Left Lateral Lobe Of Liver Research Articles

Assessment of liver ischemia reperfusion injury in mice using hepatic T2 mapping: Comparison with histopathology.

Liver ischemia reperfusion injury (IRI) occurs during liver surgery or transplantation resulting in an inflammatory response, tissue damage, and functional impairment of the organ. To assess the feasibility of T2 mapping for noninvasive quantification of liver edema after partial liver IRI in mice. Prospective, experimental study. Partial liver IRI was induced in C57BL/6-mice by transient clamping of the left lateral and median liver lobes for 35 (n = 8), 45 (n = 6), 60 (n = 17), or 90 minutes (n = 5). For comparison, healthy C57BL/6-mice were examined as controls (n = 9). Functional liver MRI was performed on a 7T scanner using a respiratory-triggered multiecho spin-echo sequence. Healthy control mice and mice with partial liver IRI on day 1 after surgery, and additionally on day 7 in a subgroup with 60 minutes IRI (n = 8) were examined. Maps of T2 relaxation time of liver tissue were used to assess distribution, severity of tissue edema (mean T2 time), and the percentage of edematous liver tissue. One-way analysis of variance (ANOVA) with Tukey's honest significant difference (HSD), paired t-tests, Pearson's test for correlation of MRI parameters with levels of liver enzymes, and histopathology, receiver operating characteristic (ROC) analysis. Significant tissue edema induced by liver IRI as compared to the control group was detected by increased mean T2 times in groups with 60 minutes (P < 0.001) and 90 minutes IRI (P < 0.001). The percentage of edematous liver tissue significantly increased with longer ischemia times (controls 3.4 ± 0.4%, 35 minutes 5.3 ± 0.6%, 45 minutes 23.3 ± 7.6%, 60 minutes 39.7 ± 3.6%, 90 minutes 51.3 ± 4.5%). Mean T2 times and the percentage of edematous liver tissue significantly correlated with elevation of liver enzymes (P < 0.001), histological evidence of liver injury (r = 0.80 and r = 0.82, P < 0.001), and neutrophil infiltration (r = 0.70 and r = 0.74, P < 0.001). In the subgroup with follow-up, the severity (P < 0.01) and extent of liver edema decreased significantly over time (P < 0.01). T2 mapping allows quantification and follow-up of liver injury in mice. 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1586-1594.

Remote Ischemic Preconditioning Is Efficient in Reducing Hepatic Ischemia-Reperfusion Injury in a Growing Rat Model and Does Not Promote Histologic Lesions in Distant Organs

ObjectiveIschemic preconditioning (IPC) was developed to diminish ischemia-reperfusion injury (IRI). There are two main ways of performing it: direct ischemic-preconditioning (DIP) and remote ischemic-preconditioning (RIP). The objectives of this study were to investigate local and systemic effects of DIP and RIP in liver IRI. MethodsThirty-two weaning rats (50–70 g body weight; 21 days old) were divided into 4 groups: control (C); ischemia followed by reperfusion (IR); DIP followed by ischemia and reperfusion; and RIP followed by ischemia and reperfusion. In the IR group, the vascular pedicles of medial and left lateral liver lobes were clamped for 60 minutes and then unclamped. In the DIP group, a 10-minute cycle of ischemia followed by a 10-minute reperfusion of the same lobes was performed before 60 minutes of ischemia. In the RIP group, three 5-minute cycles of clamping and unclamping of the femoral vessels were performed before liver ischemia. The animals were euthanized 24 hours after the surgical procedures. ResultsThe serum levels of liver enzymes were significantly lower in the RIP group compared to the control and IR groups and to the DIP group. The scores of histologic hepatic lesions were significantly lower in RIP animals than those of IR animals (P = .002) and similar to the C group animals. The Bax/BCl-xl relation was lower in the DIP group than that in the RIP group (P = .045) and no differences were observed in histologic analyses of kidney, lung, intestine, and heart. ConclusionIn young animals, the beneficial effects of RIP are more evident than those of DIP.

Arantius Ligament Suspension: A Novel Technique for Retraction of the Left Lateral Lobe Liver During Laparoscopic Isolated Caudate Lobectomy.

Laparoscopic isolated caudate lobectomy remains a challenging procedure because of its deep location and proximity to the important vessels. We present a novel technique, Arantius ligament suspension, which could improve operative field exposure in laparoscopic isolated caudate lobectomy through retraction of the left lateral lobe liver. The Arantius ligament suspension technique was performed in 6 selected patients during laparoscopic isolated caudate lobectomy in our center: 2 with symptomatic hepatic cavernous hemangioma and 4 with hepatocellular carcinoma (HCC). The Arantius ligament suspension technique was performed using a 2-0 polypropylene suture (Prolen2-0®; Ethicon, Somerville, NJ), which was secured to the Arantius ligament with surgical clips at its halfway point and the left lateral lobe of liver would be retracted toward the abdominal wall when the suture was tightened. Perioperative data of these patients and follow-up data of HCC patients were retrospectively reviewed. All 6 procedures were completed without conversion to open surgery or requiring additional ports. The mean tumor size was 5.4 cm (2.2-7.8 cm), the mean blood loss was 260 mL (50-440 mL), and no patients required blood transfusion during the operation. The mean time required for this technique was 2 minutes 5 seconds (1 minutes 36 seconds-2 minutes 44 seconds) and the mean duration of entire surgery was 249 minutes (173-300 minutes). The mean postoperative hospital stay was 7 days (5-9 days) and no postoperative complication related to the suspension procedure occurred. Our outcomes demonstrated the Arantius ligament suspension technique is a feasible and ideal method during laparoscopic isolated caudate lobectomy for providing a rapid and safe left lateral lobe retraction.

Platelets are key in cold physical plasma-facilitated blood coagulation in mice

PurposeSurgical interventions inevitably lead to destruction of blood vessels. This is especially dangerous in anticoagulated patients. Electrocauterization is a frequently used technique to seal incised tissue. However, leading to a superficial layer of necrotic tissue, the treated area evolves a high vulnerability to contact, making it prone to detachment. As a result, dangerous postoperative bleeding may occur. Cold physical plasma was previously suggested as a pro-coagulant treatment method. It mainly acts by expelling a delicate mixture of oxidants. We therefore tested the suitability of an atmospheric pressure plasma jet (kINPen MED) as a new medical device for sufficient blood coagulation in a murine model of liver incision. MethodsPlasma treatment of murine blood ex vivo induced sufficient coagula. This effect did not affect any tested parameter of plasmatic coagulation cascade, suggesting the mechanism to be related to cellular coagulation. Indeed, isolated platelets were significantly activated following exposure to plasma, although this effect was less pronounced in whole blood. To analyze the biological effect of plasma-on blood coagulation in vivo, mice were anticoagulated (clopidogrel inhibiting cellular and rivaroxaban inhibiting plasmatic hemostasis) or received vehicle only. Afterwards, a partial resection of the left lateral liver lobe was performed. The quantification of the blood loss after liver incision followed by treatment with kINPen MED plasma or electrocauterization revealed a similar and significant hemostatic performance in native and rivaroxaban but not clopidogrel-treated animals compared to argon gas-treated controls. In contrast to electrocauterization, kINPen MED plasma treatment did not cause necrotic cell layers. ConclusionOur results propose a prime importance of platelets in cold physical plasma-mediated hemostasis and suggest a clinical benefit of kINPen MED plasma treatment as coagulation device in liver surgery.

Mesenchymal hamartoma of the liver extending through a localized chest wall defect

Abstract Mesenchymal hamartoma of the liver (MHL), a common benign hepatic tumor in children, is not commonly associated with other congenital malformations. We describe a novel case of MHL extending through a localized chest wall defect. A 15-day-old Han female presented with a red, staghorn-shaped skin mass overlying the left chest wall. Ultrasound, CT and MRI showed masses in the left chest wall and liver that appeared connected. Laparoscopy identified a mass on the left lateral liver lobe that extended through an intercostal space to connect with the mass outside the left chest wall. The masses were surgically resected. Pathology indicated MHL with a localized chest wall defect. There were no complications or recurrence.

Oral administration of cilostazol improves survival rate after rat liver ischemia/reperfusion injury

BackgroundCilostazol is a type III phosphodiesterase inhibitor used to treat the symptoms of intermittent claudication. Recent studies have shown that cilostazol decreases ischemia/reperfusion (I/R) injury in several organs. Materials and methodsWe evaluated the effects of cilostazol in a rat model of liver I/R injury. Thirty male Wistar rats with liver I/R injury were divided into a cilostazol or saline (control) group (n = 15 each). Each rat was orally administered cilostazol or saline for 3 d before I/R injury. Liver I/R injury was induced via 1 h of warm ischemia of the median and left lateral liver lobes, followed by 3 h of reperfusion. The rats were then euthanized. Serum aspartate aminotransferase, alanine aminotransferase, interleukin (IL)-1β, IL-6, and tumor necrosis factor-α levels were measured. The Mann–Whitney U test was used to compare the differences between the treatment groups. Histologic examination was performed on the liver tissues. We also conducted a survival study to confirm the effect of cilostazol on the mortality rate in rats. For the survival study, a liver I/R injury model with an ischemia time of 1.5 h was used, and the rats were observed for 1 wk. ResultsSerum aspartate aminotransferase, alanine aminotransferase, IL-1β, and IL-6 levels were significantly lower in the cilostazol group than in the saline group. Treatment with cilostazol significantly improved pathological findings associated with liver I/R injury and increased survival rate compared to that in controls. ConclusionsCilostazol reduced mortality and alleviated the effects of liver I/R injury in Wistar rats.

Hepatic parenchymal transection increases liver volume but not function after portal vein embolization in rabbits

Associating liver partition with portal vein ligation for staged hepatectomy induces more extensive liver hypertrophy than ligation alone; however, the mechanisms underlying the accelerated liver regrowth and the functional quality of the hypertrophic liver are presently elusive. This study, therefore, investigated the effect of parenchymal transection on liver volume and function after portal vein embolization in a standardized rabbit model. Twelve rabbits were subjected to portal vein embolization of the cranial liver lobes and randomized between parenchymal transection of the left lateral liver lobe versus no transection (portal vein embolization only). Liver volume of the nonembolized liver lobe was assessed using computed tomography-volumetry, and liver uptake function was determined by 99mTc-mebrofenin hepatobiliary scintigraphy before and 3 and 7days after portal vein embolization. The increase in nonembolized liver volume 3days after portal vein embolization was 2.7-fold greater in the transected group compared with the portal vein embolization only group (56 ±16% vs 21 ±12%, respectively, P<.01) and 1.7-fold greater 7days after portal vein embolization (113 ±34% vs 68 ±24%, P<.01). Liver uptake function did not differ between groups before portal vein embolization (8.4 ±3.7%/min in the transection group vs 8.9 ±1.6%/min) on day 3 (33.2 ±4.7% after transection vs 30.3 ±4.6%/min, respectively) and day 7 after portal vein embolization (42.6 ±8.4% vs 39.1 ±5.3%/min, respectively). Parenchymal transection after portal vein embolization increases liver growth in terms of volume but not function. These results indicate that the rapid volume increase observed after associating liver partition with portal vein ligation for staged hepatectomy does not coincide with the clinically more relevant functional increase. Quantitative liver function tests might be essential in associating liver partition with portal vein ligation for staged hepatectomy to better assess the hypertrophy response and improve clinical decision-making.

Neutrophil Extracelluar Traps Contributes to the Hypercoagulable State and Liver Damage in Liver Cirrhosis

Background: We recently reported that phosphatidylserine on blood and endothelial cells played an important role in the hypercoagulable state of liver cirrhosis (Wu et al, Liver Int 2016). Recent studies showed that enoxaparin could reduce the incidence of portal vein thrombosis and alleviate liver decompensation. Thus, we speculate that there may be other mechanisms involved in the hypercoagulability of cirrhosis. Neutrophil extracelluar traps (NETs) play an important role in thrombosis and organ dysfunction. Whether the benefit of enoxaparin is due to inhibiting NETs in cirrhotic patients remains unknown. Our objectives were to study the formation of NETs and their role in the hypercoagulable state and liver damage in cirrhotic patients.Methods:Cirrhotic patients (n = 36), healthy controls (n = 10), and mice treated with CCl4 (n = 50) were studied. Immunofluorescence confocal microscope was used to analyze and quantify NETs formation in neutrophil cells from human and mice. TAT and fibrin formation assays in normal and cirrhotic plasma were performed to analyze the procoagulant activity of NETs. Calibrated automated thrombography (CAT) was performed with and without 6 nM thrombomodulin I to analyze TM resistance changes induced by NETs. Liver injury was assessed by plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, determined spectrophotometrically, and by morphometric evaluation of left lateral liver lobes. DNase I and activated protein C (APC) were used to abolish NETs.Results: We observed that cirrhotic platelets induced 1.9 fold higher NETs formation in neutrophil cells (p = 0.021). Increased NETs promoted higher TAT (Fig 1A, B) and fibrin formation in normal and cirrhotic plasma (p < 0.05). DNase I abolished the procoagulant activity of NETs in corn trypsin inhibitor (CTI ) or anti-TF pre-treated plasma (p < 0.001) (Fig 1C). TM pre-induced with NETs for 24 h showed a higher endogenous thrombin potential (ETP) than no treatment in normal plasma using CAT (p = 0.032). APC and de-N-sulfated heparin (de-N-Hep), but not DNase I, can decrease the ETP ratio (with/without TM) in cirrhotic plasma (p < 0.05) (Fig 1D). Mice treated with CCl4 showed a higher ALT, AST, necrotic area (Fig 2), and NETs formation than control (p < 0.05). DNase I and enoxaparin decreased ALT, AST, necrotic area (Fig 2) and NETs formation (p < 0.05).Conclusions:Cirrhotic patients have enhanced NETs formation compared to healthy controls. NETs initiated intrinsic and extrinsic coagulation pathway and impaired anticoagulant function of TM. Additionally, NETs partly contributed to tissue injury in the liver of cirrhotic mice. DNase I and enoxaparin can disconnect NETs and decreased the toxin to liver. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Semi-quantitative assessment of the presence and Child–Pugh class of hepatitis B related cirrhosis by using liver lobe-based dynamic contrast-enhanced MRI

To determine whether liver lobe-based DCE-MRI can be used to detect the presence and Child-Pugh class of hepatitis B-related cirrhosis. Fifty-six cirrhotic patients with hepatitis B and 20 healthy participants underwent liver DCE-MRI, and the positive enhancement integral (PEI), time to peak (TTP), maximum slope of increase (MSI) and maximum slope of decrease (MSD) of the left lateral liver lobe (LLL), left medial liver lobe (LML), right liver lobe (RL), and caudate lobe (CL) were measured and analysed statistically to evaluate cirrhosis. TTP values of the LLL, LML, RL and CL were positively correlated with the Child-Pugh class of cirrhosis (r=0.452 to 0.55, all p<0.05). PEI values of the LLL, LML, RL and CL, as well as the MSI of the CL and the MSD of the RL, were inversely correlated with the Child-Pugh class (r=-0.349 to -0.72, all p<0.05). PEI values of the LLL and CL, or TTP values of the RL had the most area under receiver operating characteristic curve (AUC) of 0.99 for identifying the presence of liver cirrhosis. The PEI of the RL had the largest AUC of 0.975 and 0.78 for distinguishing the Child-Pugh class A of cirrhosis from class B-C and class A-B of cirrhosis from class C, respectively. Liver lobe-based DCE-MRI parameters are associated with the presence and Child-Pugh class of hepatitis B-related cirrhosis.

Liver Lobe Torsion in a Domestic Ferret (Mustela putorius furo)

A 6-year-old female domestic ferret presented with a 3-day history of lethargy and anorexia. Clinical examination revealed severe jaundice, painful abdominal palpation, and a mass in the left cranial abdomen. Blood diagnostic tests of the patient revealed a regenerative anemia, severe neutrophilic and monocytic leukoctytosis, increased alanine aminotransferase and total bilirubin, and decreased albumin and glucose concentrations. Liver lobe torsion (LLT) was identified through radiographic and ultrasonographic imaging. Postmortem examination confirmed a left lateral liver lobe torsion, and a generalized hepatic lipidosis. LLT is a rare condition with few reported cases in veterinary medicine. LLT should be considered as a differential disease diagnosis in ferrets presenting with acute abdomen.

The progress of living donor liver transplantation at Cipto Mangunkusumo Hospital Jakarta Indonesia

Liver transplantation nowadays has become the standard choice of practice for pediatric and adult patients with end-stage liver disease. We report our result for living donor liver transplantation (LDLT). Nine LDLT were performed on 6 paediatric and 3 adult cases starting at December 2010 was supported by colleagues from abroad (China, Singapore and Japan). The first adult LDLT was performed at our hospital. The indication of LT in pediatric cases were 4 biliary atresia and 2 autoimmune liver disease while 2 HCC with hepatitis B and one Kasai procedure survivor were the indication in adult. All the Donors were genetically related and there was one biliary leak which was treated by internal stent the rest are healthy and able to resume their routine after 2 weeks. There were no operative mortality in the paediatric patients while one adult patient died 32 days post operation due to aspiration induced by bile leaks sepsis. All the pediatric patients and the first adult patient survives until now with a good quality of life. The other one died after one year due to rejection. Prolong ascites and portal hypertension were the most common complications, both of which were successfully managed conservatively. All the pediatric cases received the left lateral liver lobe and the adult donors give their liver segment 5, 6, 7, 8 of with preservation of the middle hepatic vein. The adult graft to recipient ratio was 0.9%–1%. Conclusion: Availability of living donor and the tight schedule made the program progress run slowly.

Clinical application of robot-assisted surgical system in the simultaneous radial resection of colorectal liver metastases

Objective To investigate the application value of robot-assisted surgical system in the simultaneous radical resection of colorectal liver metastases (CRLM). Methods The retrospective cross-sectional study was adopted.Thirty-one patients with CRLM were admitted to the Zhongshan Hospital of Fudan University between May 2013 and June 2015. After the discussion of multidisciplinary team, robot-assisted simultaneous radical resection of CRLM was performed. Of the 31 patients, a typical 59-year-old male patient was diagnosed as with rectal adenocarcinoma by preoperative colonoscopic biopsy and metastatic cancer at left lateral lobe of liver by preoperative MRI.The chemotherapy regimens were prepared according to the postoperative pathological examination. The follow-up of outpatient reexamination was performed till December 2015, including physical examination, serum tumor markers test, abdominal/pelvic enhanced CT, pulmonary CT, hepatic MRI, pelvic MRI and colonoscopy. Results All the 31 patients underwent successful operations, with no severe perioperative complications and death and without conversion to open surgery or laparoscopic surgery. The typical patient underwent robot-assisted left lateral lobectomy of liver+ partial left internal lobectomy of liver+ radical resection of rectal cancer. The lesion at the left internal lobe of liver was detected by intraoperative ultrasonic probe of robot-assisted surgical system with a diameter of 0.5 cm, and CRLM was confirmed by postoperative pathological examination. The operation time was 280 minutes, including robot-assisted surgery time of 210 mintues, assisted incision anastomosis time of 40 mintues and robotic arm assembly time of 30 minutes.Volume of intraoperative blood loss was 100 mL. The postoperative exsufflation, fluid diet intake, abdominal drainage-tube removal and discharge from hospital occurred at postoperative day 2, 3, 6 and 7, respectively, wiht no occurrence of complications. The postoperative pathological examination result showed ulcerative rectal adenocarcinoma with the grade Ⅱ-Ⅲ differentiation and T3NOM1 stage, and 18 mesenteric lymph nodes were detected without cancer metastasis. Three resectable lesions of liver metastasis were confirmed as with CRLM by postoperative pathological examination. The typical patient received adjuvant chemotherapy of mFOLFOX6 regimen once every 2 weeks up to 12 times from 2 weeks postoperativly, with no reccurrence of tumor during the follow-up. Conclusion Robot-assisted surgical system in the simultaneous radical resection of CRLM is safe, effective and feasible, with an advantage of faster postoperative recovery. Key words: Colorectal neoplasms; Liver metastases; Robot-assisted surgical system

Liver lobe-based magnetic resonance diffusion-weighted imaging using multiple b values in patients with hepatitis B-related liver cirrhosis: association with the liver disease severity according to the Child-Pugh class

OBJECTIVE:To determine the associations of liver lobe-based magnetic resonance diffusion-weighted imaging findings using multiple b values with the presence and Child-Pugh class of cirrhosis in patients with hepatitis B.METHODS:Seventy-four cirrhotic patients with hepatitis B and 25 healthy volunteers underwent diffusion-weighted imaging using b values of 0, 500, 800 and 1000 sec/mm2. The apparent diffusion coefficients of individual liver lobes for b(0,500), b(0,800) and b(0,1000) were derived from the signal intensity averaged across images obtained using b values of 0 and 500 sec/mm2, 0 and 800 sec/mm2, or 0 and 1000 sec/mm2, respectively, and were statistically analyzed to evaluate cirrhosis.RESULTS:The apparent diffusion coefficients for b(0,500), b(0,800) and b(0,1000) inversely correlated with the Child-Pugh class in the left lateral liver lobe, the left medial liver lobe, the right liver lobe and the caudate lobe (r=–0.35 to –0.60, all p<0.05), except for the apparent diffusion coefficient for b(0,1000) in the left medial liver lobe (r=–0.17, p>0.05). Among these parameters, the apparent diffusion coefficient for b(0,500) in the left lateral liver lobe best differentiated normal from cirrhotic liver, with an area under the receiver operating characteristic curve of 0.989. The apparent diffusion coefficient for b(0,800) in the right liver lobe best distinguished Child-Pugh class A from B–C and A–B from C, with areas under the receiver operating characteristic curve of 0.732 and 0.747, respectively.CONCLUSION:Liver lobe-based apparent diffusion coefficients for b(0,500) and b(0,800) appear to be associated with the presence and Child-Pugh class of liver cirrhosis.

Living Donor Liver Transplantation With Vena Cava Replacement

ObjectivesThis study sought to evaluate the indications, techniques, and results of inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT). Materials and MethodsWe performed 821 LDLTs and 11 (1.3%) patients required concomitant IVC replacement. We analyzed the indications, replacement materials, and outcomes. ResultsRight, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients, respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients (Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1), involvement with mass in 3 patients (Echinococcus alveolaris 2, hepatoblastoma 1) and iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n = 5, IVC n = 4, iliac vein n = 1) or synthetic graft (n = 1) were used for replacements. In 1 patient, hepatic outflow obstruction developed at 39 days and was treated successfully by interventional radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were patent after a mean 7.7 months of follow-up (range 1 to 17 months). ConclusionsAlthough rare, IVC replacement can be necessary at LDLT. Budd-Chiari and E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement with cryopreserved vascular grafts can provide successful short-term and long-term patency.

Long-term results after in-situ split (ISS) liver resection.

In-situ split (ISS) liver resection is a novel method to induce rapid hypertrophy of the contralateral liver lobe in patients at risk for postoperative liver failure due to insufficient liver remnant. So far, no data about oncological long-term survival after ISS liver resection is available. We retrospectively analyzed our patients treated with ISS liver resection at the Department of Surgery of the University of Regensburg, the first center worldwide to perform ISS. Between 2007 and 2014, ISS liver resection was performed in 16 patients. Two patients (12.5 %) were lost in early postoperative phase (90 days) and one was lost to follow-up. Thirteen patients with a follow-up period of more than 3 months were included into oncologically focused analyses. Median follow-up was 26.4 months (range 3.2-54.6). Seven patients had suffered from colorectal liver metastases (CRLM) and six from various other liver malignancies (non-CRLM). The ISS procedure had led to a median increase of 86.3 % of the left lateral liver lobe after a median of 9 days (range 4-28 days). Median disease-free survival (DFS) was 14.6 months and median overall survival (OS) was 41.7 months (26.4 months when including 90-days mortality). Three-year survival was calculated with 56.4 and 48.9 % when including perioperative mortality, respectively (CRLM 64.3 % vs. non-CRLM 50 %). ISS liver resection can provide long-term survival of selected patients with advanced liver malignancies that otherwise are not eligible for liver resection due to insufficient liver remnant.

Incidence of Cystic Liver Caused byCysticercus fasciolarisin Laboratory Rat

Herein we are reporting about an incidence of Cysticercus fasciolaris infestation in a male and female Sprague Dawley housed for experimental purpose. The clinical finding includes anorexia and dullness. Post mortem examination of both the animals revealed cystic liver with irregular lump of hard tissue attached to left lateral lobe of liver in male rat. A thin, pale white segmented larva with distinct head was found lodged inside the cyst in both the animals. Based upon the morphological features, the larva was identified to be intermediate stage of Taenia taeniaeformis which is a tapeworm of cat with rodents acting as intermediate host. Most of the rodent facilities do not screen laboratory animals for presence of this parasite in regular health monitoring procedures. The findings are important due to impact of this parasite on animal health, research studies and sporadic zoonotic potential.

Albumin and magnetic resonance imaging-liver volume to identify hepatitis B-related cirrhosis and esophageal varices.

To investigate whether liver lobe volume and albumin (ALB) could predict the presence and severity of liver cirrhosis, and esophageal varices. Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study. All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume, and biochemical workup for testing ALB and Child-Pugh class. All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices. Right liver lobe volume (RV), left medial liver lobe volume (LMV), left lateral liver lobe volume (LLV), and caudate lobe volume (CV) were measured using enhanced magnetic resonance imaging. The ratios of RV to ALB (RV/ALB), LMV to ALB (LMV/ALB), LLV to ALB (LLV/ALB) and CV to ALB (CV/ALB) were calculated. Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis, and the presence of esophageal varices. RV, LMV, LLV and CV decreased (r = -0.51-0.373; all P < 0.05), while RV/ALB increased (r = 0.424; P < 0.05), with the progress of Child-Pugh class of liver cirrhosis. RV, LMV, CV, LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV, LMV, LLV, CV, RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV, RV/ALB and CV/ALB could identify presence of esophageal varices (all P < 0.05). Among these parameters, CV/ALB could best identify the presence of liver cirrhosis, with an area under receiver operating characteristic curve (AUC) of 0.860, a sensitivity of 82.0% and a specificity of 83.0%. LLV could best distinguish class A from B, with an AUC of 0.761, a sensitivity of 74.4% and a specificity of 73.1%. RV could best distinguish class A from C, with an AUC of 0.900, a sensitivity of 90.3% and a specificity of 84.5%. LLV/ALB could best distinguish class B from C, with an AUC of 0.900, a sensitivity of 93.8% and a specificity of 81.5%. RV/ALB could best identify esophageal varices, with an AUC of 0.890, a sensitivity of 80.0% and a specificity of 83.5%. The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis, and presence of esophageal varices.

Abstract 175: Vasopressin Maintains Robust Organ Blood Flow During Resuscitation from Hemorrhagic Shock

Background: We have reported beneficial hemodynamic and survival effects of vasopressin (VP) infusion in swine models of hemorrhagic shock (HS), and attributed the effects to increases in peripheral vascular resistance. However, VP may also exert a minor effect on venous return. In the present study we used fluorescent microspheres to measure the effects of VP on blood flow to organs of interest during HS produced by liver laceration (LL). Methods: Forty male domestic pigs (32.3 to 40.3 kg) had their left lateral liver lobe lacerated with a sharpened steel, X-shaped 5 cm blade clamp. Thirty-two pigs received a second LL in the same lobe 7.5 minutes later and 24 pigs received a third LL in the left medial lobe at 15 minutes from the first LL. Pigs were randomized 1:1 to receive an infusion of VP (0.04 U/kg•min-1) or vehicle intraosseously starting 7 minutes after the first LL until the end of the experiment (240 min). Microspheres were injected into the left ventricle at baseline (BL) and during HS at times shown in the Table. Results: At 60 minutes of HS, VP infusion was associated with higher aortic blood pressure and lower cardiac index (both NS) along with overall reductions in blood flow to various organs (Table) coincident with a statistically significant reduction in heart rate (157±43 vs 184±29 min-1; p≤0.05). At 120 and 180 minutes of HS, the heart rate was only mildly reduced (NS). The aortic pressures remained high but without a reduction in cardiac index. Organ blood flows were all comparable or higher with VP than in control pigs attaining statistical significance for renal cortical blood flow. Conclusion: Contrary to the expected hemodynamic effects of VP redistributing blood flow away from “non-vital organs,” we observed a robust hemodynamic effect that adequately perfused vital and “non-vital” organs during HS without deterioration over time. Early and sustained VP infusion could represent a highly effective intervention for hemodynamic stabilization during severe HS.

A comparison of liver sampling techniques in dogs.

BackgroundThe liver sampling technique in dogs that consistently provides samples adequate for accurate histopathologic interpretation is not known.Hypothesis/ObjectivesTo compare histopathologic results of liver samples obtained by punch, cup, and 14 gauge needle to large wedge samples collected at necropsy.AnimalsSeventy dogs undergoing necropsy.MethodsProspective study. Liver specimens were obtained from the left lateral liver lobe with an 8 mm punch, a 5 mm cup, and a 14 gauge needle. After sample acquisition, two larger tissue samples were collected near the center of the left lateral lobe to be used as a histologic standard for comparison. Histopathologic features and numbers of portal triads in each sample were recorded.ResultsThe mean number of portal triads obtained by each sampling method were 2.9 in needle samples, 3.4 in cup samples, 12 in punch samples, and 30.7 in the necropsy samples. The diagnoses in 66% of needle samples, 60% of cup samples, and 69% of punch samples were in agreement with the necropsy samples, and these proportions were not significantly different from each other. The corresponding kappa coefficients were 0.59 for needle biopsies, 0.52 for cup biopsies, and 0.62 for punch biopsies.Conclusion and Clinical ImportanceThe histopathologic interpretation of a liver sample in the dog is unlikely to vary if the liver biopsy specimen contains at least 3–12 portal triads. However, in comparison large necropsy samples, the accuracy of all tested methods was relatively low.

Portal vein embolization with plug/coils improves hepatectomy outcome

BackgroundPortal vein embolization (PVE) has become the standard of care before extended hepatectomy. Various PVE methods using different embolization materials have been described. In this study, we compared PVE with polyvinyl alcohol particles alone (PVA only) versus PVA with plug or coils (PVA + plug/coils). Materials and methodsPatients undergoing PVE before hepatectomy were included. PVA alone was used until December 2013, thereafter plug or coils were placed in addition. The volume of left lateral liver lobe (LLL), clinical parameters, and liver function tests were measured before PVE and resection. ResultsA total of 43 patients were recruited into the PVA only group and 42 were recruited into the PVA + plug/coils group. There were no major differences between groups except significantly higher total bilirubin level before PVE in the PVA only group, which improved before hepatectomy. Mean LLL volume increased by 25.7% after PVE in the PVA only group and by 44% in the PVA + plug/coils group (P < 0.001). Recanalization was significantly less common in the PVA + plug/coils group. In multivariate regression, initial LLL volume and use of plug or coils were the only parameters influencing LLL volume increase. The postoperative liver failure rate was significantly reduced in PVA + plug/coils group (P = <0.001). ConclusionsPVE using PVA particles together with plug or coils is a safe and efficient method to increase future liver remnant volume. The additional central embolization with plug or coils led to an increased hypertrophy, due to lower recanalization rates, and subsequently decreased incidence of postoperative liver failure. No additional procedure-specific complications were observed in this series.