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Two-stage laparoscopic liver resection for bilateral colorectal liver metastasis

MACHADO, M. A.; MAKDISSI, F. F.; SURJAN, R. C.; KAPPAZ, G. T.; YAMAGUCHI, N.
Fonte: SPRINGER Publicador: SPRINGER
Tipo: Artigo de Revista Científica
ENG
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Hepatectomy may prolong the survival of colorectal cancer patients with liver metastases. Two-stage liver surgery is a valid option for the treatment of bilobar colorectal liver metastasis. This video demonstrates technical aspects of a two-stage pure laparoscopic hepatectomy for bilateral liver metastasis. To the authors` knowledge, this is the first description of a two-stage laparoscopic liver resection in the English literature. A 54-year-old man with right colon cancer and synchronous bilobar colorectal liver metastasis underwent laparoscopic right colon resection followed by oxaliplatin-based chemotherapy. The patient then was referred for surgical treatment of liver metastasis. Liver volumetry showed a small left liver remnant. Surgical planning was for a totally laparoscopic two-stage liver resection. The first stage involved laparoscopic resection of segment 3 and ligature of the right portal vein. The postoperative pathology showed high-grade liver steatosis. After 4 weeks, the left liver had regenerated, and volumetry of left liver was 43%. The second stage involved laparoscopic right hepatectomy using the intrahepatic Glissonian approach. Intrahepatic access to the main right Glissonian pedicle was achieved with two small incisions...

Avaliação do emprego da pentoxifilina na regeneração hepática em ratos submetidos à hepatectomia parcial; Effect of pentoxifylline in liver regeneration in rats submitted to partial hepatectomy

Martino, Rodrigo Bronze de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 28/04/2010 PT
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A cirurgia do fígado apresentou extraordinário avanço desde a primeira ressecção planejada realizada por Langenbuch em 1888, e o primeiro transplante de fígado realizado por Starzl em 1963, até atualmente quando extensas ressecções e transplantes de partes do fígado são possíveis. Isso se deve graças, entre outros fatores, ao reconhecimento da grande capacidade regenerativa do fígado. A regeneração hepática tem sido objeto de estudo por quase 100 anos, no entanto, o mecanismo pelo qual o hepatócito é estimulado à replicação não foi completamente elucidado. As citocinas têm papel fundamental no mecanismo de regeneração do fígado, destacando-se entre elas o TNF- e a IL-6. Elas favorecem a indução de outras citocinas e estimulam a regeneração. Elas, no entanto, contribuem também no mecanismo de lesão do hepátocito em situações como a da isquemia e reperfusão. Alguns dados da literatura são conflitantes e mostram respostas diferentes na regeneração hepática provocadas pela inibição do TNF-. A pentoxifilina é um derivado da metilxantina que tem uma potente ação inibidora da síntese de TNF-. O presente estudo visa a avaliar o efeito da administração de pentoxifilina na regeneração hepática em ratos submetidos a ressecção de 70% do parênquima hepático. Os animais foram divididos em 4 grupos: Controle...

O valor da biópsia do fígado na doença hepática gordurosa não alcoólica em pacientes com colelitíase submetidos à colecistectomia laparoscópica; The importance of liver biopsy in non-alcoholic fatty liver disease in patients with cholelithiasis submitted to laparoscopic cholecystectomy

Pinto, Monica Madeira
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 07/04/2011 PT
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A colelitíase é uma doença frequente na população geral. Um dos seus fatores de risco é a diabetes melitus tipo 2, relacionada à anormalidades metabólicas associadas a sobrepeso, obesidade, resistência à insulina, hipertrigliceridemia e hábitos dietéticos. Fatores de risco semelhantes são encontrados na doença hepática gordurosa não alcoólica (DHGNA). A DHGNA engloba um espectro de condições patológicas que pode evoluir da esteatose, para esteato-hepatite (EHNA), fibrose, cirrose e neoplasia hepática. A distinção entre esteatose e EHNA é de grande relevância na prática clínica, em virtude de a primeira ser uma condição benigna e reversível, enquanto que a segunda apresenta potencial evolutivo para cirrose e carcinoma hepatocelular. Somente a biópsia hepática pode classificar e estadiar a DHGNA. A DHGNA e a colelitíase têm similaridade quanto à patogênese e aos fatores de risco, o que nos motivou a realizar este estudo. Os objetivos do trabalho foram: a) Definir a frequência da esteatose hepática e da EHNA em pacientes com colelitíase submetidos à colecistectomia laparoscópica. b) Avaliar as alterações histopatológicas da DHGNA nos pacientes com colelitíase. c) Avaliar a acurácia dos exames de imagem-ultrassonografia abdominal (US) e tomografia computadorizada (TC) no diagnóstico da DHGNA. d) Relacionar aspectos clínicos...

Efeito da hepatectomia parcial associada à administração de fatores nutricionais hepatotróficos sobre a morfologia, função e expressão de genes pró-fibróticos na cirrose hepática em ratos Wistar induzida por tiocetamida; Effects of partial hepatectomy associated with administration of nutritional hepatotrophic factors in morphology, function and expression of pro-fibrotic genes in thioacetamide-induced liver cirrhosis in Wistar rats

Trotta, Mauricio de Rosa
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 15/12/2011 PT
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O presente trabalho avaliou o papel da solução parenteral de fatores hepatotróficos nutricionais em animais com cirrose submetidos à hepatectomia parcial. Este procedimento é temido nestes animais devido à possibilidade de ocorrência de falência hepática aguda, já que a remoção de um fragmento do fígado reduz ainda mais a capacidade funcional de um órgão já comprometido. Além disso, é conhecido que o fígado cirrótico diminui sua capacidade regenerativa, fato que atrasa a recuperação do animal, bem como também regenera cirroticamente. Esses fatores, aliados, contribuem para uma considerável taxa de mortalidade pós-operatória. Porém, há algumas situações em que estes pacientes precisam ser submetidos a ressecções hepáticas, tais como traumas, infecções e neoplasias. De fato, a presença de hepatocarcinomas representa a maior indicação deste procedimento em fígados cirróticos. Por outro lado, tem-se mostrado que a administração parenteral de solução de fatores hepatotróficos nutricionais (FHN), uma mistura de aminoácidos, vitaminas, sais minerais e hormônios, aumenta consideravelmente a proliferação celular e o tamanho do fígado em animais sadios, com fibrose e com cirrose. Nestes dois últimos...

Elastografia hepática em pacientes com carcinoma hepatocelular em triagem para transplante de fígado; Liver elastography in patients with hepatocellular carcinoma in screening for liver transplantation

Nacif, Lucas Souto
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 15/12/2014 PT
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INTRODUÇÃO: A cirrose é a oitava causa de mortalidade no mundo, e sua progressão e estadiamento são de extrema importância nos pacientes com doença terminal do fígado. A presença de cirrose é reconhecida como risco aumentado de carcinoma hepatocelular (CHC) e o seu aparecimento está diretamente relacionado ao grau de fibrose do fígado. Na última década, notou-se o desenvolvimento e aperfeiçoamento dos métodos de predição do grau de fibrose e cirrose, através de métodos não-invasivos, com o objetivo de substituir a biópsia hepática. A população em lista de espera para transplante de fígado apresenta graus diferentes de fibrose hepática, que pode não estar diretamente relacionada ao MELD. Além disso, esses pacientes apresentam CHC no momento da triagem para transplante de fígado. Não existe avaliação desta população por elastografia. OBJETIVO: O objetivo deste trabalho foi avaliar os pacientes em triagem para transplante de fígado, com e sem carcinoma hepatocelular, pela elastografia hepática com Fibroscan® e ARFI. MÉTODO: Foram estudados 103 pacientes adultos do ambulatório de triagem da Disciplina de Transplante de Órgãos do Aparelho Digestivo HC/FMUSP, no período de outubro de 2012 à dezembro de 2013. A amostragem foi por conveniência e foram avaliados dados clínicos...

Liver transplantation for acute liver failure: a 5 years experience

Viana,Cyntia Ferreira Gomes; Rocha,Tarciso Daniel Santos; Cavalcante,Fernanda Paula; Valença Jr.,José Telmo; Coelho,Gustavo Rêgo; Garcia,Jose Huygens Parente
Fonte: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED Publicador: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2008 EN
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BACKGROUND: Fulminant hepatic failure carries a high morbidity and mortality. Liver transplantation has markedly improved the prognosis of patients with fulminant hepatic failure. AIM: To evaluate the outcome of 20 patients with acute liver failure and indication for liver transplantation. METHODS: A retrospective review of 20 patients with acute liver failure and indication for liver transplantation was performed. Patients were divided into two groups: group A with 12 patients who underwent liver transplantation and group B with 8 patients who did not receive liver transplantation. Both groups were analyzed according to age, sex, ABO blood type, etiology of acute liver failure, time on list until transplantation or death, and survival rates. Group A patients were additionally analyzed according to preoperative INR, AST, and ALT peak values and MELD (Model for End-stage Liver Disease) scores; intraoperative red blood cells and plasma transfusion and cold ischemia time; postoperative lenght of intensive care unit and hospital stay, and needed for dialysis. RESULTS: Group A: there were four men and eight women with an average age of 24.6 years. The average liver waiting time period was 3.4 days and MELD score 36. Seven patients are alive with good hepatic function at a medium follow-up of 26.2 months. The actuarial survival rate was 65.2% at 1 year. Group B: There were two men and six women with an average age of 30.9 years. The mean waiting time on list until death was 7.4 days. All patients died while waiting for a liver donor. CONCLUSION: Despite the improvements in intensive care management...

Anti-hepatitis C virus treatment may prevent the progression of liver fibrosis in non-responder human immunodeficiency virus/hepatitis C virus coinfected patients

Sagnelli,Caterina; Uberti-Foppa,Caterina; Galli,Laura; Pasquale,Giuseppe; Coppola,Nicola; Albarello,Luca; Doglioni,Carlo; Lazzarin,Adriano; Sagnelli,Evangelista
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2014 EN
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AIM: To evaluate changes in liver histology in patients with human immunodeficiency virus/hepatitis C virus coinfection non-responders to a suboptimal Interferon+Ribavirine regimen. MATERIALS AND METHODS: We investigated 49 patients with two sequential liver biopsies: 18 were non-responders to Interferon+Ribavirine treatment (Group hepatitis C virus Rx) administered after the 1st liver biopsy who underwent a 2nd liver biopsy after a median period of 3.92 year and 31 were patients who remained untreated for hepatitis C virus disease (Group hepatitis C virus untreated) after the 1st liver biopsy because of refusal and underwent a 2nd liver biopsy after a median period of 5.05-years. Most patients in both groups were under highly active antiretroviral therapy. At the time of 1st liver biopsy similar degrees of necro-inflammation, fibrosis and steatosis were observed in both groups. Changes in liver lesions between 1st and 2nd liver biopsys were adjusted for different intervals between liver biopsys by a mathematic formula. RESULTS: Liver fibrosis did not change in 88.9% of patients in Group hepatitis C virus Rx and in 77.4% in Group hepatitis C virus untreated. A marked deterioration in liver fibrosis was observed in 5 (16%) patients in Group hepatitis C virus untreated and in none in Group hepatitis C virus treated. Necro-inflammation and steatosis remained substantially unchanged in both groups. CONCLUSION: Liver histology remained substantially unchanged in human immunodeficiency virus/hepatitis C virus patients non-responder to anti-hepatitis C virus therapy over 4 years observation...

Liver transplantation: history, outcomes and perspectives

Meirelles Júnior,Roberto Ferreira; Salvalaggio,Paolo; Rezende,Marcelo Bruno de; Evangelista,Andréia Silva; Guardia,Bianca Della; Matielo,Celso Eduardo Lourenço; Neves,Douglas Bastos; Pandullo,Fernando Luis; Felga,Guilherme Eduardo Gonçalves; Alves,Jef
Fonte: Instituto Israelita de Ensino e Pesquisa Albert Einstein Publicador: Instituto Israelita de Ensino e Pesquisa Albert Einstein
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2015 EN
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In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first five liver transplantations no patient survived more than 23 days. In 1967, stimulated by Calne who used antilymphocytic serum, Starzl began a successful series of liver transplantation. Until 1977, 200 liver transplantations were performed in the world. In that period, technical problems were overcome. Roy Calne, in 1979, used the first time cyclosporine in two patients who had undergone liver transplantation. In 1989, Starzl et al. reported a series of 1,179 consecutives patients who underwent liver transplantation and reported a survival rate between one and five years of 73% and 64%, respectively. Finally, in 1990, Starzl et al. reported successful use of tacrolimus in patents undergoing liver transplantation and who had rejection despite receiving conventional immunosuppressive treatment. Liver Transplantation Program was initiated at Hospital Israelita Albert Einstein in 1990 and so far over 1,400 transplants have been done. In 2013, 102 deceased donors liver transplantations were performed. The main indications for transplantation were hepatocellular carcinoma (38%)...

Markers of autoimmune liver diseases in postmenopausal women with osteoporosis

Demirdal,Umit Secil; Ciftci,Ihsan Hakkı; Kavuncu,Vural
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2010 EN
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INTRODUCTION: Osteoporosis is a common complication of chronic liver diseases. However, there is limited information about autoimmune liver diseases as a factor of secondary osteoporosis. Therefore, we aimed to investigate the autoantibodies of autoimmune liver diseases in patients with osteoporosis. METHODS: One hundred fifty female patients with postmenopausal osteoporosis were included. Bone mineral density was measured by dual energy X-ray absorptiometry. We analysized autoantibodies including antinuclear antibodies, liver membrane antibodies, anti-liver/kidney microsomal autoantibodies1, liver-specific protein, antismooth muscle antibodies, and anti-mitochondrial antibodies by indirect immunofluorescence. Serum was assayed for the levels of aminotransferases. RESULTS: The mean age of the patients was 63,13±8,6 years. The mean values of L1-L4 T-scores and femur total T-scores were -3,08±0,58 and -1,53±0,81, respectively. Among the 150 patients with osteoporosis, 14 (9.3%) were antinuclear antibodies, four (2.7%) were liver membrane antibodies, three (2.0%) were anti-liver/kidney microsomal autoantibodies1, and two (1.3%) were liver-specific protein positive. None of the patients had anti-mitochondrial antibodies or smooth muscle antibodies positivity. The mean values of levels of aminotransferases were within normal range. CONCLUSIONS: The presence of liver membrane antibodies...

Chemotherapy induced liver abnormalities: an imaging perspective

Sharma, Ankush; Houshyar, Roozbeh; Bhosale, Priya; Choi, Joon-Il; Gulati, Rajesh; Lall, Chandana
Fonte: The Korean Association for the Study of the Liver Publicador: The Korean Association for the Study of the Liver
Tipo: Artigo de Revista Científica
EN
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Treating patients undergoing chemotherapy who display findings of liver toxicity, requires a solid understanding of these medications. It is important for any clinician to have an index of suspicion for liver toxicity and be able to recognize it, even on imaging. Cancer chemotherapy has evolved, and newer medications that target cell biology have a different pattern of liver toxicity and may differ from the more traditional cytotoxic agents. There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount. Conditions such as sinusoidal obstructive syndrome, steatosis, and pseudocirrhosis are more commonly associated with chemotherapy. These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure. It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken. Often times, patients with these liver manifestations can be managed with supportive therapies, and liver toxicity may resolve after discontinuation of chemotherapy.

Establishment and characterization of several liver cell lines as tools for the study of physio-pathological cellular interplay

COSTA, VIVIANA
Fonte: La Sapienza Universidade de Roma Publicador: La Sapienza Universidade de Roma
Tipo: Tese de Doutorado
EN
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Establishment and characterization of cell lines as tools for the study of physio-pathological liver cellular interplay The liver is the largest internal organ of the body, constituting approximately 2% to 5% of body weight in the adult and 5% in the neonate. This organ plays a central role in metabolic homeostasis and it is responsible for the synthesis, storage and redistribution of nutrients, carbohydrates, fats and vitamins. The liver has a peculiar and fascinating ability: it is able to regenerate itself after loss of parenchyma for surgical resection or injury caused by drugs, toxins or acute viral disease. Considering the variety of liver functions, it is not surprising that a large number of cell types and cell–cell interactions are required for its functionality. Most of the liver functions are carried out by the hepatocytes (about 70-75% of hepatic cells); these, together with cholangiocytes (10-5 %), both of endodermal derivation, constitute the hepatic parenchyma. The other 20% made up of non-parenchymal cells, includes: 1) Kupffer cells, essential for the phagocytosis of foreign particles as well as for the cytokines production, 2) stellate cells, that store vitamin A and produce extra-cellular matrix (ECM) components...

A Novel 3-D Segmentation Algorithm for Anatomic Liver and Tumor Volume Calculations for Liver Cancer Treatment Planning

Goryawala, Mohammed
Fonte: FIU Digital Commons Publicador: FIU Digital Commons
Tipo: Artigo de Revista Científica Formato: application/pdf
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Three-Dimensional (3-D) imaging is vital in computer-assisted surgical planning including minimal invasive surgery, targeted drug delivery, and tumor resection. Selective Internal Radiation Therapy (SIRT) is a liver directed radiation therapy for the treatment of liver cancer. Accurate calculation of anatomical liver and tumor volumes are essential for the determination of the tumor to normal liver ratio and for the calculation of the dose of Y-90 microspheres that will result in high concentration of the radiation in the tumor region as compared to nearby healthy tissue. Present manual techniques for segmentation of the liver from Computed Tomography (CT) tend to be tedious and greatly dependent on the skill of the technician/doctor performing the task. This dissertation presents the development and implementation of a fully integrated algorithm for 3-D liver and tumor segmentation from tri-phase CT that yield highly accurate estimations of the respective volumes of the liver and tumor(s). The algorithm as designed requires minimal human intervention without compromising the accuracy of the segmentation results. Embedded within this algorithm is an effective method for extracting blood vessels that feed the tumor(s) in order to plan effectively the appropriate treatment. Segmentation of the liver led to an accuracy in excess of 95% in estimating liver volumes in 20 datasets in comparison to the manual gold standard volumes. In a similar comparison...

Bioartificial liver support devices: historical perspectives

Court, F.; Wemyss-Holden, S.; Dennison, A.; Maddern, G.
Fonte: Blackwell Science Asia Publicador: Blackwell Science Asia
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
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Fulminant hepatic failure (FHF) is an important cause of death worldwide. Despite significant improvements in critical care therapy there has been little impact on survival with mortality rates approaching 80%. In many patients the cause of the liver failure is reversible and if short-term hepatic support is provided, the liver may regenerate. Survivors recover full liver function and a normal life expectancy1. For many years the only curative treatment for this condition has been liver transplantation, subjecting many patients to replacement of a potentially self-regenerating organ, with the lifetime danger of immunosuppression and its attendant complications, such as malignancy2. Because of the shortage of livers available for transplantation, many patients die before a transplant can be performed, or are too ill for operation by the time a liver becomes available. Many patients with hepatic failure do not qualify for liver transplantation because of concomitant infection, metastatic cancer, active alcoholism or concurrent medical problems. The survival of patients excluded from liver transplantation or those with potentially reversible acute hepatitis might be improved with temporary artificial liver support. With a view to this...

Expression and function of osteopontin variants in HCV-related liver disease and hepatocellular carcinoma.

Phillips, Renee Jade
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2010
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Osteopontin (OPN) is a highly secreted multi-functional sialoprotein that is widely expressed in tissues, blood and urine. It is involved in a number of normal physiological functions, but is also significantly elevated in a number of cancers. While OPN is significantly expressed in hepatocellular carcinoma (HCC) little is known as to its role and if it is expressed in the pre-cancerous hepatitis C virus (HCV) infected liver. In this thesis we show that OPN is expressed in the liver and in HCC as three variants, the full-length protein OPN-A and two splice variants OPN-B and OPN-C. Through production of stable Huh-7 cells expressing the OPN variants, we show for the first time that all variants increase proliferation of a range of cultured hepatoma cell lines in a paracrine manner through interactions with the cell surface OPN receptor CD44. Similarly, OPN-A (and to a lesser extent OPN-B and –C) accelerated Huh-7 derived tumor growth in a nude mouse model. We also show for the first time expression of all three OPN variants in the non-diseased liver as it was previously thought that splicing was a feature specific for tumor cells. Clinically, OPN is known to be highly expressed in HCC, however, its expression in chronic hepatitis C is not well documented. In this thesis we show that OPN mRNA expression is elevated in the HCV-infected liver with a trend towards increased expression as liver disease progresses. Consistent with an increase in mRNA...

Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)

Rahbari, N.; Garden, J.; Padbury, R.; Brooke-Smith, M.; Crawford, M.; Adam, R.; Koch, M.; Makuuchi, M.; DeMatteo, R.; Christophi, C.; Banting, S.; Usatoff, V.; Nagino, M.; Maddern, G.; Hugh, T.; Vauthey, J.N.; Greig, P.; Rees, M.; Yokoyama, Y.; Sheung, T.
Fonte: Mosby Inc Publicador: Mosby Inc
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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BACKGROUND: Posthepatectomy liver failure is a feared complication after hepatic resection and a major cause of perioperative mortality. There is currently no standardized definition of posthepatectomy liver failure that allows valid comparison of results from different studies and institutions. The aim of the current article was to propose a definition and grading of severity of posthepatectomy liver failure. METHODS: A literature search on posthepatectomy liver failure after hepatic resection was conducted. Based on the normal course of biochemical liver function tests after hepatic resection, a simple and easily applicable definition of posthepatectomy liver failure was developed by the International Study Group of Liver Surgery. Furthermore, a grading of severity is proposed based on the impact on patients' clinical management. RESULTS: No uniform definition of posthepatectomy liver failure has been established in the literature addressing hepatic surgery. Considering the normal postoperative course of serum bilirubin concentration and International Normalized Ratio, we propose defining posthepatectomy liver failure as the impaired ability of the liver to maintain its synthetic, excretory, and detoxifying functions, which are characterized by an increased international normalized ratio and concomitant hyperbilirubinemia (according to the normal limits of the local laboratory) on or after postoperative day 5. The severity of posthepatectomy liver failure should be graded based on its impact on clinical management. Grade A posthepatectomy liver failure requires no change of the patient's clinical management. The clinical management of patients with grade B posthepatectomy liver failure deviates from the regular course but does not require invasive therapy. The need for invasive treatment defines grade C posthepatectomy liver failure. CONCLUSION: The current definition of posthepatectomy liver failure is simple and easily applicable in clinical routine. This definition can be used in future studies to allow objective and accurate comparisons of operative interventions in the field of hepatic surgery.; Nuh N. Rahbari... Guy Maddern... et al.

Hepatic tissue engineering: from transplantation to customized cell-based liver directed therapies from the laboratory

Fiegel, Henning C; Kaufmann, Peter M; Bruns, Helge; Kluth, Dietrich; Horch, Raymund E; Vacanti, Joseph P; Kneser, Ulrich
Fonte: Blackwell Publishing Ltd Publicador: Blackwell Publishing Ltd
Tipo: Artigo de Revista Científica
EN_US
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Abstract Today, liver transplantation is still the only curative treatment for liver failure due to end-stage liver diseases. Donor organ shortage, high cost and the need of immunosuppressive medications are still the major limitations in the field of liver transplantation. Thus, alternative innovative cell-based liver directed therapies, for example, liver tissue engineering, are under investigation with the aim that in future an artificial liver tissue could be created and be used for the replacement of the liver function in patients. Using cells instead of organs in this setting should permit (i) expansion of cells in an in vitro phase, (ii) genetic or immunological manipulation of cells for transplantation, (iii) tissue typing and cryopreservation in a cell bank and (iv) the ex vivo genetic modification of patient's own cells prior to re-implantation. Function and differentiation of liver cells are influenced by the three-dimensional organ architecture. The use of polymeric matrices permits the three-dimensional formation of a neo tissue and specific stimulation by adequate modification of the matrix surface, which might be essential for appropriate differentiation of transplanted cells. In addition, culturing hepatocytes on three-dimensional matrices permits culture in a flow bioreactor system with increased function and survival of the cultured cells. Based on bioreactor technology...

Portal flow steal after liver transplantation

Kim, Bohyun; Kim, Kyoung Won; Song, Gi-Won; Lee, Sung-Gyu
Fonte: The Korean Association for the Study of the Liver Publicador: The Korean Association for the Study of the Liver
Tipo: Artigo de Revista Científica
EN
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Portal flow steal occasionally persists even after the liver transplantation, which may reduce the portal flow and thus threaten the patients' outcome. Therefore, pre- and peri-operative detection of portal steal phenomenon requiring radiological or surgical interruption is essential for the liver transplantation candidates as well as for the recipients.

Potential of human Induced Pluripotent Stem Cells in studies of liver disease

Sampaziotis, Fotios; Segeritz, Charis-Patricia; Vallier, Ludovic
Fonte: Wiley on behalf of the American Association for the Study of Liver Diseases Publicador: Wiley on behalf of the American Association for the Study of Liver Diseases
Tipo: Article; accepted version
EN
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This is the accepted manuscript. The final published version is available from Wiley at http://onlinelibrary.wiley.com/doi/10.1002/hep.27651/abstract.; Liver disease is a leading cause of death in the Western World. However, our insight into the underlying disease mechanisms and development of novel therapeutic agents has been hindered by limited availability of primary tissue, intra-species variability associated with the use of animal models and reduced long-term viability of isolated and diseased liver cells. The emergence of hIPSCs (human Induced Pluripotent Stem Cells) and differentiation protocols to generate hepatocyte-like cells has opened the possibility of addressing these issues. Here we discuss the recent progress and potential in the production of various cell types constituting the liver and their applications to model liver diseases and test drug toxicity in vitro.; FS is supported by an Addenbrooke?s Charitable Trust Clinical Research Training Fellowship, a joint Sparks-MRC Clinical Research Training Fellowship and the Cambridge Hospitals National Institute for Health Research Biomedical Research Center. CPS is supported by the Children?s Liver Disease Foundation. LV is supported by the ERC starting grant Relieve IMDs...

Markers of autoimmune liver diseases in postmenopausal women with osteoporosis

Demirdal, Umit Secil; Ciftci, Ihsan Hakkı; Kavuncu, Vural
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; ; Formato: application/pdf
Publicado em 01/01/2010 ENG
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INTRODUCTION: Osteoporosis is a common complication of chronic liver diseases. However, there is limited information about autoimmune liver diseases as a factor of secondary osteoporosis. Therefore, we aimed to investigate the autoantibodies of autoimmune liver diseases in patients with osteoporosis. METHODS: One hundred fifty female patients with postmenopausal osteoporosis were included. Bone mineral density was measured by dual energy X-ray absorptiometry. We analysized autoantibodies including antinuclear antibodies, liver membrane antibodies, anti-liver/kidney microsomal autoantibodies1, liver-specific protein, antismooth muscle antibodies, and anti-mitochondrial antibodies by indirect immunofluorescence. Serum was assayed for the levels of aminotransferases. RESULTS: The mean age of the patients was 63,13±8,6 years. The mean values of L1-L4 T-scores and femur total T-scores were -3,08±0,58 and -1,53±0,81, respectively. Among the 150 patients with osteoporosis, 14 (9.3%) were antinuclear antibodies, four (2.7%) were liver membrane antibodies, three (2.0%) were anti-liver/kidney microsomal autoantibodies1, and two (1.3%) were liver-specific protein positive. None of the patients had anti-mitochondrial antibodies or smooth muscle antibodies positivity. The mean values of levels of aminotransferases were within normal range. CONCLUSIONS: The presence of liver membrane antibodies...

Low-dose imaging of liver diseases through neutron stimulated emission computed tomography: Simulations in GEANT4

Agasthya, Greeshma Ananth
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Dissertação
Publicado em //2013
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Neutron stimulated emission computed tomography (NSECT) is a non-invasive, tomographic imaging technique with the ability to locate and quantify elemental concentration in a tissue sample. Previous studies have shown that NSECT has the ability to differentiate between benign and malignant tissue and diagnose liver iron overload while using a neutron beam tomographic acquisition protocol followed by iterative image reconstruction. These studies have shown that moderate concentrations of iron can be detected in the liver with moderate dose levels and long scan times. However, a low-dose, reduced scan time technique to differentiate various liver diseases has not been tested. As with other imaging modalities, the performance of NSECT in detecting different diseases while reducing dose and scan time will depend on the acquisition techniques and parameters that are used to scan the patients. In order to optimize a clinical liver imaging system based on NSECT, it is important to implement low-dose techniques and evaluate their feasibility, sensitivity, specificity and accuracy by analyzing the generated liver images from a patient population. This research work proposes to use Monte-Carlo simulations to optimize a clinical NSECT system for detection...