for acute variceal hemorrhage: Is sooner really better?

Early HVPG measurement and TIPS for acute variceal hemorrhage: Is sooner really better?

The ???small for size??? liver syndrome

Small-for-size syndrome (SFSS) is a clinical syndrome described following liver transplantation (LT) and extended hepatectomy. New evidence has emerged documenting the importance of preoperative evaluation of functional liver mass, liver quality, influence of portal hypertension, and variations in surgical technique to improve outcome. SFSS is characterized by postoperative coagulopathy and liver dysfunction due to insufficient functional liver mass. Recent radiologic advances allow accurate preoperative estimation of total, graft, and remnant liver volume (RLV). In adult-to-adult living donor liver transplantation (LDLT), a graft-to-recipient body weight ratio > or = 0.8% or graft weight ratio > or = 30% are important to avoid SFSS. Minimal functional RLV following extended hepatectomy is > or = 25% in a normal liver, and > or = 40% with preoperative liver dysfunction. Preoperative portal vein or hepatic artery embolization to increase RLV and function after extended hepatectomy, and the increasing use of parenchymal-sparing segmental resections have improved outcome. In LT, the evolving use of split livers, LDLT and marginal grafts has resulted in increased recognition of SFSS. This has led to a renewed interest in defining the pathophysiology, and the development of new surgical techniques to reduce its incidence. Current radiologic imaging techniques can be used to evaluate liver volume and the risk of SFSS following LT and extended hepatectomy. Intraoperative techniques to predict postoperative dysfunction are emerging, and may be helpful in directing the use of pre-emptive surgical interventions. The future lies in the development of perioperative liver protection and support in predicted SFSS, and enhancement of healthy liver regeneration.

Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding

Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding

Spontaneous bacterial peritonitis in the Czech Republic

The objective of the study was to assess the prevalence and more detailed data pertaining to the incidence of spontaneous bacterial peritonitis (SBP) in the Czech Republic. The authors examined 99 patients with cirrhosis of the liver and ascites. SBP was diagnosed in a high percentage--35 patients, i.e. 35.4%. It was found more frequently in patients with an alcoholic etiology of cirrhosis who had a history of subfebrile and febrile temperatures and increasing trend of ascites. For the diagnosis the increase of leucocytes in serum and C reactive protein levels may prove useful. Lower values of total protein and albumin in ascites predispose to the development of this infection. Reduction of the number of thrombocytes in the group of patients with SBP indicates the influence of portal hypertension in the etiology of this disease.

Spontaneous bacterial peritonitis in the Czech Republic: prevalence and aetiology.

The aim of the study was to determine the prevalence and detailed data concerning the incidence of spontaneous bacterial peritonitis in the Czech Republic. Ninety-nine patients with liver cirrhosis and ascites were examined. Spontaneous bacterial peritonitis was diagnosed in 35 patients (35.4%). It was revealed more often in patients with alcoholic aetiology of cirrhosis whose anamnesis involved sub-febrile or febrile states and the deterioration of ascites. Elevated serum leucocyte counts and increased levels of C-reactive protein can contribute to the diagnosis. A low level of total protein and albumin in ascites predisposes to the increase of this infection. The reduction of the platelet count in a set of patients with spontaneous bacterial peritonitis indicates the influence of portal hypertension in the aetiology of the disease.

Influence of portal hypertension on secretion of gastric mucus in rats.

To assess the effect of portal hypertension on gastric adherent and soluble mucus in rats. Experimental study. Teaching hospital, Taiwan. 30 male Wistar rats. Portal hypertension was induced experimentally by partial ligation of the portal vein in 20 male Wistar rats: ten rats were examined after 4 weeks and the remaining 10 after 8. Another group of 10 rats (controls) had sham operations. Portal pressure, the severity of gross gastric mucosal lesions, and measurement of gastric adherent and soluble mucus. The portal pressure and the gross mucosal damage differed significantly between the experimental and the control groups (p < 0.01). There was significantly less gastric adherent mucus in the two experimental groups than in the control group (p = 0.002 and <0.001, respectively), whereas there was no significant differences in the amount of gastric soluble mucus (p = 0.5 and 0.1, respectively). The reduction in the gastric adherent mucus was closely related to the increase in portal pressure (p < 0.001) and the severity of portal hypertension-induced gastropathy (p < 0.001). Gastric adherent mucus may have an important role in the pathogenesis of portal hypertensive gastropathy, and its protective capacity is reduced by portal hypertension, as indicated by the decrease in gastric adherent mucus.

Effect of portal vein ligation and silymarin treatment on aspirin metabolism and disposition in rats.

The influence of portal hypertension on the metabolism and pharmacokinetics of aspirin was evaluated after the administration of a single oral dose of acetylsalicylic acid (20 mgkg(-1)) in portal-vein-ligated (PVL) rats. Experiments were also performed in control (sham-operated rats) and in rats that received an oral daily dose (150 mgkg(-1)) of silymarin from the tenth day after surgery for 7 d. Plasma concentration profiles of all groups exhibited monoexponential decay but with important changes in pharmacokinetic parameters. The aspirin elimination constant (k) for PVL rats was lower than for control rats, whereas the plasma half-life and area under the curve were greater than those in the control group. However, Cmax was comparable with that of the control rats. Urinary excretion of the metabolites (salicylic acid and glucuronides) was significantly altered in PVL rats: the urinary glucuronides were reduced and urinary salicylic acid was increased. The activities of plasma and liver esterases were increased significantly in PVL rats, while the activity of p-nitroanisole-O-demethylase was not affected. Depletion of cytochrome P 450 was also noted in the same group of rats. Silymarin markedly reversed the alterations found in the PVL group.