Background Recent advancement of liver transplantation technology and donor shortage has urged patients to have living donor liver transplantation. One of the issues is small-for-size graft syndrome, which is life-threatening with severe liver damage by excessively elevated portal pressure in an adult case and difficult to solve. Materials and Methods Twelve beagle dogs of about 1 year in age were randomly divided into Groups H (underwent 70% hepatectomy) and JH (70% hepatectomy after jejunectomy=50%proximal resection of the small intestine). Three dogs in each group were euthanized at 1 week after the operation and the remaining three dogs in each group at 4 weeks. We studied effects of the jejunectomy on the remnant liver after the massive hepatectomy with hemodynamic changes, liver functions, and liver histology. Results The portal pressure in Group JH (n=6) was significantly reduced one hour after the hepatectomy in comparison with that in Group A (n=6, p=0.002). Hepatic arterial flow was significantly higher in Group JH than in Group H (p=0.004). Subsequently, the total hepatic flow also rose to a higher value in Group JH than in Group A (p=0.037). Hepatic tissue flow was significantly higher in Group JH (p=0.025). On the earlier postoperative days, AST, ALT, ALB and AT3 of Group JH were significantly better than those of Group H. Histology of the remnant liver in the early phase showed significantly more swollen hepatocytes with subsequent more apoptotic cells in Group H than in Group JH. Conclusions Our results suggest that the portal pressure control by the jejunectomy can forestall liver dysfunction in small-for-size graft syndrome after living donor liver transplantation in adults.
Bleeding from esophagogastric varices is a catastrophic complication of chronic liver disease. We have been attempted surgery, embolization, and endoscopic treatment for the treatment of esophagogastric varices. Endoscopic injection sclerotherapy (EIS) is an established treatment for esophageal varices. EIS is associated with a high incidence of local and systemic complications. Endoscopic variceal ligation (EVL) is increasingly used because of its safety and simplicity and because no sclerosant is used. Nevertheless, EVL is not always effective, and early recurrences have been reported. Furthermore, most patients with esophageal varices treated endoscopically require treatment for recurrent varices. We invented that EVL performed three times at bimonthly intervals. EVL performed at bimonthly intervals for the treatment of esophageal varices attained a higher complete eradication rate, a lower recurrence rate, and a lower additional treatment rate. It is generally believed that bleeding from gastric varices is more severe than bleeding from esophageal varices, but bleeding from gastric varices occurs less commonly than from esophageal varices. The endoscopic risk factors for bleeding from esophageal varices include presence of raised red markings, cherry-red spots, blue color, and large size. However the risk factors for bleeding from gastric varices have yet to be characterized. Once gastric variceal hemorrhage did occur, bleeding from these varices was successfully stopped in all cases. Therefore, prophylactic treatment of gastric varices is not recommended.
Chymase, a protease of human mast cells, promotes myocardial and renal interstitial fibrosis by converting angiotensin I to angiotensin II. We established a method for measuring chymase in liver tissue and examined the relationship between chymase and fibrosis in livers of patients with chronic hepatitis or autoimmune disease. We found that chymase levels were higher in livers from patients with chronic hepatitis and more severe fibrosis and were higher in livers from patients with autoimmune disease than in livers from patients with acute hepatitis. When sections of livers from patients with chronic hepatitis or autoimmune disease were immunostained for chymase, immunoreactive mast cells were detected in portal areas and sinusoidal walls, coinciding with the zone of fibrosis. Thus, chymase appears to be involved in hepatic fibrosis in chronic liver diseases.
We present a case of hyperreactio luteinalis complicated by pedicle torsion at 30 weeks' gestation. The case was diagnosed as hyperreactio luteinalis on the basis of clinical findings and the presence of the D567G mutation.
In this study, the cul-de-sac fluid to serum hCG ratios in patients with ectopic pregnancy were examined. The cul-de-sac fluid to serum hCG ratios were>1 in 7 patients with ampullary pregnancy, while they were<1 in 3 patients with unruptured isthmic pregnancy. The cul-de-sac fluid to serum hCG ratio may be dependent on the location of the gestational product.
Double inferior vena cava is a congenital venous anomaly that is found at about 1% to 3% of routine autopsies and has been described in numerous reports over the years. According to Adachi (1940), it has an incidence of 1.4±0.34%. More recently, diagnostic imaging has revealed that double inferior vena cava tends to be found in patients with hydronephrosis and various other conditions. During routine anatomical practice at Nippon Medical School in 2000, a case of double inferior vena cava was observed in a Japanese woman who had died of subarachnoid hemorrhage at 66 years of age. Bilateral inferior venae cavae, left renal vein, and transiliac vein were found through dissection. These findings are supplemented by a discussion of the literature with respect to embryological studies, morphological classifications, and disease correlations.
Viral hepatitis is the most common cause of acute and chronic hepatitis. The term viral hepatitis generally refers to infections resulting from one of the hepatotrophic viruses: hepatitis A, B, C, D, or E. These viruses can be broadly divided into those transmitted via the fecal-oral route (hepatitis A and hepatitis E), and those by blood, blood products and body fluids (hepatitis B, C and D). Hepatitis A, B and C represent the major public health problems. In the case of HAV, older age groups (over 50) are now deemed at risk. Hepatitis E is rarely reported in Japan, and most Japanese patients have been recognized as an imported infection. Recently, however, the presence of indigenous HEV (genotypes III and IV) and its animal reservoirs have been disclosed in our country. The epidemiology of hepatitis B is changing in response to vaccination particularly in preventing vertical (maternal) transmission. Hepatitis C is another important cause of death worldwide. The infection easily becomes refractory and the chronicity contributes to the development of cirrhosis and hepatocellular carcinoma. Development of sensitive and specific immunoassays, as well as polymerase chain reaction for recognition of viral genes, has enabled detection of specific agents. This has allowed for identification of infected patients and monitoring response to therapy. Additionally, serologic markers have allowed for isolation of contaminated blood products and a reduction in the spread of disease. No approved test is available to diagnose hepatitis E. This article briefly explores the outline of the risk factors, epidemiology, clinical and laboratory characteristics, and treatment of the hepatotrophic viral infections.
A 50-year old woman complained of right wrist pain 7 years after surgery for breast cancer. Osteosclerosis of the scaphoid was recognized on X-ray film, and extension of the bone lesion to the lunate was revealed by magnetic resonance. Metastasis of breast cancer was strongly suggested by magnetic resonance, but the lesion was diagnosed as ischemic osteonecrosis of both the scaphoid and lunate on the basis of computed tomographic and radiographic findings. Since the wrist pain gradually increased, radial closing wedged osteotomy was performed. The wrist pain resolved postoperatively.