BACKGROUND Pancreaticoduodenectomy combined with portal vein(PV)and/or superior mesenteric vein(SMV)resection in patients with pancreaticobiliary malignancy has become a common surgical procedure.There are various gra...BACKGROUND Pancreaticoduodenectomy combined with portal vein(PV)and/or superior mesenteric vein(SMV)resection in patients with pancreaticobiliary malignancy has become a common surgical procedure.There are various grafts currently used for PV and/or SMV reconstruction,but each of these grafts have certain limitations.Therefore,it is necessary to explore novel grafts that have an extensive resource pool,are low cost with good clinical application,and are without immune response rejection or additional damage to patients.AIM To observe the anatomical and histological characteristics of the ligamentum teres hepatis(LTH)and evaluate PV/SMV reconstruction using an autologous LTH graft in pancreaticobiliary malignancy patients.METHODS In 107 patients,the post-dilated length and diameter in resected LTH specimens were measured.The general structure of the LTH specimens was observed by hematoxylin and eosin(HE)staining.Collagen fibers(CFs),elastic fibers(EFs),and smooth muscle(SM)were visualized by Verhoeff-Van Gieson staining,and the expression of CD34,factor VIII-related antigen(FVIIIAg),endothelial nitric oxide synthase(eNOS),and tissue type plasminogen activator(t-PA)were detected using immunohistochemistry in LTH and PV(control)endothelial cells.PV and/or SMV reconstruction using the autologous LTH was conducted in 26 patients with pancreaticobiliary malignancies,and the outcomes were retrospectively analyzed.RESULTS The post-dilated length of LTH was 9.67±1.43 cm,and the diameter at a pressure of 30 cm H2O was 12.82±1.32 mm at the cranial end and 7.06±1.88 mm at the caudal end.Residual cavities with smooth tunica intima covered by endothelial cells were found in HE-stained LTH specimens.The relative amounts of EFs,CFs and SM in the LTH were similar to those in the PV[EF(%):11.23±3.40 vs 11.57±2.80,P=0.62;CF(%):33.51±7.71 vs 32.11±4.82,P=0.33;SM(%):15.61±5.26 vs 16.74±4.83,P=0.32].CD34,FVIIIAg,eNOS,and t-PA were expressed in both LTH and PV endothelial cells.The PV and/or SMV reconstructions were successfully completed in all patients.The overall morbidity and mortality rates were 38.46%and 7.69%,respectively.There were no graft-related complications.The postoperative vein stenosis rates at 2 wk,1 mo,3 mo and 1 year were 7.69%,11.54%,15.38%and 19.23%,respectively.In all 5 patients affected,the degree of vascular stenosis was less than half of the reconstructed vein lumen diameter(mild stenosis),and the vessels remained patent.CONCLUSION The anatomical and histological characteristics of LTH were similar to the PV and SMV.As such,the LTH can be used as an autologous graft for PV and/or SMV reconstruction in pancreaticobiliary malignancy patients who require PV and/or SMV resection.展开更多
OBJECTIVE: To study the correlation between human cholangiocarcinoma in the porta hepatis and the infection of hepatitis virus. METHODS: Immunohistochemistry was used to detect HBxAg and HCV-C protein in formalin-fixe...OBJECTIVE: To study the correlation between human cholangiocarcinoma in the porta hepatis and the infection of hepatitis virus. METHODS: Immunohistochemistry was used to detect HBxAg and HCV-C protein in formalin-fixed and paraffin-embedded samples taken from 68 patients with cholangiocarcinoma in the porta hepatis. The findings were reviewed against the clinical records of the patients. RESULTS: Six patients (8.8%) were positive for HBxAg and 24 (35%) for HCV-C protein, respectively. One patient was positive for both HBxAg and HCV-C protein. There were statistically differences in the extent of differentiation, invasion, lymph-node metastasis, and treatment between the patients with cholangiocarcinomas in the porta hepatis with HB(C) V infection and those without infection. CONCLUSIONS: HB(C) V infection is correlated to the development of cholangiocarcinoma in the porta hepatis. The tumor with HB(C) V infection may have a higher malignancy biologically and poorer prognosis. HBxAg and HCV-C protein may play an important role in the pathogenesis of cholangiocarcinoma in the porta hepatis.展开更多
Hepatitis C virus(HCV)infection and alcohol abuse are two most important causes of chronic liver disease in the United States.Alcoholic hepatitis is a unique clinical syndrome among patients with chronic and active al...Hepatitis C virus(HCV)infection and alcohol abuse are two most important causes of chronic liver disease in the United States.Alcoholic hepatitis is a unique clinical syndrome among patients with chronic and active alcohol abuse with a potential for high short-term mortality.About 20%of patients presenting with alcoholic hepatitis have concomitant HCV infection.Mortality from alcoholic hepatitis is increased in the presence of concomitant hepatitis C due to synergistic interaction between HCV and alcohol in causing hepatocellular damage.Large prospective randomized studies are needed to develop guidelines on the use of corticosteroids among patients with alcoholic hepatitis and concomitant HCV infection.The impact of antiviral therapy on mortality and outcome in the setting of alcoholic hepatitis remains a novel area for future research.展开更多
Objective: To evaluate retrospectively the feasibility and effect of hepatic trisegmentectomy in therapy of huge neoplasms of the liver. Methods: From July 1993 to October 1999, 29 pa- tients with huge hepatic neoplas...Objective: To evaluate retrospectively the feasibility and effect of hepatic trisegmentectomy in therapy of huge neoplasms of the liver. Methods: From July 1993 to October 1999, 29 pa- tients with huge hepatic neoplasms underwent hepatic trisegmentectomy. Of these, 23 patients suffered from primary liver cancer, 1 hepatic infiltration of gallbladder cancer, 1 metastasis of colon cancer, 1 hepatic angiosarcoma, 1 hepatic neurofibroma, and 2 huge liver cysts. Twenty-six patients were subjected to right trisegmentectomy and the rest 3 left triseg- mentectomy. All trisegmentectomies were performed under normothermic interruption of the porta hepatis at single time and these interruptions lasted 15 to 40 minutes. Results: The relatively good effect was seen in our se- ries. The 1-, 3-, 5-year survival rates for primary liver cancer patients were 63.6%, 36.4% and 27.3 %, respectively. The survival period for the pa- tients with hepatic infiltration of gallbladder cancer and liver metastasis of colon cancer was 6 months. Those with hepatic angiosarcoma, hepatic neurofi- broma and huge liver cysts have been surviving 35, 26, 25 and 40 months, respectively. Major complica- tions were noted in 5 patients, and one (3.4%, 1/29) died. Conclusion: Hepatic trisegmentectomy is safe and ef- fective in treatment of huge hepatic neoplasms if its indications and operative techniques are properly mastered.展开更多
Peliosis hepatis is a rare condition characterized by dilatation of hepatic sinusoids and blood-filled spaces in the liver mainly observed in subjects exposed to toxic substances or estrogens, which is frequently asym...Peliosis hepatis is a rare condition characterized by dilatation of hepatic sinusoids and blood-filled spaces in the liver mainly observed in subjects exposed to toxic substances or estrogens, which is frequently asymptomatic. Non-cirrhotic idiopathic portal hypertension （NCIPH） is also a vascular disease of the liver rarely observed in European countries, which is usually diagnosed only when the hemorrhagic complications of portal hypertension occur. We report a case of NCIPH in a young Caucasian male who was diagnosed with liver peliosis, showing ultrasonographic and endoscopic signs of portal hypertension four years after. A second biopsy was diagnostic for NCIPH. Even if the pathogenesis remains obscure, peliosis hepatis can be considered as an early sign of vascular disease of the liver, which may progress to more definite conditions.展开更多
Hepatitis B virus(HBV)is a major global health problem.Despite the success of the general measures against blood transmitted infections in hemodialysis(HD)units,the prevalence of HBV infection among the HD patients is...Hepatitis B virus(HBV)is a major global health problem.Despite the success of the general measures against blood transmitted infections in hemodialysis(HD)units,the prevalence of HBV infection among the HD patients is still high.Thus vaccination against HBV is indicating in this population.However,compared with the general population the seroprotection achieved in HD patients remains relatively low,at about 70%.In this review patient,HD procedure and vaccine-associated factors that affect the efficacy of HBV vaccination are analyzed.Also alternative routes of HBV vaccine administration as well as new and more immunogenic vaccine formulations are discussed.However,besides scientific progress,vigilance of HD physicians and staff regarding the general measures against the transmission of blood borne infections and the vaccination against HBV is also required for reducing the prevalence of this viral infection.展开更多
Purpose: The aim of this report is to describe the unusual MR imaging characteristics observed in two patients with biopsy-proven peliosis hepatis. Imaging findings using gadoxetate disodium (Eovist) as the contrast a...Purpose: The aim of this report is to describe the unusual MR imaging characteristics observed in two patients with biopsy-proven peliosis hepatis. Imaging findings using gadoxetate disodium (Eovist) as the contrast agent in a patient with peliosis hepatis are presented for the first time. Methods: This is a retrospective review of the MRI findings in two patients reviewed independently by two specialized abdominal imaging radiologists. The radiological findings were correlated with clinical history and histopathology. Results: Peliosis hepatis is a rare clinical and radiological entity that is often a diagnostic dilemma due to its non-specific clinical characteristics. Unusual imaging characteristics in this rare entity make diagnosis even more challenging. Conclusions: Improved understanding of the imaging characteristics of peliosis hepatis may prevent unnecessary and potentially dangerous biopsies in select patients with peliosis hepatis. This requires a high index of suspicion for practicing radiologists due to the rarity of this disease.展开更多
Peliosis hepatis(PH)is a vascular lesion of the liver that mimics a hepatic tumor.PH is often associated with underlying conditions,such as chronic infection and tumor malignancies,or with the use of anabolic steroids...Peliosis hepatis(PH)is a vascular lesion of the liver that mimics a hepatic tumor.PH is often associated with underlying conditions,such as chronic infection and tumor malignancies,or with the use of anabolic steroids,immunosuppressive drugs,and oral contraceptives.Most patients with PH are asymptomatic,but some present with abdominal distension and pain.In some cases,PH may induce intraperitoneal hemorrhage and portal hypertension.This study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal transplantation.The patient experienced progressive abdominal distention and pain in the six months prior to this study.Initially,imaging studies revealed multiple liver tumor-like abnormalities,which were determined to be PH by pathological analysis.Because the hepatic lesions were progressively enlarged,the patient suffered from complications related to portal hypertension,such as intense ascites and esophageal varices bleeding.Although the patient was scheduled to undergo liver transplantation,he suffered hepatic failure and died prior to availability of a donor organ.展开更多
AIM: To evaluate the effect of rosiglitazone in a murine model of liver fibrosis induced by Schistosoma japonicum infection. METHODS: A total of 50 mice were randomly and averagely divided into groups A, B, C, D and E...AIM: To evaluate the effect of rosiglitazone in a murine model of liver fibrosis induced by Schistosoma japonicum infection. METHODS: A total of 50 mice were randomly and averagely divided into groups A, B, C, D and E. The mice in group A served as normal controls, while those in the other four groups were infected with Schistosoma japonicum to induce the model of liver fibrosis. Besides, the mice in groups C, D and E were treated with praziquantel, rosiglitazone and praziquantel plus rosiglitazone, respectively. NF-κB binding activity and expression of PPARγ-mRNA were determined by Western blot assay and real-time quantitative PCR. Radioimmunonassay technique was used to detect the serum content changes of TNF-α and IL-6. Histological specimens were stained with HE. Expression of TGF-β1, a-smooth muscle actin and type ?Ⅰ?and type Ⅲ collagen was detected by immunohistochemistry and multimedia color pathographic analysis system. RESULTS: Inflammation and fibrosis in the rosiglitazone plus praziquantel treatment group (group E) were lightest among the mice infected with Schistosoma (P < 0.05). To further explore the mechanism of rosiglitazone action, we found that rosiglitazone can significantly increase the expression of PPARγ [E: -18.212 ± (-3.909) vs B: -27.315 ± (-6.348) and C: -25.647 ± (-5.694), P < 0.05],reduce the NF-κB binding activity (E: 88.89 ± 19.34 vs B: 141.11 ± 15.37, C: 112.89 ± 20.17 and D: 108.89 ± 20.47, P < 0.05), and lower the serum level of TNF-α (E: 1.613 ± 0.420 ng/mL vs B: 2.892 ± 0.587 ng/mL, C: 2.346 ± 0.371 ng/mL and D: 2.160 ± 0.395 ng/mL, P < 0.05) and IL-6 (E: 0.106 ± 0.021 ng/mL vs B: 0.140 ± 0.031 ng/mL and C: 0.137 ± 0.027 ng/mL, P < 0.05) in mice with liver fibrosis. Rosiglitazone can also substantially reduce the hepatic expression of TGF-β1, α-SMA type Ⅰand type Ⅲ collagen in mice with liver fibrosis. CONCLUSION: The activation of PPARγ by its ligand can retard liver fibrosis and suggest the use of rosiglitazone for the treatment of liver fibrosis due to Schistosoma japonicum infection.展开更多
This report describes a case of a space-occupying lesion in the right liver in a 38-year-old man who was found to have peliosis hepatis. Clinical data of this patient were presented, including medical history, laborat...This report describes a case of a space-occupying lesion in the right liver in a 38-year-old man who was found to have peliosis hepatis. Clinical data of this patient were presented, including medical history, laboratory test and imaging results, and postoperative pathological findings (hematoxylin and eosin staining). Review of his medical history showed that the patient had been bitten by a dog three years earlier. B-mode ultrasonography revealed an uneven echo mass in the right hemiliver, and magnetic resonance imaging scans also showed a mass in the anterior segment of the right liver. Upon surgical removal, the mass was found to be 4.0 cm × 3.8 cm × 3.8 cm in size and located in segment Ⅵ. The mass had a dark and soft appearance, with an irregular edge on intraoperative ultrasonography. Postoperative pathological findings revealed many small capsules filled with blood cells. The patient was diagnosed with peliosis hepatis based on his medical history of having been bitten by a dog, presence of mild anemia, and lack of characteristic symptoms, including fever of unknown origin, abdominal pain, and hepatosplenomegaly, combined with intraoperative and postoperative pathologic findings. The operation was successful, and after being treated with anti-infection agents, the patient had a good recovery.展开更多
The studies on hepatitis C virus(HCV) infection in prison populations are few and mostly cross-sectional. We analyzed prevalently the articles appearing on Pub Med in the last ten years. HCV infection is frequent in p...The studies on hepatitis C virus(HCV) infection in prison populations are few and mostly cross-sectional. We analyzed prevalently the articles appearing on Pub Med in the last ten years. HCV infection is frequent in prisoners, prevalences ranging from 3.1% to 38% according to the HCV endemicity in the geographical location of the prison and in the countries of origin of the foreign prisoners and to the prevalence of intravenous drug use, which is the most important risk factor for HCV infection, followed by an older age of prisoners and previous prison terms. HCV replication in anti-HCVpositive cases varies from 45% to 90% in different studies, and the most common HCV genotypes are generally 1 and 3. The response to antiviral treatment is similar in prisoners to that of the general population. Unfortunately, treatment is administered less frequently to prisoners because of the difficulties in management and follow-up. The new directly acting antivirals offer a good therapy option for inmates because of their good efficacy, short duration of treatment and low incidence of side effects. The efforts of the prison authorities and medical staff should be focused on reducing the spread of HCV infection in prisons by extending the possibility of follow-up and treatment to more prisoners with chronic hepatitis C.展开更多
AIM: To evaluate the success rates, procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS).
BACKGROUND: The treatment for primary tumor in the caudate lobe of the liver is difficult because of its unique anatomical location. This study was undertaken to improve operative techniques and results by a new anato...BACKGROUND: The treatment for primary tumor in the caudate lobe of the liver is difficult because of its unique anatomical location. This study was undertaken to improve operative techniques and results by a new anatomical method of caudate lobectomy. METHODS: Clinical data of 16 patients who had had caudate lobectomy for the liver from January 1996 to November 2004 were retrospectively analyzed. The third porta hepatis anatomical method was performed in all 16 patients. Operative time, intraoperative blood loss, postoperative complications were recorded. The 1-, 3-, and 5-year survival rates of 13 patients with caudate lobe carcinoma were followed up. Anatomical status, operative routes, operative procedures, liver blood supply were evaluated. RESULTS: The operation was successful in the 16 patients. The operative time was 255±70 minutes and blood loss 740±402 ml. None of the patients died from massive bleeding during the operation, nor did complications such as biliary fistula and liver failure occurred. In 13 patients with malignant tumor, 7 died from recurrence and metastasis of the tumor and the other 6 are still alive at the end of follow-up. One patient has survived for 6 years. The 1-, 3-, and 5-year survival rates in the 13 patients were 83.9%, 58.7% and 39.2%, respectively. CONCLUSION: Caudate lobectomy by the third porta hepatis anatomical method can improve operative effect and increase the resection probability for solitary tumor in the caudate lobe.展开更多
Peliosis hepatis is a rare pathological entity and may cause fatal hepatic hemorrhage and liver failure.Here, we present a young male patient with aplastic anemia,who had received long-term treatment with oxymetholone...Peliosis hepatis is a rare pathological entity and may cause fatal hepatic hemorrhage and liver failure.Here, we present a young male patient with aplastic anemia,who had received long-term treatment with oxymetholone.The patient suffered from sudden onset of intra-abdominal hemorrhage with profuse hemoperitoneum.The patient was treated successfully with a right hemihepatectomy and is in good health after 13 postoperative months.We suggest that peliosis hepatis be considered in patients with hepatic parenchymal hematoma,especially in patients under prolonged synthetic anabolic steroid medication.The possibility of a potentially life-threatening complication of massive intra-abdominal bleeding should also be considered.展开更多
<div style="text-align:justify;"> Hepatitis B is an infectious disease of great public health importance. Nigeria is one of the countries with the highest incidence of Hepatitis B Virus (HBV) infection...<div style="text-align:justify;"> Hepatitis B is an infectious disease of great public health importance. Nigeria is one of the countries with the highest incidence of Hepatitis B Virus (HBV) infection worldwide. However, the accessibility and affordability of HBV DNA quantification (viral load) assay is the key laboratory test for therapy initiation, and monitoring is a challenge to HBV management. This study aimed at determining the relationship between HBV DNA quantification and routine haemato-serological parameters in order to develop a more cost-effective diagnostic algorithm for Hepatitis B management. Cross sectional study design was used with a total of 264 subjects comprising of 88 HBsAg seropositive treatment na<span style="color:#4F4F4F;font-family:"font-size:14px;white-space:normal;background-color:#F7F7F7;">ï</span>ve subjects, 88 HBsAg seropositive subjects on antiviral therapy as case subjects and 88 age-matched apparently healthy HBsAg seronegative individuals were recruited as control subjects. Hepatitis B Virus DNA assay was performed using real time PCR technique while ELISA technique was used for Hepatitis B surface antigen quantification. HBsAg quantification showed strong positive correlation with HBV DNA viral load both in treatment and non-treatment groups (r = 0.673;p < 0.001). However, the Receiver Operation Characteristics curve indicated a very poor performance characteristics (AUC = 0.537, p = 0.002). The non-treatment group has higher viral load (M = 805.50 IU/ml) compared with treatment group (M = 65.50 IU/ml) (p < 0.001). There was a significant difference in HBV DNA levels among the four serological patterns observed in the study (p < 0.001). This study has revealed that HBsAg quantification has strong correlation with HBV viral load but might not be efficient in clinical practice as a predictor of serum HBV viral load due to its poor performance characteristics in identifying high positive viral load. </div>展开更多
Peliosis hepatis(PH) is a rare benign condition characterized by the presence of multiple,randomly distributed,blood filled cystic areas of variable size within the liver parenchyma.PH is difficult to recognize and ma...Peliosis hepatis(PH) is a rare benign condition characterized by the presence of multiple,randomly distributed,blood filled cystic areas of variable size within the liver parenchyma.PH is difficult to recognize and may be mistaken for neoplasm,metastases or multiple abscesses.A 75-year-old female with a previous history of colon cancer was admitted when a liver mass in the right liver lobe was found 11 mo after surgery during the follow-up period.Computed tomography and magnetic resonance imaging scan of the abdomen were performed.The initial possible diagnosis was metastatic hepatocellular carcinoma.The patient underwent excision of the hepatic segment where the nodule was located.The pathological diagnosis of the surgical specimen was PH.PH should be considered in the differential diagnosis of new liver lesions in patients whose clinical settings do not clearly favor metastasization.Clinicians and radiologists must recognize these lesions to minimize the probability of misdiagnosis and inappropriate treatment.展开更多
Peliosis hepatis is a rare benign disease,but in last years the number of identified cases has increased.This disease is known to be sometimes accompanied by hepatocellular carcinoma.In the recent article,Yu et al des...Peliosis hepatis is a rare benign disease,but in last years the number of identified cases has increased.This disease is known to be sometimes accompanied by hepatocellular carcinoma.In the recent article,Yu et al describe a case of liver peliosis,characterized by an increased proliferative index.Therefore,additional diagnosis of patients should include analyzing other tumor markers expression in order to assess the risk of malignant cell transformation in peliosis hepatis.展开更多
BACKGROUND Peliosis hepatis(PH)is a rare benign lesion of vascular origin with a pathological characteristic of multiple blood-filled cavities in the liver parenchyma.It is commonly misdiagnosed due to its lack of spe...BACKGROUND Peliosis hepatis(PH)is a rare benign lesion of vascular origin with a pathological characteristic of multiple blood-filled cavities in the liver parenchyma.It is commonly misdiagnosed due to its lack of specificity in clinical presentation and laboratory test results.Herein,a case of a patient with PH who was misdiagnosed with hepatic echinococcosis before operation to remove the lesions was analyzed,with an emphasis on the computed tomography and magnetic resonance imaging characteristics of PH.CASE SUMMARY We outline the case of a 40-year-old Chinese female who was admitted with aggravated abdominal pain with fever for 1 wk.Ultrasound examination at the local hospital indicated hepatic echinococcosis.However,discordance between imaging diagnosis,clinical history and laboratory examinations in our hospital.Subsequently,the patient was pathologically confirmed as having PH-like changes,which recurred 1 year after operation removal of the lesion.CONCLUSION Our objective is to highlight the imaging diagnostic value of PH.展开更多
BACKGROUND Ectopic thyroid is defined as a rare developmental anomaly where thyroid tissues are atypically found in locations other than its normal anatomical position:Anterolateral to the second,third,and fourth trac...BACKGROUND Ectopic thyroid is defined as a rare developmental anomaly where thyroid tissues are atypically found in locations other than its normal anatomical position:Anterolateral to the second,third,and fourth tracheal cartilages.An intemperate descent or a migration failure of the thyroid anlage results in sub-diaphragmatic thyroid ectopia,a sparse clinical entity.CASE SUMMARY This case portrays a 63-year-old female patient presenting with chronic abdominal discomfort at a local hospital whereby a computed tomography(CT)scan revealed a well-defined mass in the hepatic entrance.For further examination,the patient underwent a CT scan with contrast,magnetic resonance imaging(MRI),and CT-angiography(CTA)at our department.The CT scan showed a welldefined and high attenuated mass measuring 43 mm×38 mm in the hepatic entrance with calcification.The CTA revealed an additional finding:Blood supply to the mass from the right hepatic artery.MRI of the upper abdomen demonstrated a mass with mixed signal intensity on T1 and T2 weighted images in the hepatic entrance.The patient underwent surgery with resection of the mass which was sent for histopathology.Ectopic thyroid at the level of porta hepatis with nodules was the definitive diagnosis since histopathological report revealed presence of thyroid tissue in the resected liver mass.CONCLUSION This case delivers a rare insight of pre-operative radiological imaging of an ectopic thyroid located in the liver.These findings can aid in narrowing down potential differential diagnosis when managing a patient with those subsequent findings.展开更多
<b>Introduction:</b> Clear Cell Myomelanocytic Tumor (CCMMT) of ligamentum teres hepatis is a pathological classification of Perivascular Epithelioid Cell tumor (PEComa), which is rare clinically and easy ...<b>Introduction:</b> Clear Cell Myomelanocytic Tumor (CCMMT) of ligamentum teres hepatis is a pathological classification of Perivascular Epithelioid Cell tumor (PEComa), which is rare clinically and easy to misdiagnose. <b>Objective:</b> To report a case of a rare type of PEComa located in the ligamentum teres hepatis. <b>Case Report:</b> A 22-year-old Asian female was diagnosed with abdominal mass during physical examination in September 2018, and was admitted to the general surgery department of our hospital that month. She was diagnosed with abdominal mass, the nature of which remains to be determined is: teratoma, pheochromocytoma or ganglioma. At the time of admission, the patient had no symptoms or signs, and no other medical history. The patient was diagnosed with an abdominal mass by abdominal plain scan and enhanced CT, whose nature was to be determined: pheochromocytoma, paragangliomas or other mesenchymal tumors, or giant lymph node hyperplasia. The patient underwent abdominal mass resection and appendectomy without incident, without any complications at discharge, and there was no significant difference in follow-up. <b>Conclusions:</b> The clinical data, imaging features and pathological features of one patient diagnosed with CCMMT in our hospital were retrospectively analyzed, and the literature was reviewed in combination with the research progress of CCMMT, in order to improve the understanding and diagnostic accuracy of this disease.展开更多
基金Supported by the Science and Technology Research and Development Program of Shandong Province,No. 2009GGl0002047the National Natural Science Fund,No. 81502069
文摘BACKGROUND Pancreaticoduodenectomy combined with portal vein(PV)and/or superior mesenteric vein(SMV)resection in patients with pancreaticobiliary malignancy has become a common surgical procedure.There are various grafts currently used for PV and/or SMV reconstruction,but each of these grafts have certain limitations.Therefore,it is necessary to explore novel grafts that have an extensive resource pool,are low cost with good clinical application,and are without immune response rejection or additional damage to patients.AIM To observe the anatomical and histological characteristics of the ligamentum teres hepatis(LTH)and evaluate PV/SMV reconstruction using an autologous LTH graft in pancreaticobiliary malignancy patients.METHODS In 107 patients,the post-dilated length and diameter in resected LTH specimens were measured.The general structure of the LTH specimens was observed by hematoxylin and eosin(HE)staining.Collagen fibers(CFs),elastic fibers(EFs),and smooth muscle(SM)were visualized by Verhoeff-Van Gieson staining,and the expression of CD34,factor VIII-related antigen(FVIIIAg),endothelial nitric oxide synthase(eNOS),and tissue type plasminogen activator(t-PA)were detected using immunohistochemistry in LTH and PV(control)endothelial cells.PV and/or SMV reconstruction using the autologous LTH was conducted in 26 patients with pancreaticobiliary malignancies,and the outcomes were retrospectively analyzed.RESULTS The post-dilated length of LTH was 9.67±1.43 cm,and the diameter at a pressure of 30 cm H2O was 12.82±1.32 mm at the cranial end and 7.06±1.88 mm at the caudal end.Residual cavities with smooth tunica intima covered by endothelial cells were found in HE-stained LTH specimens.The relative amounts of EFs,CFs and SM in the LTH were similar to those in the PV[EF(%):11.23±3.40 vs 11.57±2.80,P=0.62;CF(%):33.51±7.71 vs 32.11±4.82,P=0.33;SM(%):15.61±5.26 vs 16.74±4.83,P=0.32].CD34,FVIIIAg,eNOS,and t-PA were expressed in both LTH and PV endothelial cells.The PV and/or SMV reconstructions were successfully completed in all patients.The overall morbidity and mortality rates were 38.46%and 7.69%,respectively.There were no graft-related complications.The postoperative vein stenosis rates at 2 wk,1 mo,3 mo and 1 year were 7.69%,11.54%,15.38%and 19.23%,respectively.In all 5 patients affected,the degree of vascular stenosis was less than half of the reconstructed vein lumen diameter(mild stenosis),and the vessels remained patent.CONCLUSION The anatomical and histological characteristics of LTH were similar to the PV and SMV.As such,the LTH can be used as an autologous graft for PV and/or SMV reconstruction in pancreaticobiliary malignancy patients who require PV and/or SMV resection.
文摘OBJECTIVE: To study the correlation between human cholangiocarcinoma in the porta hepatis and the infection of hepatitis virus. METHODS: Immunohistochemistry was used to detect HBxAg and HCV-C protein in formalin-fixed and paraffin-embedded samples taken from 68 patients with cholangiocarcinoma in the porta hepatis. The findings were reviewed against the clinical records of the patients. RESULTS: Six patients (8.8%) were positive for HBxAg and 24 (35%) for HCV-C protein, respectively. One patient was positive for both HBxAg and HCV-C protein. There were statistically differences in the extent of differentiation, invasion, lymph-node metastasis, and treatment between the patients with cholangiocarcinomas in the porta hepatis with HB(C) V infection and those without infection. CONCLUSIONS: HB(C) V infection is correlated to the development of cholangiocarcinoma in the porta hepatis. The tumor with HB(C) V infection may have a higher malignancy biologically and poorer prognosis. HBxAg and HCV-C protein may play an important role in the pathogenesis of cholangiocarcinoma in the porta hepatis.
文摘Hepatitis C virus(HCV)infection and alcohol abuse are two most important causes of chronic liver disease in the United States.Alcoholic hepatitis is a unique clinical syndrome among patients with chronic and active alcohol abuse with a potential for high short-term mortality.About 20%of patients presenting with alcoholic hepatitis have concomitant HCV infection.Mortality from alcoholic hepatitis is increased in the presence of concomitant hepatitis C due to synergistic interaction between HCV and alcohol in causing hepatocellular damage.Large prospective randomized studies are needed to develop guidelines on the use of corticosteroids among patients with alcoholic hepatitis and concomitant HCV infection.The impact of antiviral therapy on mortality and outcome in the setting of alcoholic hepatitis remains a novel area for future research.
文摘Objective: To evaluate retrospectively the feasibility and effect of hepatic trisegmentectomy in therapy of huge neoplasms of the liver. Methods: From July 1993 to October 1999, 29 pa- tients with huge hepatic neoplasms underwent hepatic trisegmentectomy. Of these, 23 patients suffered from primary liver cancer, 1 hepatic infiltration of gallbladder cancer, 1 metastasis of colon cancer, 1 hepatic angiosarcoma, 1 hepatic neurofibroma, and 2 huge liver cysts. Twenty-six patients were subjected to right trisegmentectomy and the rest 3 left triseg- mentectomy. All trisegmentectomies were performed under normothermic interruption of the porta hepatis at single time and these interruptions lasted 15 to 40 minutes. Results: The relatively good effect was seen in our se- ries. The 1-, 3-, 5-year survival rates for primary liver cancer patients were 63.6%, 36.4% and 27.3 %, respectively. The survival period for the pa- tients with hepatic infiltration of gallbladder cancer and liver metastasis of colon cancer was 6 months. Those with hepatic angiosarcoma, hepatic neurofi- broma and huge liver cysts have been surviving 35, 26, 25 and 40 months, respectively. Major complica- tions were noted in 5 patients, and one (3.4%, 1/29) died. Conclusion: Hepatic trisegmentectomy is safe and ef- fective in treatment of huge hepatic neoplasms if its indications and operative techniques are properly mastered.
基金a grant on Vascular Disorders of the Liver from Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Universita di Bologna to Dr. A Berzigotti
文摘Peliosis hepatis is a rare condition characterized by dilatation of hepatic sinusoids and blood-filled spaces in the liver mainly observed in subjects exposed to toxic substances or estrogens, which is frequently asymptomatic. Non-cirrhotic idiopathic portal hypertension （NCIPH） is also a vascular disease of the liver rarely observed in European countries, which is usually diagnosed only when the hemorrhagic complications of portal hypertension occur. We report a case of NCIPH in a young Caucasian male who was diagnosed with liver peliosis, showing ultrasonographic and endoscopic signs of portal hypertension four years after. A second biopsy was diagnostic for NCIPH. Even if the pathogenesis remains obscure, peliosis hepatis can be considered as an early sign of vascular disease of the liver, which may progress to more definite conditions.
文摘Hepatitis B virus(HBV)is a major global health problem.Despite the success of the general measures against blood transmitted infections in hemodialysis(HD)units,the prevalence of HBV infection among the HD patients is still high.Thus vaccination against HBV is indicating in this population.However,compared with the general population the seroprotection achieved in HD patients remains relatively low,at about 70%.In this review patient,HD procedure and vaccine-associated factors that affect the efficacy of HBV vaccination are analyzed.Also alternative routes of HBV vaccine administration as well as new and more immunogenic vaccine formulations are discussed.However,besides scientific progress,vigilance of HD physicians and staff regarding the general measures against the transmission of blood borne infections and the vaccination against HBV is also required for reducing the prevalence of this viral infection.
文摘Purpose: The aim of this report is to describe the unusual MR imaging characteristics observed in two patients with biopsy-proven peliosis hepatis. Imaging findings using gadoxetate disodium (Eovist) as the contrast agent in a patient with peliosis hepatis are presented for the first time. Methods: This is a retrospective review of the MRI findings in two patients reviewed independently by two specialized abdominal imaging radiologists. The radiological findings were correlated with clinical history and histopathology. Results: Peliosis hepatis is a rare clinical and radiological entity that is often a diagnostic dilemma due to its non-specific clinical characteristics. Unusual imaging characteristics in this rare entity make diagnosis even more challenging. Conclusions: Improved understanding of the imaging characteristics of peliosis hepatis may prevent unnecessary and potentially dangerous biopsies in select patients with peliosis hepatis. This requires a high index of suspicion for practicing radiologists due to the rarity of this disease.
文摘Peliosis hepatis(PH)is a vascular lesion of the liver that mimics a hepatic tumor.PH is often associated with underlying conditions,such as chronic infection and tumor malignancies,or with the use of anabolic steroids,immunosuppressive drugs,and oral contraceptives.Most patients with PH are asymptomatic,but some present with abdominal distension and pain.In some cases,PH may induce intraperitoneal hemorrhage and portal hypertension.This study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal transplantation.The patient experienced progressive abdominal distention and pain in the six months prior to this study.Initially,imaging studies revealed multiple liver tumor-like abnormalities,which were determined to be PH by pathological analysis.Because the hepatic lesions were progressively enlarged,the patient suffered from complications related to portal hypertension,such as intense ascites and esophageal varices bleeding.Although the patient was scheduled to undergo liver transplantation,he suffered hepatic failure and died prior to availability of a donor organ.
文摘AIM: To evaluate the effect of rosiglitazone in a murine model of liver fibrosis induced by Schistosoma japonicum infection. METHODS: A total of 50 mice were randomly and averagely divided into groups A, B, C, D and E. The mice in group A served as normal controls, while those in the other four groups were infected with Schistosoma japonicum to induce the model of liver fibrosis. Besides, the mice in groups C, D and E were treated with praziquantel, rosiglitazone and praziquantel plus rosiglitazone, respectively. NF-κB binding activity and expression of PPARγ-mRNA were determined by Western blot assay and real-time quantitative PCR. Radioimmunonassay technique was used to detect the serum content changes of TNF-α and IL-6. Histological specimens were stained with HE. Expression of TGF-β1, a-smooth muscle actin and type ?Ⅰ?and type Ⅲ collagen was detected by immunohistochemistry and multimedia color pathographic analysis system. RESULTS: Inflammation and fibrosis in the rosiglitazone plus praziquantel treatment group (group E) were lightest among the mice infected with Schistosoma (P < 0.05). To further explore the mechanism of rosiglitazone action, we found that rosiglitazone can significantly increase the expression of PPARγ [E: -18.212 ± (-3.909) vs B: -27.315 ± (-6.348) and C: -25.647 ± (-5.694), P < 0.05],reduce the NF-κB binding activity (E: 88.89 ± 19.34 vs B: 141.11 ± 15.37, C: 112.89 ± 20.17 and D: 108.89 ± 20.47, P < 0.05), and lower the serum level of TNF-α (E: 1.613 ± 0.420 ng/mL vs B: 2.892 ± 0.587 ng/mL, C: 2.346 ± 0.371 ng/mL and D: 2.160 ± 0.395 ng/mL, P < 0.05) and IL-6 (E: 0.106 ± 0.021 ng/mL vs B: 0.140 ± 0.031 ng/mL and C: 0.137 ± 0.027 ng/mL, P < 0.05) in mice with liver fibrosis. Rosiglitazone can also substantially reduce the hepatic expression of TGF-β1, α-SMA type Ⅰand type Ⅲ collagen in mice with liver fibrosis. CONCLUSION: The activation of PPARγ by its ligand can retard liver fibrosis and suggest the use of rosiglitazone for the treatment of liver fibrosis due to Schistosoma japonicum infection.
基金Supported by The National Natural Science Foundation of China, No. 81272373the Natural Science Foundation of Fujian Province, China, No. 2012J01358
文摘This report describes a case of a space-occupying lesion in the right liver in a 38-year-old man who was found to have peliosis hepatis. Clinical data of this patient were presented, including medical history, laboratory test and imaging results, and postoperative pathological findings (hematoxylin and eosin staining). Review of his medical history showed that the patient had been bitten by a dog three years earlier. B-mode ultrasonography revealed an uneven echo mass in the right hemiliver, and magnetic resonance imaging scans also showed a mass in the anterior segment of the right liver. Upon surgical removal, the mass was found to be 4.0 cm × 3.8 cm × 3.8 cm in size and located in segment Ⅵ. The mass had a dark and soft appearance, with an irregular edge on intraoperative ultrasonography. Postoperative pathological findings revealed many small capsules filled with blood cells. The patient was diagnosed with peliosis hepatis based on his medical history of having been bitten by a dog, presence of mild anemia, and lack of characteristic symptoms, including fever of unknown origin, abdominal pain, and hepatosplenomegaly, combined with intraoperative and postoperative pathologic findings. The operation was successful, and after being treated with anti-infection agents, the patient had a good recovery.
文摘The studies on hepatitis C virus(HCV) infection in prison populations are few and mostly cross-sectional. We analyzed prevalently the articles appearing on Pub Med in the last ten years. HCV infection is frequent in prisoners, prevalences ranging from 3.1% to 38% according to the HCV endemicity in the geographical location of the prison and in the countries of origin of the foreign prisoners and to the prevalence of intravenous drug use, which is the most important risk factor for HCV infection, followed by an older age of prisoners and previous prison terms. HCV replication in anti-HCVpositive cases varies from 45% to 90% in different studies, and the most common HCV genotypes are generally 1 and 3. The response to antiviral treatment is similar in prisoners to that of the general population. Unfortunately, treatment is administered less frequently to prisoners because of the difficulties in management and follow-up. The new directly acting antivirals offer a good therapy option for inmates because of their good efficacy, short duration of treatment and low incidence of side effects. The efforts of the prison authorities and medical staff should be focused on reducing the spread of HCV infection in prisons by extending the possibility of follow-up and treatment to more prisoners with chronic hepatitis C.
文摘AIM: To evaluate the success rates, procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS).
文摘BACKGROUND: The treatment for primary tumor in the caudate lobe of the liver is difficult because of its unique anatomical location. This study was undertaken to improve operative techniques and results by a new anatomical method of caudate lobectomy. METHODS: Clinical data of 16 patients who had had caudate lobectomy for the liver from January 1996 to November 2004 were retrospectively analyzed. The third porta hepatis anatomical method was performed in all 16 patients. Operative time, intraoperative blood loss, postoperative complications were recorded. The 1-, 3-, and 5-year survival rates of 13 patients with caudate lobe carcinoma were followed up. Anatomical status, operative routes, operative procedures, liver blood supply were evaluated. RESULTS: The operation was successful in the 16 patients. The operative time was 255±70 minutes and blood loss 740±402 ml. None of the patients died from massive bleeding during the operation, nor did complications such as biliary fistula and liver failure occurred. In 13 patients with malignant tumor, 7 died from recurrence and metastasis of the tumor and the other 6 are still alive at the end of follow-up. One patient has survived for 6 years. The 1-, 3-, and 5-year survival rates in the 13 patients were 83.9%, 58.7% and 39.2%, respectively. CONCLUSION: Caudate lobectomy by the third porta hepatis anatomical method can improve operative effect and increase the resection probability for solitary tumor in the caudate lobe.
文摘Peliosis hepatis is a rare pathological entity and may cause fatal hepatic hemorrhage and liver failure.Here, we present a young male patient with aplastic anemia,who had received long-term treatment with oxymetholone.The patient suffered from sudden onset of intra-abdominal hemorrhage with profuse hemoperitoneum.The patient was treated successfully with a right hemihepatectomy and is in good health after 13 postoperative months.We suggest that peliosis hepatis be considered in patients with hepatic parenchymal hematoma,especially in patients under prolonged synthetic anabolic steroid medication.The possibility of a potentially life-threatening complication of massive intra-abdominal bleeding should also be considered.
文摘<div style="text-align:justify;"> Hepatitis B is an infectious disease of great public health importance. Nigeria is one of the countries with the highest incidence of Hepatitis B Virus (HBV) infection worldwide. However, the accessibility and affordability of HBV DNA quantification (viral load) assay is the key laboratory test for therapy initiation, and monitoring is a challenge to HBV management. This study aimed at determining the relationship between HBV DNA quantification and routine haemato-serological parameters in order to develop a more cost-effective diagnostic algorithm for Hepatitis B management. Cross sectional study design was used with a total of 264 subjects comprising of 88 HBsAg seropositive treatment na<span style="color:#4F4F4F;font-family:"font-size:14px;white-space:normal;background-color:#F7F7F7;">ï</span>ve subjects, 88 HBsAg seropositive subjects on antiviral therapy as case subjects and 88 age-matched apparently healthy HBsAg seronegative individuals were recruited as control subjects. Hepatitis B Virus DNA assay was performed using real time PCR technique while ELISA technique was used for Hepatitis B surface antigen quantification. HBsAg quantification showed strong positive correlation with HBV DNA viral load both in treatment and non-treatment groups (r = 0.673;p < 0.001). However, the Receiver Operation Characteristics curve indicated a very poor performance characteristics (AUC = 0.537, p = 0.002). The non-treatment group has higher viral load (M = 805.50 IU/ml) compared with treatment group (M = 65.50 IU/ml) (p < 0.001). There was a significant difference in HBV DNA levels among the four serological patterns observed in the study (p < 0.001). This study has revealed that HBsAg quantification has strong correlation with HBV viral load but might not be efficient in clinical practice as a predictor of serum HBV viral load due to its poor performance characteristics in identifying high positive viral load. </div>
文摘Peliosis hepatis(PH) is a rare benign condition characterized by the presence of multiple,randomly distributed,blood filled cystic areas of variable size within the liver parenchyma.PH is difficult to recognize and may be mistaken for neoplasm,metastases or multiple abscesses.A 75-year-old female with a previous history of colon cancer was admitted when a liver mass in the right liver lobe was found 11 mo after surgery during the follow-up period.Computed tomography and magnetic resonance imaging scan of the abdomen were performed.The initial possible diagnosis was metastatic hepatocellular carcinoma.The patient underwent excision of the hepatic segment where the nodule was located.The pathological diagnosis of the surgical specimen was PH.PH should be considered in the differential diagnosis of new liver lesions in patients whose clinical settings do not clearly favor metastasization.Clinicians and radiologists must recognize these lesions to minimize the probability of misdiagnosis and inappropriate treatment.
文摘Peliosis hepatis is a rare benign disease,but in last years the number of identified cases has increased.This disease is known to be sometimes accompanied by hepatocellular carcinoma.In the recent article,Yu et al describe a case of liver peliosis,characterized by an increased proliferative index.Therefore,additional diagnosis of patients should include analyzing other tumor markers expression in order to assess the risk of malignant cell transformation in peliosis hepatis.
文摘BACKGROUND Peliosis hepatis(PH)is a rare benign lesion of vascular origin with a pathological characteristic of multiple blood-filled cavities in the liver parenchyma.It is commonly misdiagnosed due to its lack of specificity in clinical presentation and laboratory test results.Herein,a case of a patient with PH who was misdiagnosed with hepatic echinococcosis before operation to remove the lesions was analyzed,with an emphasis on the computed tomography and magnetic resonance imaging characteristics of PH.CASE SUMMARY We outline the case of a 40-year-old Chinese female who was admitted with aggravated abdominal pain with fever for 1 wk.Ultrasound examination at the local hospital indicated hepatic echinococcosis.However,discordance between imaging diagnosis,clinical history and laboratory examinations in our hospital.Subsequently,the patient was pathologically confirmed as having PH-like changes,which recurred 1 year after operation removal of the lesion.CONCLUSION Our objective is to highlight the imaging diagnostic value of PH.
基金Supported by The Key Research and Development Program of Zhejiang Province,No.2019C03064Program Cosponsored by Province and Ministry,No.WKJ-ZJ-1926。
文摘BACKGROUND Ectopic thyroid is defined as a rare developmental anomaly where thyroid tissues are atypically found in locations other than its normal anatomical position:Anterolateral to the second,third,and fourth tracheal cartilages.An intemperate descent or a migration failure of the thyroid anlage results in sub-diaphragmatic thyroid ectopia,a sparse clinical entity.CASE SUMMARY This case portrays a 63-year-old female patient presenting with chronic abdominal discomfort at a local hospital whereby a computed tomography(CT)scan revealed a well-defined mass in the hepatic entrance.For further examination,the patient underwent a CT scan with contrast,magnetic resonance imaging(MRI),and CT-angiography(CTA)at our department.The CT scan showed a welldefined and high attenuated mass measuring 43 mm×38 mm in the hepatic entrance with calcification.The CTA revealed an additional finding:Blood supply to the mass from the right hepatic artery.MRI of the upper abdomen demonstrated a mass with mixed signal intensity on T1 and T2 weighted images in the hepatic entrance.The patient underwent surgery with resection of the mass which was sent for histopathology.Ectopic thyroid at the level of porta hepatis with nodules was the definitive diagnosis since histopathological report revealed presence of thyroid tissue in the resected liver mass.CONCLUSION This case delivers a rare insight of pre-operative radiological imaging of an ectopic thyroid located in the liver.These findings can aid in narrowing down potential differential diagnosis when managing a patient with those subsequent findings.
文摘<b>Introduction:</b> Clear Cell Myomelanocytic Tumor (CCMMT) of ligamentum teres hepatis is a pathological classification of Perivascular Epithelioid Cell tumor (PEComa), which is rare clinically and easy to misdiagnose. <b>Objective:</b> To report a case of a rare type of PEComa located in the ligamentum teres hepatis. <b>Case Report:</b> A 22-year-old Asian female was diagnosed with abdominal mass during physical examination in September 2018, and was admitted to the general surgery department of our hospital that month. She was diagnosed with abdominal mass, the nature of which remains to be determined is: teratoma, pheochromocytoma or ganglioma. At the time of admission, the patient had no symptoms or signs, and no other medical history. The patient was diagnosed with an abdominal mass by abdominal plain scan and enhanced CT, whose nature was to be determined: pheochromocytoma, paragangliomas or other mesenchymal tumors, or giant lymph node hyperplasia. The patient underwent abdominal mass resection and appendectomy without incident, without any complications at discharge, and there was no significant difference in follow-up. <b>Conclusions:</b> The clinical data, imaging features and pathological features of one patient diagnosed with CCMMT in our hospital were retrospectively analyzed, and the literature was reviewed in combination with the research progress of CCMMT, in order to improve the understanding and diagnostic accuracy of this disease.
