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Ji J, Ma Q, Tian Y, Shi X, Chen L, Zhu X, Yu D, Qiu Y, Li B. Effect of inferior vena cava respiratory variability-guided fluid therapy after laparoscopic hepatectomy: a randomized controlled clinical trial. Chin Med J (Engl) 2023. [PMID: 36752804 DOI: 10.1097/CM9.0000000000002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU). METHODS This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy. RESULTS Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D-lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups. CONCLUSION Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR. TRIAL REGISTRATION ChiCTR-INR-17013093.
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Almabayev Y, Salimgereeva B, Kamyspayev M, Yergazina M, Yermentayeva Z, Zhelderbayeva M, Dzhunusova R, Fakhradiyev I, Tanabayeva S. The Use of Newly Synthesized Composite Scaffolds for Bone Regeneration - A Review of Literature. Serbian Journal of Experimental and Clinical Research 2022; 0. [DOI: 10.2478/sjecr-2021-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
At present, clamping of the portal triad is a widespread surgical procedure in hospitals. Such an operation can prevent pathological changes in the organs. However, the optimal time for clamping remains unclear. To determine the starting time of irreversible morphological changes in the small intestine due to the clamping of the portal triad. The study was carried out on rats (n=94). Animals were randomly subdivided into 4 groups based on the duration of clamping of the portal triad (PT): I control group (CG; without clamping the PT; n=10); II intervention group (6-IG; clamping PT for 6 min; n=28); III intervention group (12-IG; clamping time of the PT for 12 min; n=28); IV intervention group (24-IG; clamping time of the PT for 24 min; n=28). In groups 6- IG, 12-IG, 24-IG, after clamping the portal triad, animals were withdrawn from the experiment after 3 hours, 6 hours, 12 hours, 1 day, 3 days and 7 days. Morphological changes in the small intestine were assessed by measuring the diameter of the lumen of micro-vessels. In addition, the mortality in the groups was analysed as well. In the CG group, the diameter of the arterioles of the small intestine was 34±4 μm, the diameters of pre-capillaries were 15±2μm, the capillaries were 5.4±1 μm, the post-capillaries were 18±2 μm, and the diameter of the lumen of the venues was 40±3 μm. In the 6-IG group (on the 3rd day), the structure of the small intestine showed the recovery signs. By the 7th day, the indicators returned to their original values. In the 12-IG group, the parameters of the small intestine were restored on the seventh day that corresponds to the usual course of the disease. However, in the 24-IG group, changes in these organs persisted until the end of the study. No deaths were reported in the CG and 6-IG animal groups. Mortality among rats of the 12-IG group was 14.3%, while in the 24-IG group with PT clamping for 24 minutes it was 42.8%, respectively. The morphological changes in the microvasculature of the small intestine after 6-minute PT clamping showed a tendency to recover (back to the control parameters). Nevertheless, after 24 minutes of clamping, the changes in the intestinal tissue were irreversible.
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Ypsilantis P, Lambropoulou M, Karayiannakis A, Zacharoulis D, Passos I, Smyrlis C, Charisis C, Ypsilantis K, Pitiakoudis M. Gut Barrier Disruption Secondary to Radiofrequency-Assisted Liver Parenchyma Resection in a Porcine Model. J Gastrointest Surg 2022; 26:1881-1889. [PMID: 35676456 DOI: 10.1007/s11605-022-05370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiofrequency-assisted liver resection (RF-LR) techniques minimize intraoperative blood loss, while avoiding the Pringle maneuver. Both surgical excision and radiofrequency ablation of liver parenchyma compromise gut barrier function with subsequent bacterial translocation. The present study sought to investigate in a porcine model the impact of two RF-LR techniques on the integrity and inflammatory response of the gut barrier. METHODS Twenty-four pigs were subjected to either (a) partial hepatectomy (PH) employing the "sequential coagulate-cut" technique using a monopolar electrode (SCC group), the one using the bipolar Habib-4X device (group H), or the "crush-clamp" technique (group CC) or (b) sham operation (group Sham). At 48-h post-operation, ileal tissue was excised to be subjected to histopathologic examination, histomorphometric analysis, and immunohistochemical assessment of the mitotic and apoptotic activities and the expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNFα), and nuclear factor-κB (NFκΒ). RESULTS Histopathologic score increased in all PH groups, being higher in group SCC, while lower in group H. Villous height decreased in group SCC only. Mitotic index decreased, while apoptotic index increased in all PH groups. An increase in tissue expression score was noted for IL-6 in group CC, for TNFα in all PH groups, being lower in group H compared to group CC, and for NFκB in all PH groups. CONCLUSIONS The Habib-4X technique for liver resection proved to preserve the integrity of gut barrier, being less injurious in the intestinal mucosa compared to the SCC and CC techniques.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anastasios Karayiannakis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | | | - Ioannis Passos
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Christos Smyrlis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Christos Charisis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Konstantinos Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
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Manning MW, Kumar PA, Maheshwari K, Arora H. Post-Reperfusion Syndrome in Liver Transplantation—An Overview. J Cardiothorac Vasc Anesth 2020; 34:501-511. [DOI: 10.1053/j.jvca.2019.02.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/15/2019] [Accepted: 02/28/2019] [Indexed: 01/13/2023]
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Pietersen LC, Sarton E, Alwayn I, Lam HD, Putter H, van Hoek B, Braat AE. Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation. Liver Transpl 2019; 25:1690-1699. [PMID: 31276282 DOI: 10.1002/lt.25592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/06/2019] [Indexed: 01/13/2023]
Abstract
The use of a temporary portocaval shunt (TPCS) as well as the order of reperfusion (initial arterial reperfusion [IAR] versus initial portal reperfusion) in orthotopic liver transplantation (OLT) is controversial and, therefore, still under debate. The aim of this study was to evaluate outcome for the 4 possible combinations (temporary portocaval shunt with initial arterial reperfusion [A+S+], temporary portocaval shunt with initial portal reperfusion, no temporary portocaval shunt with initial arterial reperfusion, and no temporary portocaval shunt with initial portal reperfusion) in a center-based cohort study, including liver transplantations (LTs) from both donation after brain death and donation after circulatory death (DCD) donors. The primary outcome was the perioperative transfusion of red blood cells (RBCs), and the secondary outcomes were operative time and patient and graft survival. Between January 2005 and May 2017, all first OLTs performed in our institution were included in the 4 groups mentioned. With IAR and TPCS, a significantly lower perioperative transfusion of RBCs was seen (P < 0.001) as well as a higher number of recipients without any transfusion of RBCs (P < 0.001). A multivariate analysis showed laboratory Model for End-Stage Liver Disease (MELD) score (P < 0.001) and IAR (P = 0.01) to be independent determinants of the transfusion of RBCs. When comparing all groups, no statistical difference was seen in operative time or in 1-year patient and graft survival rates despite more LTs with a liver from a DCD donor in the A+S+ group (P = 0.005). In conclusion, next to a lower laboratory MELD score, the use of IAR leads to a significantly lower need for perioperative blood transfusion. There was no significant interaction between IAR and TPCS. Furthermore, the use of a TPCS and/or IAR does not lead to increased operative time and is therefore a reasonable alternative surgical strategy.
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Affiliation(s)
- Lars Cornelis Pietersen
- Division of Transplantation, Departments of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Elise Sarton
- Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ian Alwayn
- Division of Transplantation, Departments of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hwai-Ding Lam
- Division of Transplantation, Departments of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hein Putter
- Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart van Hoek
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Andries Erik Braat
- Division of Transplantation, Departments of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Subasi O, Yildiz SY, Yuksel A, Coskun M, Turgut HT, Yildiz E. The effect of immunonutrition on bacterial translocation after Pringle maneuverer in rats. Prz Gastroenterol 2019; 14:178-82. [PMID: 31649788 DOI: 10.5114/pg.2019.88166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/16/2019] [Indexed: 11/17/2022]
Abstract
Introduction Temporary clamping of the hepatoduodenal ligament (the Pringle manoeuvre) is the most commonly used method to prevent intraoperative blood loss in liver surgery. Some side effects of the Pringle manoeuvre (PM) can occur. Aim To investigate the effectiveness of preoperative immunonutritional support to prevent bacterial translocation (BT) in rats due to PM. Material and methods Forty Wistar albino rats were randomly divided into four groups. Groups 1 and 2 were fed with normal rat diet and water, and groups 3 and 4 were fed with enteral immunonutrition (Impact Glutamine) containing 1 g/kg/day amino acid in the preoperative period. Group 1 (n = 10) and 4 (n = 10) rats were treated only with laparotomy; group 2 (n = 10) and 3 (n = 10) rats were treated with PM for 30 min with laparotomy. After 30 min, relaparotomy was applied to all groups and portal blood, mesentery, spleen samples were taken for culture purposes. Results Proliferation in portal blood cultures was significantly higher in the samples from the normally fed group (group 2) in whom PM was applied, compared to the other groups (p < 0.001). No proliferation was observed in the PM-treated group (group 3), who also received preoperative immunonutritional support. Conclusions Preoperative immunonutritional support is effective in the prevention of BT due to PM in rats.
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Affiliation(s)
- Lucinda Shen
- Department of Translational Physiology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Zühre Uz
- Department of Translational Physiology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Experimental Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Can Ince
- Department of Translational Physiology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Thomas van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Jansen-Winkeln B, Tagkalos E, Heimann A, Gaiser T, Hirsch D, Gockel I, Mittler J, Lang H, Heinrich S. Pringle maneuver increases the risk of anastomotic leakage after colonic resection in rats. HPB (Oxford) 2018; 20:392-397. [PMID: 29306581 DOI: 10.1016/j.hpb.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/29/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many centers use the Pringle's maneuver during liver resections. Since this maneuver might impair healing of bowel anastomoses, we evaluated its influence on the healing of colonic anastomosis in rats. METHODS Male Wistar rats underwent median laparotomy and sigmoid resection with end-to-end anastomosis under inhalation anesthesia. Thereafter, rats received a 25 minutes Pringle's maneuver (PM, group 1) or were kept under anesthesia for the same period of time (group 2). The anastomotic bursting pressure (BP) was measured on postoperative days (POD) 3, 6 and 9. Hematoxylin and Eosin (H&E) staining was used for histopathological evaluation of the anastomosis. The Mann-Whitney U and χ2 -tests were used, p<0.05 values were considered significant. RESULTS All animals (n=48) lost body weight (BW) until POD3 (95.2% vs. 85.7%, p=0.003), and BW remained lower after PM (106.2% vs. 92.8%, p=0.001). The anastomotic BP was lower in group 1 compared to group 2 on POD 3 (116mmHg vs. 176.28mmHg, p=0.001), POD 6 (182.8mmHg vs. 213mmHg, p=0.029) and POD 9 (197.2mmHg vs. 251.7mmHg, p=0.009), and mortality was higher in group 1 (1 vs. 7, p=0.022). CONCLUSIONS Pringle's maneuver increases anastomotic complications in rats. Therefore, a Pringle's maneuver should be avoided during simultaneous liver and colorectal surgery.
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Affiliation(s)
- Boris Jansen-Winkeln
- Department of General, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Evangelos Tagkalos
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Axel Heimann
- Institute for Neurosurgical Pathophysiology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Timo Gaiser
- Department of Pathology, University Hospital Mannheim, Mannheim, Germany
| | - Daniela Hirsch
- Department of Pathology, University Hospital Mannheim, Mannheim, Germany
| | - Ines Gockel
- Department of General, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Jens Mittler
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Stefan Heinrich
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany.
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9
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Rayar M, Levi Sandri GB, Cusumano C, Locher C, Houssel-Debry P, Camus C, Lombard N, Desfourneaux V, Lakehal M, Meunier B, Sulpice L, Boudjema K. Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis. Liver Transpl 2017; 23:174-183. [PMID: 27706895 DOI: 10.1002/lt.24650] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023]
Abstract
During orthotopic liver transplantation (OLT), clamping of the portal vein induces splanchnic venous congestion and accumulation of noxious compounds. These adverse effects could increase ischemia/reperfusion injury and subsequently the risk of graft dysfunction, especially for grafts harvested from extended criteria donors (ECDs). Temporary portocaval shunt (TPCS) could prevent these complications. Between 2002 and 2013, all OLTs performed in our center were retrospectively analyzed and a propensity score matching analysis was used to compare the effect of TPCS in 686 patients (343 in each group). Patients in the TPCS group required fewer intraoperative transfusions (median number of packed red blood cells-5 versus 6; P = 0.02; median number of fresh frozen plasma-5 versus 6; P = 0.02); had improvement of postoperative biological parameters (prothrombin time, Factor V, international normalized ratio, alkaline phosphatase, and gamma-glutamyltransferase levels); and showed significant reduction of biliary complications (4.7% versus 10.2%; P = 0.006). Survival analysis revealed that TPCS improved 3-month graft survival (94.2% versus 88.6%; P = 0.01) as well as longterm survival of elderly (ie, age > 70 years) donor grafts (P = 0.02). In conclusion, the use of TPCS should be recommended especially when considering an ECD graft. Liver Transplantation 23 174-183 2017 AASLD.
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Affiliation(s)
- Michel Rayar
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Giovanni B Levi Sandri
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Caterina Cusumano
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Clara Locher
- Service de Pharmacologie Clinique et Épidémiologique, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Pauline Houssel-Debry
- Service des Maladies du Foie, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Christophe Camus
- Réanimation Médicale, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France
| | - Nicolas Lombard
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Veronique Desfourneaux
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Mohamed Lakehal
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Bernard Meunier
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Laurent Sulpice
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
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Olthof PB, Huiskens J, Schulte NR, Wicherts DA, Besselink MG, Busch ORC, Tanis PJ, van Gulik TM. Hepatic vascular inflow occlusion is associated with reduced disease free survival following resection of colorectal liver metastases. Eur J Surg Oncol 2016; 43:100-106. [PMID: 27692534 DOI: 10.1016/j.ejso.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/19/2016] [Accepted: 09/02/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatic vascular inflow occlusion (VIO) can be applied during resection of colorectal liver metastases (CRLM) to control intra-operative blood loss, but has been linked to accelerated growth of micrometastases in experimental models. This study aimed to investigate the effects of hepatic VIO on disease-free and overall survival (DFS and OS) in patients following resection for CRLM. METHODS All patients who underwent liver resection for CRLM between January 2006 and September 2015 at our center were analyzed. Hepatic VIO was performed if deemed indicated by the operating surgeon and severe ischemia was defined as ≥20 min continuous or ≥45 min cumulative intermittent VIO. Cox regression analysis was performed to identify predictive factors for DFS and OS. RESULTS A total of 208 patients underwent liver resection for CRLM. VIO was performed in 64 procedures (31%), and fulfilled the definition of severe ischemia in 40 patients. Patients with severe ischemia had inferior DFS (5-year DFS 32% vs. 11%, P < 0.01), and inferior OS (5-year OS 37% vs. 64%, P < 0.01). At multivariate analysis, a high clinical risk score (Hazard ratio (HR) 1.60 (1.08-2.36)) and severe ischemia (HR 1.89 (1.21-2.97)) were independent predictors of worse DFS. Severe ischemia was not an independent predictor of OS. CONCLUSION The present cohort study suggests that prolonged hepatic VIO during liver resection for CRLM was associated with reduced DFS. A patient-tailored approach seems advisable although larger studies should confirm these findings.
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Affiliation(s)
- P B Olthof
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - J Huiskens
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - N R Schulte
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - D A Wicherts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - O R C Busch
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - T M van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Fayed NA, Sayed EI, Saleh SM, Ehsan NA, Elfert AY. Effect of dexmedetomidine on hepatic ischemia-reperfusion injury in the setting of adult living donor liver transplantation. Clin Transplant 2016; 30:470-82. [DOI: 10.1111/ctr.12713] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Nirmeen A. Fayed
- Anesthesia and Intensive Care; National Liver Institute; Menoufia University; ShebeenAlkoom Menoufia Egypt
| | - Eman I. Sayed
- Anesthesia and Intensive Care; National Liver Institute; Menoufia University; ShebeenAlkoom Menoufia Egypt
| | - Sherif M. Saleh
- Hepatobiliary Surgery; National Liver Institute; Menoufia University; ShebeenAlkoom Menoufia Egypt
| | - Nermen A. Ehsan
- Pathology; National Liver Institute; Menoufia University; ShebeenAlkoom Menoufia Egypt
| | - Ashraf Y. Elfert
- Clinical Biochemistry; National Liver Institute; Menoufia University; ShebeenAlkoom Menoufia Egypt
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12
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Kolahdoozan M, Behdad A, Hosseinpour M, Behdad S, Rezaei MT. Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits. Arch Trauma Res 2016; 4:e30244. [PMID: 26848477 PMCID: PMC4733517 DOI: 10.5812/atr.30244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/31/2015] [Accepted: 09/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle's maneuver), continuous prolonged clamping results in liver ischemia. OBJECTIVES The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models. MATERIALS AND METHODS In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers. RESULTS There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation. CONCLUSIONS Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.
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Affiliation(s)
- Mohsen Kolahdoozan
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Akbar Behdad
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mehrdad Hosseinpour
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Samin Behdad
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Samin Behdad, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540026, Fax: +98-36262828, E-mail:
| | - Mohammad Taghi Rezaei
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Nastos C, Kalimeris K, Papoutsidakis N, Defterevos G, Pafiti A, Kalogeropoulou E, Zerva L, Nomikos T, Papalois A, Kostopanagiotou G, Smyrniotis V, Arkadopoulos N. Bioartificial liver attenuates intestinal mucosa injury and gut barrier dysfunction after major hepatectomy: Study in a porcine model. Surgery 2016; 159:1501-1510. [PMID: 26847802 DOI: 10.1016/j.surg.2015.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/20/2015] [Accepted: 12/09/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether bioartificial liver support can attenuate gut mucosa injury in a porcine model of posthepatectomy liver dysfunction. METHODS Posthepatectomy liver failure was induced in pigs combining major (70%) liver resection and ischemia/reperfusion injury. An ischemic period of 150 minutes was followed by reperfusion for 24 hours. Animals were divided randomly into 2 groups: a control group (n = 6) that received standard critical care and a bioartificial liver support group (Hepat, n = 6) that were subjected to extracorporeal liver support for 6 hours during reperfusion. Intestinal mucosal injury, bacterial translocation, and endotoxin translocation were evaluated in all animals. Intestinal mucosa was also evaluated with markers of oxidative injury and immunohistochemical staining for caspase 3. RESULTS When compared with median values, the control group, animals in the Hepat group had a lesser intestinal mucosal injury score (4.0 [range:2.0-5.0] vs 1.0 [range:1.0-2.0]; P < .01), decreased bacterial translocation in the portal and the systemic circulation at 24 hours of reperfusion (P < .05), and decreased portal and systemic endotoxin levels at 24 hours (P < .05). At 24 hours after reperfusion, mucosal protein carbonyls and malondialdehyde levels were decreased in Hepat animals (0.57 nmol/mg [range:0.32-0.70] vs 0.33 nmol/mg [range:0.03-0.53] and 3.85 nmol/mg [range:3.01-6.43] vs 3.27 nmol/mg [range:1.46-3.55], respectively; P < .05). There was no difference in tissue caspase staining. CONCLUSION Bioartificial liver support seems to attenuate intestinal mucosal injury and gut barrier dysfunction after major hepatectomy.
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Affiliation(s)
- Constantinos Nastos
- Second Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece.
| | - Konstantinos Kalimeris
- Second Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Papoutsidakis
- Second Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Defterevos
- Second Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece
| | - Agathi Pafiti
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece
| | | | - Loukia Zerva
- Laboratory of Biopathology, Attikon University Hospital, Athens, Greece
| | - Tzortzis Nomikos
- Department of the Science Nutrition - Dietetics, Harokopio University, Athens, Greece
| | | | - Georgia Kostopanagiotou
- Second Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vasillios Smyrniotis
- Fourth Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Arkadopoulos
- Fourth Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Chi X, Yao W, Xia H, Jin Y, Li X, Cai J, Hei Z. Elevation of HO-1 Expression Mitigates Intestinal Ischemia-Reperfusion Injury and Restores Tight Junction Function in a Rat Liver Transplantation Model. Oxid Med Cell Longev 2015; 2015:986075. [PMID: 26064429 DOI: 10.1155/2015/986075] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/26/2015] [Indexed: 12/17/2022]
Abstract
Aims. This study was aimed at investigating whether elevation of heme oxygenase-1 (HO-1) expression could lead to restoring intestinal tight junction (TJ) function in a rat liver transplantation model. Methods. Intestinal mucosa injury was induced by orthotopic autologous liver transplantation (OALT) on male Sprague-Dawley rats. Hemin (a potent HO-1 activator) and zinc-protoporphyrin (ZnPP, a HO-1 competitive inhibitor), were separately administered in selected groups before OALT. The serum and intestinal mucosa samples were collected at 8 hours after the operation for analysis. Results. Hemin pretreatment significantly reduced the inflammation and oxidative stress in the mucosal tissue after OALT by elevating HO-1 protein expression, while ZnPP pretreatment aggravated the OALT mucosa injury. Meanwhile, the restriction on the expression of tight junction proteins zonula occludens-1 and occludin was removed after hemin pretreatment. These molecular events led to significant improvement on intestinal barrier function, which was proved to be through increasing nuclear translocation of nuclear factor-E2-related factor 2 (Nrf2) and reducing nuclear translocation of nuclear factor kappa-B (NF-κB) in intestinal injured mucosa. Summary. Our study demonstrated that elevation of HO-1 expression reduced the OALT-induced intestinal mucosa injury and TJ dysfunction. The HO-1 protective function was likely mediated through its effects of anti-inflammation and antioxidative stress.
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15
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Kageyama S, Hata K, Tanaka H, Hirao H, Kubota T, Okamura Y, Iwaisako K, Takada Y, Uemoto S. Intestinal ischemic preconditioning ameliorates hepatic ischemia/reperfusion injury in rats: role of heme oxygenase 1 in the second window of protection. Liver Transpl 2015; 21:112-22. [PMID: 25234134 DOI: 10.1002/lt.24006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 01/12/2023]
Abstract
Preconditioning by brief ischemia protects not only the concerned organ but also other distant organs against subsequent lethal damage; this is called remote ischemic preconditioning (RIPC). This study was designed to investigate the impact of intestinal RIPC on hepatic ischemia/reperfusion injury (IRI) with a special interest in heme oxygenase 1 (HO-1) induction in the second window of protection (SWOP). Male Wistar rats were randomly assigned to 1 of 2 groups: an RIPC group or a sham group. Before hepatic IRI, either intestinal RIPC, consisting of 2 cycles of 4-minute superior mesenteric artery clamping separated by 11 minutes of declamping (RIPC group), or a sham procedure (sham group) was performed. After 48 hours of recovery, the rats were exposed to 30 minutes of total hepatic IRI. Transaminase releases and proinflammatory cytokines were determined at several time points after reperfusion. Histopathological analysis and animal survival were also investigated. Intestinal RIPC significantly lowered transaminase release (alanine aminotransferase at 2 hours: 873.3 ± 176.4 IU/L for the RIPC group versus 3378.7 ± 871.1 IU/L for the sham group, P < .001) as well as proinflammatory cytokine production (tumor necrosis factor α at 2 hours: 930 ± 42 versus 387 ± 17 pg/μL, P < .001). The morphological integrity of the liver and the ileum was maintained significantly better with intestinal RIPC; this reached statistical significance not only in Suzuki's liver injury score (3.5 ± 0.2 versus 0.7 ± 0.5, P = .007) but also in Park's score for intestinal damage (4.0 ± 0.4 versus 2.0 ± 0.2, P = .007). Animal survival was also markedly improved (83.1% versus 15.4%, P < .001). As a mechanism underlying this protection, HO-1 was substantially induced in liver tissue, especially in hepatocytes, with remarkable up-regulation of bradykinin in the portal blood, whereas HO-1 protein induction in enterocytes was not significant. In conclusion, intestinal RIPC remarkably attenuates hepatic IRI in the SWOP, presumably by HO-1 induction in hepatocytes.
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Affiliation(s)
- Shoichi Kageyama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
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16
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Leng J, Xing H, Tan J, Chen K, Dong J. The safe minimally ischemic liver remnant for small-for-size syndrome in porcine hepatectomy. Transplant Proc 2013; 45:2419-24. [PMID: 23953558 DOI: 10.1016/j.transproceed.2012.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/30/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The minimal functional remnant liver mass or graft after an ischemic injury in hepatectomy or living donor liver transplantation (LDLT) is not clear. This study sought to determine the minimal remnant liver (MRL) size after 20 minutes hepatic inflow occlusion (HIO) and the maximal portal flow with which the liver remnant can sustain in a porcine model. METHODS Twenty pigs that underwent massive hepatectomy were randomly divided into 3 groups: 30% group, the remnant constituted about 30% of total liver volume (TLV); 35%+O group, the remnant constitute about 35% of TLV with 20 minutes HIO, and 30%+O group, the remnant constituted about 30% of TLV with 20 minutes of HIO. We evaluated survival rates, kinetic portal vein pressures (PVP), hemodynamics, hepatocyte metabolism, and injury. RESULTS The 14-day survival rate in the 30%+O group was significantly reduced compared with that of either the 30% group or the 35%+O group: l00% versus 28.6% versus 85.7% respectively (P = .009). The tissue, serum analyses, and PVP in the 30%+O group were significantly different compared with the measurements among the other groups (P < .05), revealing that the liver remnant in 30%+O group could not sustain more than 3 times baseline portal flow, whereas in 35%+O group it could sustain 2.8 times baseline portal flow. CONCLUSIONS Intraoperative ischemia can injure the sinusoidal endothelium, decreasing its ability to regulate portal hyperperfusion, causing less than 30% to 35% of TLV to show small-for-size syndrome or postoperative liver failure.
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Nastos C, Kalimeris K, Papoutsidakis N, Tasoulis MK, Lykoudis PM, Theodoraki K, Nastou D, Smyrniotis V, Arkadopoulos N. Global consequences of liver ischemia/reperfusion injury. Oxid Med Cell Longev 2014; 2014:906965. [PMID: 24799983 DOI: 10.1155/2014/906965] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/02/2014] [Accepted: 01/13/2014] [Indexed: 12/11/2022]
Abstract
Liver ischemia/reperfusion injury has been extensively studied during the last decades and has been implicated in the pathophysiology of many clinical entities following hepatic surgery and transplantation. Apart from its pivotal role in the pathogenesis of the organ's post reperfusion injury, it has also been proposed as an underlying mechanism responsible for the dysfunction and injury of other organs as well. It seems that liver ischemia and reperfusion represent an event with “global” consequences that influence the function of many remote organs including the lung, kidney, intestine, pancreas, adrenals, and myocardium among others. The molecular and clinical manifestation of these remote organs injury may lead to the multiple organ dysfunction syndrome, frequently encountered in these patients. Remote organ injury seems to be in part the result of the oxidative burst and the inflammatory response following reperfusion. The present paper aims to review the existing literature regarding the proposed mechanisms of remote organ injury after liver ischemia and reperfusion.
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18
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Pessaux P, van den Broek MAJ, Wu T, Olde Damink SWM, Piardi T, Dejong CHC, Ntourakis D, van Dam RM. Identification and validation of risk factors for postoperative infectious complications following hepatectomy. J Gastrointest Surg 2013; 17:1907-16. [PMID: 23661000 DOI: 10.1007/s11605-013-2226-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/29/2013] [Indexed: 02/07/2023]
Abstract
UNLABELLED Postoperative infectious complications (PICs) are associated with significant morbidity after abdominal surgery. Using multivariate analysis of data from a prospective database, our study focused on the risk factors for PICs and the prevention of these complications after hepatectomy, with the goal of improving outcomes and reducing the length of hospital stays. BACKGROUND PICs following surgery are associated with significant morbidity, increase the length of hospital stays, and have a negative impact on long-term oncological outcome. The aim of this study was to determine the risk factors for PICs following partial hepatectomy and to validate these results with an external database. METHODS Between January 2006 and December 2009, 555 patients underwent elective partial hepatectomy. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. The dependent variables studied were the occurrence of PICs, defined as development of one or more of the following conditions: pneumonia, sepsis, Central line-associated bloodstream infection, urinary tract infection, wound infection, and infected intra-abdominal fluid collection. PICs were devised in medical (PIMCs) and surgical (PISCs) complications. The incidence of PICs and validation of the predictive score were determined using an external prospective database of 342 patients. RESULTS The multivariate analysis identified three independent risk factors for PICs: the presence of a nasogastric tube (OR = 1.8), blood transfusion (OR = 1.9), and diabetes (OR = 2.4). The multivariate analysis identified only one independent risk factor for PISCs: an associated portal venous resection (OR = 5.5). The multivariate analysis identified four independent risk factors for PIMCs: presence of a biliary drainage (OR = 1.9), blood transfusion (OR = 2.1), diabetes (OR = 2.9), and presence of atrial fibrillation (OR = 3.6). According to the three predictive factors, the observed rates of PICs ranged from 18.8 % to 77.8 % and ranged from 24.2 % to 100 % in the external database. Predicted and observed risks of PICs were not statistically different. CONCLUSIONS The correction of modifiable risk factors among the identified factors could reduce the incidence of PICs and, as a consequence, improve patient outcomes and reduce the length of hospital stays.
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Affiliation(s)
- Patrick Pessaux
- Department of Hepato-Biliary and Pancreatic Surgery, Nouvel Hopital Civil, Université de Strasbourg, IHU MixSurg, IRCAD, 1 place de l'hôpital, 67091, Strasbourg, France,
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19
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Abstract
Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a potent mitogen and chemotactic factor. HB-EGF attenuates intestinal ischemia/reperfusion injury caused by superior mesenteric artery occlusion. We examined whether HB-EGF offers protection against intestinal congestion/reperfusion (C/R) injury, which is caused by portal triad clamping. Male Sprague-Dawley rats were randomly divided into three equally sized groups: I, sham-operated; II, portal triad clamping (Pringle maneuver); III, II + intraluminal administration of HB-EGF. Compared with sham-operated rats, all rats in group II exhibited significant increases in intestinal histologic injury, pro-inflammatory cytokine expression, myeloperoxidase activity, malonaldehyde levels, and apoptosis indices. Intraluminal administration of HB-EGF in group III significantly reduced these indicators when compared with group II. Clamping of the portal triad followed by reperfusion causes intestinal C/R injury and intraluminal administration of HB-EGF reduces the severity of intestinal C/R injury in rats.
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Affiliation(s)
- Xinxin Liao
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Republic of China
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20
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Narita M, Oussoultzoglou E, Fuchshuber P, Chenard MP, Rosso E, Yamamoto K, Jaeck D, Bachellier P. Prolonged Portal Triad Clamping Increases Postoperative Sepsis after Major Hepatectomy in Patients with Sinusoidal Obstruction Syndrome and/or Steatohepatitis. World J Surg 2012; 36:1848-57. [DOI: 10.1007/s00268-012-1565-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Dello SAWG, Reisinger KW, van Dam RM, Bemelmans MHA, van Kuppevelt TH, van den Broek MAJ, Olde Damink SWM, Poeze M, Buurman WA, Dejong CHC. Total intermittent Pringle maneuver during liver resection can induce intestinal epithelial cell damage and endotoxemia. PLoS One 2012; 7:e30539. [PMID: 22291982 PMCID: PMC3265485 DOI: 10.1371/journal.pone.0030539] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/18/2011] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The intermittent Pringle maneuver (IPM) is frequently applied to minimize blood loss during liver transection. Clamping the hepatoduodenal ligament blocks the hepatic inflow, which leads to a non circulating (hepato)splanchnic outflow. Also, IPM blocks the mesenteric venous drainage (as well as the splenic drainage) with raising pressure in the microvascular network of the intestinal structures. It is unknown whether the IPM is harmful to the gut. The aim was to investigate intestinal epithelial cell damage reflected by circulating intestinal fatty acid binding protein levels (I-FABP) in patients undergoing liver resection with IPM. METHODS Patients who underwent liver surgery received total IPM (total-IPM) or selective IPM (sel-IPM). A selective IPM was performed by selectively clamping the right portal pedicle. Patients without IPM served as controls (no-IPM). Arterial blood samples were taken immediately after incision, ischemia and reperfusion of the liver, transection, 8 hours after start of surgery and on the first post-operative day. RESULTS 24 patients (13 males) were included. 7 patients received cycles of 15 minutes and 5 patients received cycles of 30 minutes of hepatic inflow occlusion. 6 patients received cycles of 15 minutes selective hepatic occlusion and 6 patients underwent surgery without inflow occlusion. Application of total-IPM resulted in a significant increase in I-FABP 8 hours after start of surgery compared to baseline (p<0.005). In the no-IPM group and sel-IPM group no significant increase in I-FABP at any time point compared to baseline was observed. CONCLUSION Total-IPM in patients undergoing liver resection is associated with a substantial increase in arterial I-FABP, pointing to intestinal epithelial injury during liver surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT01099475.
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Affiliation(s)
- Simon A W G Dello
- Department of Surgery, Maastricht University Medical Center & Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
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Ellett JD, Atkinson C, Evans ZP, Amani Z, Balish E, Schmidt MG, Schnellmann RG, Chavin KD. Toll-like receptor 4 knockout mice are protected from endothelial overactivation in the absence of Kupffer cells after total hepatic ischemia/reperfusion. Liver Transpl 2011; 17:1089-98. [PMID: 21563297 PMCID: PMC3960597 DOI: 10.1002/lt.22333] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Kupffer cells (KCs) have been shown to be critical mediators of ischemia/reperfusion (I/R) injury in the murine liver. Using liposomal clodronate (LC), we found that KCs were protective in models of total hepatic ischemia with bowel congestion. We investigated the role of toll-like receptor 4 (TLR4) in the damage that occurs after I/R in KC-depleted livers. We injected 8-week-old C57BL/10J mice and C57BL/10ScN [toll-like receptor 4 knockout (TLR4KO)] mice with LC 48 hours before 35 minutes of warm hepatic ischemia with bowel congestion, which was followed by either 6 or 24 hours of reperfusion. The KC-depleted animals had increased mortality as well as a 10-fold increase in their aminotransferase levels that correlated with increases in centrilobular necrosis. These changes were absent in the TLR4KO animals. Lipopolysaccharide was bound extensively to endothelial cells after I/R, and this binding was diminished in the TLR4KO animals. In conjunction with this, there was an up-regulation of endothelial cell adhesion molecules in the LC-treated animals that was absent in the TLR4KO animals. Finally, there was a dramatic increase in the proinflammatory cytokine levels of the LC-treated animals, and the TLR4KO animals were protected against this increase. In conclusion, TLR4 promotes endothelial overactivation after I/R in the absence of KCs.
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Affiliation(s)
- Justin D Ellett
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC29425
| | - Carl Atkinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC29425
| | - Zachary P Evans
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC29425
| | - Zainab Amani
- Department of Surgery, Medical University of South Carolina, Charleston, SC29425
| | - Edward Balish
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC29425
| | - Michael G Schmidt
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC29425
| | - Rick G Schnellmann
- Department of Pharmaceutical and Biomedical Sciences, Medical University of South Carolina, Charleston, SC29425
| | - Kenneth D Chavin
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC29425,Department of Surgery, Medical University of South Carolina, Charleston, SC29425,To whom correspondence should be addressed and location where work was performed: Kenneth D Chavin, MD, PhD, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 409, Charleston, SC 29425, Phone (843) 792-3368, Fax (843) 792-8596,
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Ypsilantis P, Lambropoulou M, Grapsa A, Tentes I, Tsigalou C, Panopoulou M, Simopoulos C. Pringle maneuver deteriorates gut barrier dysfunction induced by extended-liver radiofrequency ablation. Dig Dis Sci 2011; 56:1548-56. [PMID: 20972849 DOI: 10.1007/s10620-010-1462-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 10/06/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Large volume radiofrequency ablation (RFA) of the liver disrupts intestinal mucosa barrier with subsequent bacterial translocation. AIMS To investigate the effect of the Pringle maneuver applied concurrently with extended liver RFA on gut barrier integrity and bacterial translocation. MATERIALS AND METHODS Rats were subjected to 30% liver RFA following laparotomy (group RFA), RFA plus 30 min Pringle (group RFA + P), Pringle (group P) or sham operation (group S). Intestinal tissue specimens were excised for histopathological examination and assessment of mucosal morphometry, apoptotic activity, mitotic activity and oxidative state. Tissue specimens were collected from the mesenteric lymph nodes, non-ablated liver parenchyma, kidneys and lungs for bacterial culture. Blood samples were collected from the portal and systemic circulation for endotoxin level measurement. RESULTS In group RFA + P, intestinal histopathologic lesions, mucosal atrophy and crypt cell apoptosis were more prominent compared to group RFA. Mitotic activity was suppressed. Oxidative stress was equally induced in all experimental groups. The incidence of positive bacterial cultures, bacterial counts and endotoxin levels were higher in group RFA + P compared to the other groups. CONCLUSION The application of the Pringle maneuver concurrently with extended liver RFA aggravates gut barrier dysfunction with more aggressive translocation of endotoxins and intestinal bacteria.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece.
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Vincenti M, Behrends M, Dang K, Park YH, Hirose R, Blasi-Ibanez A, Liu T, Serkova NJ, Niemann CU. Induction of intestinal ischemia reperfusion injury by portal vein outflow occlusion in rats. J Gastroenterol 2010; 45:1103-10. [PMID: 20549254 DOI: 10.1007/s00535-010-0262-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 05/12/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intestinal ischemia can occur from mesenteric artery (MA) occlusion and portal vein (PV) occlusion. The degree and mechanisms of ischemia/reperfusion (I/R) injury in these conditions may differ. Metabolic changes are seen early in I/R. This study compares tissue histology, inflammation, and metabolic response during small bowel I/R due to superior MA or PV occlusion. METHODS Anesthetized male Wistar rats (250-300 g) underwent laparotomy followed by MA or PV occlusion for 40 min. After 120 min of reperfusion, small bowel tissue was collected. The expression of heat shock protein (HSP)-32 and HSP70 was evaluated to compare physiological stress responses between groups. Metabolic profiles were obtained using (1)H-nuclear magnetic resonance spectroscopy (NMR)-based quantitative metabolomics. Histological injury of small bowel was graded from 0 (normal) to 4 (extensive ischemic damage). RESULTS Protein expression of HSP32 and HSP70 increased when compared to sham but was not different in the MA I/R and PV I/R groups. Metabolic profiles demonstrated decreased glucose levels and highly elevated tissue lactate and amino acids and fatty acids following I/R, with more pronounced changes with PV occlusion. Lipid peroxidation was equally increased in both groups, while depletion of reduced glutathione (GSH) was more severe with MA occlusion. The epithelial necrosis score was higher with MA (3.5 ± 0.6) than with PV occlusion (2.3 ± 0.8). CONCLUSIONS Histological injury of the intestine is less pronounced following PV occlusion, most likely due to higher oxygen and substrate availability during I/R by PV occlusion. This conclusion is supported by a more pronounced metabolic synthetic response (increased glycolysis and fatty acid and amino acid accumulation) with PV occlusion, while oxidative stress was higher with MA occlusion. The inflammatory response showed little difference between the groups.
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Affiliation(s)
- Marco Vincenti
- Department of Surgery, Division of Transplantation, University of California, San Francisco, CA 94143-0648, USA
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Tralhão JG, Hoti E, Oliveiros B, Abrantes AM, Botelho MF, Castro-Sousa F. Intermittent pringle maneuver and hepatic function: perioperative monitoring by noninvasive ICG-clearance. World J Surg 2009; 33:2627-34. [PMID: 19760319 DOI: 10.1007/s00268-009-0204-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intermittent Pringle maneuver or selective portal clamping often are used to control inflow during parenchymal liver transection. This study was designed to determinate whether these maneuvers are associated with adverse hepatic function. METHODS Resection was performed without portal clamping in 17 patients (group 1). Selective continuous portal clamping was performed in 11 patients (group 2) and the remaining 33 patients (group 3) had intermittent nonselective portal clamping (occlusion of the main portal trunk). The centers' protocol for total portal occlusion is 15-min occlusion alternated with 5-min reperfusion in patients with normal liver parenchyma or 10 min alternated with 5 min in patients with abnormal parenchyma. ICG elimination tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate (PDR-ICG-%/min) and 15-min retention rate after administration (ICG-R15-%). RESULTS There was no statistically difference between the three studied groups in terms of sequential changes of ICG-PDR (p < 0.625) or ICG-R15 (p < 0.398). CONCLUSIONS Our study indicates that 15 min of intermittent Pringle maneuver or selective hemihepatic continuous portal clamping are safe methods of vascular control during liver resection, with no adverse effects on hepatocellular function.
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Llamas MA, Aller MA, Marquina D, Nava MP, Arias J. Bacterial translocation to mesenteric lymph nodes increases in chronic portal hypertensive rats. Dig Dis Sci 2010; 55:2244-54. [PMID: 19834810 DOI: 10.1007/s10620-009-1001-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 09/21/2009] [Indexed: 12/12/2022]
Abstract
PURPOSE Bacterial translocation is a frequent complication in portal hypertension related to cirrhosis in the human clinical area. The aim of this study was to verify the existence of intestinal bacterial translocation to mesenteric lymph nodes in male Wistar rats with triple partial portal vein ligation during short- (48 h) and long-term (1 month) postoperative evolution. RESULTS At 48 h, ileal total aerobes bacteria (p < 0.001) and Lactobacillus decrease in sham-operated (SO) and portal hypertensive (PH) rats. At 1 month, ileal Enterococci and Streptococcus sp. show a statistically significant decrease in SO- and PH-rats. Lactobacillus decreases in the colon in SO- (p < 0.01) and in PH-rats (p < 0.001). At 1 month, colonic Enterococci decreases compared to control (p < 0.001) and SO-rats (p < 0.01). These intestinal microfloral changes are associated with bacterial translocation to mesenteric lymph nodes at 48 h (50%; p = 0.004) and 1 month (100%; p < 0.001) of postoperative evolution in PH-rats. CONCLUSIONS The enlargement of the stenosed portal tract related to triple partial portal vein ligation in the rat, since it increases the resistance to the portal blood flow, may be a key factor involved in one of the pathological consequences of portal hypertension, as is bacterial translocation to mesenteric lymph nodes.
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Grandadam S, Compagnon P, Arnaud A, Olivié D, Malledant Y, Meunier B, Launois B, Boudjema K. Role of preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma type III. Ann Surg Oncol 2010; 17:3155-61. [PMID: 20593243 DOI: 10.1245/s10434-010-1168-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term survival after complete resection of hilar cholangiocarcinoma remains disappointing. The aim of this retrospective study was to assess the impact of liver optimization on postoperative outcome of hilar cholangiocarcinoma type III. MATERIALS AND METHODS In a retrospective, single-center analysis, outcomes in patients with hilar cholangiocarcinoma type III who underwent resection after preoperative liver optimization (preoperative transhepatic biliary drainage [PTBD], bile replacement, and/or portal vein embolization [PVE]) were compared with nonoptimized controls. RESULTS Of 41 patients undergoing surgery, 38 patients undergoing curative intent procedures were identified, of whom 15 underwent preoperative optimization. After PTBD, direct bilirubin decreased from 218.0 ± 184.2 to 75.9 ± 42.7 μmol/L (P = 0.03), and there was a trend toward decreased AST and ALT levels. Overall, 3- and 5-year survival rates were 47.9 ± 9.1 and 41.9 ± 9.8%. The primary endpoint, 5-year survival after surgery, was not significantly different between groups. Preoperative jaundice was identified as an independent prognostic factor for poor outcome (hazard ratio [HR] 2.12, P = 0.02). Four patients (10.5%) without preoperative optimization died of liver failure within the first 30 days postsurgery, preceded in three cases by intra-abdominal abscesses. PTBD was associated with a lower rate of postoperative intra-abdominal abscesses; however this factor was not independently predictive of higher survival. CONCLUSION Preoperative optimization of the liver in hilar cholangiocarcinoma Type III reduced the incidence of intra-abdominal abscesses, but its impact on postoperative survival remains unclear.
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Affiliation(s)
- Stéphane Grandadam
- Service de chirurgie hépatobiliaire et digestive, CHU Pontchaillou, Université Rennes I, Rennes, France
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Ellett JD, Atkinson C, Evans ZP, Amani Z, Balish E, Schmidt MG, van Rooijen N, Schnellmann RG, Chavin KD. Murine Kupffer cells are protective in total hepatic ischemia/reperfusion injury with bowel congestion through IL-10. J Immunol 2010; 184:5849-58. [PMID: 20400698 DOI: 10.4049/jimmunol.0902024] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Kupffer cells (KCs) are thought to mediate hepatocyte injury via their production of proinflammatory cytokines and reactive oxygen species in response to stress. In this study, we depleted KCs from the liver to examine their role in total warm hepatic ischemia/reperfusion (I/R) injury with bowel congestion. We injected 8-wk-old C57BL/10J mice with liposome-encapsulated clodronate 48 h before 35 min of hepatic ischemia with bowel congestion, followed by 6 or 24 h of reperfusion. KC-depleted animals had a higher mortality rate than diluent-treated animals and a 10-fold elevation in transaminase levels that correlated with increases in centrilobular necrosis. There was extensive LPS binding to the endothelial cells, which correlated with an upregulation of endothelial adhesion molecules in the KC-depleted animals versus diluent-treated animals. There was an increase in the levels of proinflammatory cytokines in KC-depleted animals, and a concomitant decrease in IL-10 levels. When KC-depleted mice were treated with recombinant IL-10, their liver damage profile in response to I/R was similar to diluent-treated animals, and endothelial cell adhesion molecules and proinflammatory cytokine levels decreased. KCs are protective in the liver subjected to total I/R with associated bowel congestion and are not deleterious as previously thought. This protection appears to be due to KC secretion of the potent anti-inflammatory cytokine IL-10.
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Affiliation(s)
- Justin D Ellett
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, USA
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Hu M, Wang Z, Rao J, Cao Y, Jiang W, Zhang F, Li X, Wang X. Inhibition of inducible nitric oxide synthase worsens liver damage regardless of lipopolysaccharide treatment in small-for-size liver transplantation. Transpl Immunol 2010; 23:6-11. [PMID: 20206261 DOI: 10.1016/j.trim.2010.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 12/20/2009] [Accepted: 02/22/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In small-for-size liver transplantation, portal hypertension aggravates endotoxin from the gut which accelerates the activation of inducible nitric oxide synthase (iNOS). However, there is little knowledge as to the effects of iNOS inhibitors on small-for-size graft damage. Our study was designed to investigate the role of an iNOS inhibitor both with and without lipopolysaccharide (LPS) treatment in ischemia-reperfusion injury of small-for-size liver transplantation. METHODS Subjecting Sprague-Dawley rats to small-for-size grafts liver transplantation, we investigated the time course of changes in hepatic expression of iNOS and endothelial nitric oxide synthase (eNOS). Meantime, we also investigated the effects of iNOS inhibitor, both with and without LPS treatment, at 6h after reperfusion. RESULTS While iNOS mRNA expression reached a peak at 3h, the highest protein level occurred at 6h after reperfusion. Aminoguanidine (AG) significantly inhibited mRNA and protein expressions of iNOS, but not that of eNOS. However, LPS accelerated activation of iNOS, but suppressed the expression of eNOS. Meanwhile, compared with the untreated group, those treated with AG or LPS experienced worsened liver function and tissue damage, promoting neutrophil infiltration in the liver tissue. The difference between the LPS group and the LPS+AG group was found to be significant. In addition, AG and LPS treatments up-regulated the protein expression of ICAM-1 and NF-kappaB p65. CONCLUSION In a small-for-size model of rat liver transplantation, regardless of LPS treatment, the inhibitor of iNOS, AG, attenuated iNOS expression, but worsened liver function and tissue damage. The subsequent increased neutrophil infiltration in liver tissue may be associated with up-regulation of ICAM-1 and NF-kappaB expressions.
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Affiliation(s)
- MingZheng Hu
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
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Ellett JD, Evans ZP, Atkinson C, Schmidt MG, Schnellmann RG, Chavin KD. Toll-like receptor 4 is a key mediator of murine steatotic liver warm ischemia/reperfusion injury. Liver Transpl 2009; 15:1101-9. [PMID: 19718644 PMCID: PMC2938042 DOI: 10.1002/lt.21782] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Steatotic donors are routinely rejected for transplantation because of their increased rate of primary nonfunction. These grafts are more sensitive to ischemia/reperfusion (I/R) during transplantation. Removal of endotoxin before reperfusion improves liver performance post-I/R. We hypothesize that the main modality of injury in steatotic livers is toll-like receptor 4 (TLR4) signaling. We fed 4-week-old control and TLR4-deficient (TLR4KO) mice a normal diet (ND) or a 60% high-fat diet (HFD) for 4 weeks to induce steatosis. Mice were subjected to total hepatic ischemia (35 minutes) and reperfusion (1 or 24 hours). Survival improved and liver pathology decreased at 24 hours in TLR4KO HFD animals compared to control HFD animals. An investigation of infiltrates showed that neutrophils and CD4+ cells were increased at 24 hours in control HFD animals, whereas TLR4KO HFD animals were similar to ND controls. Messenger RNA levels of interleukin 6 (IL-6), IL-12, and interferon gamma were elevated at 1 hour in control HFD animals, whereas TLR4KO HFD animals were similar to ND controls. IL-10 levels at 1 hour of reperfusion in control HFD and TLR4KO animals were decreased versus control ND animals. In conclusion, these improvements in liver function in TLR4KO HFD animals implicate TLR4 as a mediator of steatotic graft failure after I/R.
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Affiliation(s)
- Justin D. Ellett
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Zachary P. Evans
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Carl Atkinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Michael G. Schmidt
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Rick G. Schnellmann
- Department of Pharmaceutical and Biomedical Sciences, Medical University of South Carolina, Charleston, SC
| | - Kenneth D. Chavin
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC,Division of Transplantation, Department of Surgery, Medical University of South Carolina, Charleston, SC
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Daglar G, Karaca T, Yuksek YN, Gozalan U, Akbiyik F, Sokmensuer C, Gurel B, Kama NA. Effect of Montelukast and MK-886 on Hepatic Ischemia-Reperfusion Injury in Rats. J Surg Res 2009; 153:31-8. [DOI: 10.1016/j.jss.2008.02.052] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 02/21/2008] [Accepted: 02/25/2008] [Indexed: 12/31/2022]
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Abstract
INTRODUCTION The consequence of excessive liver resection is the inexorable development of progressive liver failure characterised by the typical stigmata associated with this condition, including worsening coagulopathy, hyperbilirubinaemia and encephalopathy. The focus of this review will be to investigate factors contributing to hepatocyte loss and impaired regeneration. METHODS A literature search was undertaken of Pubmed and related search engines, examining for articles relating to hepatic failure following major hepatectomy. RESULTS In spite of improvements in adjuvant chemotherapy and increasing surgical confidence and expertise, the parameters determining how much liver can be resected have remained largely unchanged. A number of preoperative, intraoperative and post-operative factors all contribute to the likelihood of liver failure after surgery. CONCLUSIONS Given the magnitude of the surgery, mortality and morbidity rates are extremely good. Careful patient selection and preservation of an obligate volume of remnant liver is essential. Modifiable causes of hepatic failure include avoidance of sepsis, drainage of cholestasis with restoration of enteric bile salts and judicious use of portal triad inflow occlusion intra-operatively. Avoidance of post-operative sepsis is most likely to be achieved by patient selection, meticulous intra-operative technique and post-operative care. Modulation of portal vein pressures post-operatively may further help reduce the risk of liver failure.
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Wong KHV, Hamady ZZR, Malik HZ, Prasad R, Lodge JPA, Toogood GJ. Intermittent Pringle manoeuvre is not associated with adverse long-term prognosis after resection for colorectal liver metastases. Br J Surg 2008; 95:985-9. [PMID: 18563791 DOI: 10.1002/bjs.6129] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intermittent clamping of the porta hepatis, or the intermittent Pringle manoeuvre (IPM), is often used to control inflow during parenchymal liver transection. The aim of this study was to determine whether IPM is associated with an adverse long-term outcome after liver resection for colorectal liver metastasis (CRLM). METHODS All patients undergoing resection for CRLM in 1993-2006, for whom data on IPM were recorded, were included in the study. A total of 563 patients was available for analysis. RESULTS IPM was performed in 289 (51.3 per cent) of the patients. The duration of IPM ranged from 2 to 104 (median 22) min. There were no differences in clinicopathological features or postoperative morbidity between patients who had an IPM and those who did not. The median survival of patients undergoing IPM was 55.7 months compared with 48.9 months in those not having an IPM (P = 0.406). There was no difference in median disease-free survival between the two groups (22.1 versus 19.9 months respectively; P = 0.199). CONCLUSION IPM is not associated with an adverse long-term prognosis in patients undergoing liver resection for CRLM.
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Affiliation(s)
- K H V Wong
- Hepatopancreatobiliary and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, UK
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Yaylak F, Canbaz H, Caglikulekci M, Dirlik M, Tamer L, Ogetman Z, Polat Y, Kanik A, Aydin S. Liver Tissue Inducible Nitric Oxide Synthase (iNOS) Expression and Lipid Peroxidation in Experimental Hepatic Ischemia Reperfusion Injury Stimulated With Lipopolysaccharide: The Role of Aminoguanidine. J Surg Res 2008; 148:214-23. [DOI: 10.1016/j.jss.2007.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 09/14/2007] [Accepted: 10/12/2007] [Indexed: 11/19/2022]
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Collier C, Hofacre C, Payne A, Anderson D, Kaiser P, Mackie R, Gaskins H. Coccidia-induced mucogenesis promotes the onset of necrotic enteritis by supporting Clostridium perfringens growth. Vet Immunol Immunopathol 2008; 122:104-15. [DOI: 10.1016/j.vetimm.2007.10.014] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 10/12/2007] [Accepted: 10/23/2007] [Indexed: 11/28/2022]
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Abstract
PURPOSE Accompanying abdominal injuries are frequent in multiply injured patients and are a common cause of death. A search of the literature was performed focusing on key aspects of initial surgical procedures in abdominal injury. METHODS Literature was searched utilizing PubMed Medline, the Cochrane Central Register of Controlled Clinical Trials, and the German Institute for Medical Documentation and Information (DIMDI) database. The articles were classified according to the level of evidence following the suggestions of the Centre for Evidence Based Medicine. RESULTS Vertical laparotomy should be favored for the initial surgical therapy of abdominal injury. Especially in instable patients, principles of "damage control surgery" should be applied. In case of hollow organ injury, a primary anastomosis should be made whenever possible. A hand suture is most suitable for this. DISCUSSION Non-surgical treatment of blunt abdominal injury is gaining in importance. However, if a surgical intervention is recommended, especially in hemodynamic, instable patients, damage control principles should be favored.
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Affiliation(s)
- G Matthes
- Ernst-Moritz-Arndt-Universität Greifswald, Unfall- und Wiederherstellungschirurgie, Sauerbruchstrasse, 17475 Greifswald.
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Abstract
BACKGROUND Computer navigation systems have increasingly become part of the surgical routine due to the improvements of intraoperative visualization procedures. Because of limited space in the operating room and insufficient workflow, the project of integrated navigation had been started. METHODS As the first step, the navigation system VectorVision2 and the second-generation fluoroscopic C-arm system Orbic 3D were integrated into one common trolley. In an experimental study the integrated navigation system was used to drill 160 pedicle screws. Afterwards the system was clinically evaluated in 11 surgical procedures. RESULTS During the whole experimental study the system could be used for all 160 drilling procedures without any technical faults, causing a failure rate of 4.2%. For clinical evaluation the integrated navigation system was used in seven patients with navigated dorsal spine instrumentation, in three cases sacroiliac screws were placed, and in one case supra-acetabular screw osteosynthesis was performed for an acetabular fracture. In all cases the positioning of the screws was correct and no system failure occurred. CONCLUSIONS The combination of the navigation system and the C-arm system in one common trolley is a major improvement of the surgical workflow. In the experimental study and the clinical trials the system worked extremely reliably and with high precision.
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Affiliation(s)
- U Stöckle
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin.
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Unno N, Uchiyama T, Yamamoto N, Inuzuka K, Sagara D, Konno H. Portal Triad Occlusion Induces Endotoxin Tolerance: Role of Portal Congestion. J Surg Res 2006; 135:213-7. [PMID: 16904695 DOI: 10.1016/j.jss.2006.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Revised: 03/07/2006] [Accepted: 03/27/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Portal triad occlusion (PTO) causes portal congestion and damages the intestinal mucosa, which is associated with portal endotoxemia. However, administration of a sublethal dose of endotoxin results in resistance to its toxic activities. We tested the hypothesis that portal congestion due to PTO induces endotoxin tolerance. MATERIALS AND METHODS Rats were subjected to PTO for 15 min. In Group 1, male rats underwent laparotomy and, 48 h after the surgery, a lethal dose of Escherichia coli lipopolysaccharide was administered. In Group 2, rats were subjected to PTO for 15 min. Then a lethal dose of LPS was administered 48 h after surgery. Group 3 was treated the same as Group 2, except that PTO was performed with portosystemic shunt. Group 4 was also treated same as Group 2, except that rats received polymixin B and neomycin by gavage to eliminate intestinal luminal bacteria before PTO. Survival was examined after the administration of a lethal dose of LPS. Changes in plasma levels of cytokine are also measured after the administration of LPS. The portal endotoxin level in each group after PTO was measured. RESULTS On survival test, only rats in Group 2 and Group 4 showed significantly higher survival rates. The portal endotoxin level was significantly elevated only in Group 2. The elevation of plasma cytokine levels (IL-6, TNF-alpha) and NO production (NO(2)(-)/NO(3)(-)) in Groups 2 and 4 were inhibited compare to those in Groups 1 and 3. CONCLUSIONS PTO induced LPS tolerance possibly due to portal congestion and subsequent visceral congestion.
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Affiliation(s)
- Naoki Unno
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
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van Veen SQ, Dinant S, van Vliet AK, van Gulik TM. Alkaline phosphatase reduces hepatic and pulmonary injury in liver ischaemia -- reperfusion combined with partial resection. Br J Surg 2006; 93:448-56. [PMID: 16491472 DOI: 10.1002/bjs.5275] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lipopolysaccharides mediate inflammation in liver ischaemia-reperfusion (I/R) and partial liver resection (PHX). Bovine intestinal alkaline phosphatase (BIAP) detoxifies lipopolysaccharides by dephosphorylation and reduces inflammation in models of sepsis. This study examined the protective effects of BIAP administration in models of partial (70 per cent) liver I/R with or without partial resection of all non-ischaemic lobes during ischaemia (30 per cent). METHODS Male Wistar rats were divided into six groups: I/R + BIAP, I/R + saline, I/R + PHX + BIAP and I/R + PHX + saline, PHX only or sham laparotomy only. A single dose of BIAP (0.5 units/g) or vehicle (saline) was administered 5 min before reperfusion. Inflammatory response, and hepatic and pulmonary injury were assessed during 24 h of reperfusion. RESULTS I/R, with or without PHX, increased all markers of inflammation, and hepatic and pulmonary damage (P < 0.050 versus sham operation). I/R + PHX significantly increased release of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and hepatic neutrophil influx compared with I/R only (P < 0.050). BIAP treatment decreased hepatic wet/dry ratios, neutrophil influx and histopathological damage after I/R with or without PHX (P < 0.050), and also AST, ALT and interleukin (IL)-6 production after I/R + PHX (P < 0.050). BIAP treatment reduced the neutrophil influx after I/R, and pulmonary histopathological injury was decreased after I/R with or without PHX. CONCLUSION BIAP attenuates hepatic and pulmonary injury after partial liver I/R and PHX.
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Affiliation(s)
- S Q van Veen
- Department of Surgery (Surgical Laboratory), Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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