Prevention and treatment of opisthorchiasis of the liver

Rare cases of lethal outcomes after surgical operations on the liver were analyzed which were caused by invasion of helminth Opisthorchis felineus. It was shown that prolonged and massive invasion, in the absence of specific treatment, can result in failure of the compensatory potencies of the liver. It occurs mainly due to activation of the pathogenic flora in the bile tree against the background of the intraductal hypertension characteristic of opisthorchiasis. Destructive purulent cholangitis, cholangitic abscesses in the liver and suppuration of opisthorchiasis cysts can develop. The direct cause of death was progressing hepatic insufficiency. The postoperative lethality among patients with opisthorchiasis cysts of the liver was 5.7%, with liver abscesses--12.5%. The external drainage of the biliary tree in patients with this pathology and intraportal infusions reduce lethality and the number of specific postoperative complications.     

Endoscopic stenting of the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease awaiting orthotopic liver transplantation.

Cholecystectomy in patients with advanced cirrhosis is associated with excessive morbidity and mortality. Because open cholecystectomy in patients with Child's class C cirrhosis has a reported mortality rate as high as 83%, symptomatic gallbladder disease in patients awaiting orthotopic liver transplantation (OLT) poses a unique clinical problem. The goal of this study is to determine whether the treatment of symptomatic gallbladder disease with endoscopic stenting of the gallbladder effectively reduces biliary symptoms and complications or the need for cholecystectomy. Thirteen patients with symptomatic gallbladder disease with and without cholelithiasis and advanced cirrhosis who were candidates for OLT underwent placement of a biliary stent from the gallbladder to the duodenum at endoscopic retrograde cholangiography. In each patient, biliary symptoms and complications ceased after stent placement. Seven patients underwent successful OLT 1 to 24 months after the procedure. One patient subsequently became a noncandidate for OLT and died of diabetes complications 3 years after the procedure. Five others are awaiting OLT (6 to 28 months postprocedure). One patient had recurrent pericholecystic fluid collection requiring percutaneous drainage and antibiotic therapy 8 months after the procedure. No patient has had recurrent symptoms, and currently all patients are free of complications. None required surgical intervention of the gallbladder or biliary tree. We conclude that endoscopic stenting of the gallbladder is the preferred treatment for symptomatic gallbladder disease in patients with end-stage liver disease awaiting OLT. This approach is noninvasive, safe, and effective in preventing potential morbidity and mortality.     

肝硬化胆囊结石患者的胆囊胆汁和结石成分分析

目的: 通过测定肝硬化患者胆囊胆汁和结石成分,分析胆囊结石的类型及其与胆汁成分改变的关系. 方法: 将研究对象分四组,即非胆囊结石对照组(A组,13例)、单纯胆囊结石组(B组,16例)、肝硬化组(C组,5例)和肝硬化胆囊结石组(D组,7例).测定A组13例、B组15例、C组5例和D组7例的胆囊胆汁成分.对B组16例、D组6例行结石成分分析,用肉眼和实体显微镜观察结石的表面及剖面,并按1984年傅培彬等人提出的结石分类法分类,结石成分用化学方法分析. 结果: ①两组肝硬化的胆汁中未结合胆红素(UCB)含量明显升高,胆汁酸(TBA)含量明显降低,与对照组比较差异有显著性意义(P<0.05).结石中的66.7%为黑结石.单纯胆囊结石组胆汁中胆固醇(TC)含量明显升高,胆汁酸含量明显降低,与对照组比较差异有显著性意义(P<0.05).结石中的87.5%为胆固醇型结石.②两组肝硬化(C和D组)的血清TB和UCB均显著高于A和B两组(P<0.05).而血清TBA在B、C和D组中却明显低于A组(P<0.05).血TC在C和D两组低于A和B两组(P<0.05). 结论: 肝硬化患者好发胆囊胆色素结石,且以黑色结石多见,这与肝硬化时肝脏代谢胆红素和胆固醇障碍胆汁中UCB升高、TBA降低有关.     

Immunoreactivity of patients with pathology of the liver, gallbladder and biliary tract

In a work, the comparative analysis of the state of immunological reactivity in 25 patients with pathology of the liver, gallbladder and bile ducts and in 25 healthy subjects is presented. In patients, T-lymphocytopenia, impaired ratio of subpopulations of the helpers and suppressors, increase in the absorptive and metabolic activity of neutrophilic granulocytes, lysozyme activity of the blood serum, decrease in the immunoglobulin G content are observed.     

Outcomes in patients with hepatopulmonary syndrome undergoing liver transplantation

Hepatopulmonary syndrome (HPS) is a condition of significant hypoxia due to intrapulmonary shunting (IPS) in patients with advanced liver disease. Reversibility of HPS after liver transplantation (LT) has been suggested, but the results of LT for HPS remain poorly defined. We studied 78 patients with decompensated liver disease who underwent LT after a preoperative evaluation including contrast echocardiography. We compared the baseline characteristics and outcomes after LT in patients with HPS (n = 13) with those of patients without HPS (n = 65, controls). Before LT, prolongation of prothrombin time was more severe and an advanced Child-Pugh class were more frequent among HPS, patients compared with controls (INR 2.5 +/- 0.8 vs 1.9 +/- 0.7, P = .01; Child-Pugh class A:B:C = 0%:31%:69% vs 14%:65%:21%, P < .01). After LT, no significant differences were observed between the two groups in: clinical outcomes, duration of endotracheal intubation (4.5 +/- 7.7 vs 4.4 +/- 15.0 days), duration of intensive care unit stay (12.0 +/- 8.7 vs 14.4 +/- 19.4 days), duration of total hospital stay (40.0 +/- 33.5 vs 39.8 +/- 23.0), rate of pulmonary complications (7.7% vs 9.2%), or 3-month survival rates (92.3% vs 86.1%). These findings suggest that the presence of HPS does not significantly affect LT outcomes in patients with decompensated liver disease.     

Prognosis and therapy of liver injury in patients with multiple injuries

Between 1.7. 1986 and 31.10. 1989 abdominal trauma was seen in 108 (35.8%) of 300 polytraumatized patients, 44 of these showed rupture of the liver. 23 patients belonged to grade I-III (Moore-classification) and 11 patients to grade IV. Extensive bilobar parenchymal destruction (grade V) was found in 10 patients including 6 patients with retrohepatic vena cava injury. 80% of all patients with liver trauma had intraabdominally associated injuries. In Grade I-II (n = 4) patients were treated conservatively and continuously observed by ultrasound. Injuries graded to III (n = 19) and IV (n = 11) were mostly treated by simple suture or segmental resection. In grade V hemihepatectomy was done in 4 cases, in 2 cases combined by packing and in 1 patient packing only. In 3 patients no adequate therapy was possible. The mortality rate being 36% (n = 16), hemorrhagic complications were the most common cause of death (7 of 16 patients). This was due only to the patients graded to V. In comparison the prognostic factor in grade I-IV ruptures were the associated injuries. In all these cases hemorrhage was stopped by a conservative, organ-retaining therapy. No further hemorrhage occurred. Liver packing was mainly used as additional treatment in cases of coagulopathy after resection. Further indications are extensive bilobar parenchymal destruction without the possibility of primary reconstruction and temporary hemostasis to allow transport to a specialized hospital.     

胆囊胆固醇性结石病人肝脏ABC基因表达研究

胆囊结石多为胆固醇性或以胆固醇为主的混合性结石,胆汁胆固醇过饱和是胆囊结石发生的必要条件,胆固醇过饱和与胆汁胆固醇含量升高及胆盐与磷脂的下降有密切关系.肝细胞胆小管侧膜上有一些转运蛋白,这些蛋白都属ATP结合盒家族.     

Comparative characteristics of nonparasitic and opisthorchiasis cysts of the liver

The authors observed 24 patients with opisthorchiasis and 14--with nonparasitic cysts of the liver. No essential differences in the tactics of surgical treatment of these cysts were noted. In medium-size and large cysts, the operative treatment--excision of cystic walls with omentoplasty, liver resection--is recommended; in small opisthorchiasis and nonparasitic cysts--dynamic observation with the performance of ultrasound scanning.     

Outcomes of bariatric surgery in patients with obesity and compensated liver cirrhosis

BackgroundObesity is a major health burden worldwide and is associated with nonalcoholic fatty liver disease, which can lead to cirrhosis. Bariatric surgery is increasingly being used to treat obesity, and the number of patients with obesity and cirrhosis undergoing bariatric surgery is also rising. However, the safety and feasibility of bariatric surgery in patients with obesity and cirrhosis are controversial.ObjectivesIn this meta-analysis, we compared postoperative complications, mortality, and weight loss between patients with and without cirrhosis undergoing bariatric surgery.SettingAn electronic search of Medline, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL).MethodsPatient morbidity and mortality odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were assessed. Intraoperative and overall complications, length of hospital stay, in-hospital mortality, long-term mortality, and total weight loss were recorded.ResultsThe literature search yielded 2977 articles. Eight studies were included in the analysis. Meta-analysis showed that the overall complications (OR: 2.1; 95% CI: 1.47–3.00; P < .0001), postoperative bleeding (OR: 2.22; 95% CI: 1.95–2.54; P < .00001), length of hospital stay (MD: .68; 95% CI: .14–1.19; P = .01), and in-hospital/90-day mortality (OR: 3.59; 95% CI: 2.84–4.54; P < .00001) were significantly higher in patients with compensated cirrhosis than in patients without cirrhosis. Intraoperative complications, operation time, major complications, and long-term mortality were similar between the groups. Total weight loss was also not significantly different between the groups.ConclusionBariatric surgery can be considered only in highly selected patients with obesity and compensated cirrhosis.     

Outcomes of non-anatomic liver resection for hepatocellular carcinoma in the patients with liver cirrhosis and analysis of prognostic factors

Purpose  

In the east countries, patients with hepatocellular carcinoma (HCC) are usually associated with varied degrees of liver cirrhosis, and anatomic resection is therefore limited to use, especially in those with severe liver cirrhosis. This study aims to evaluate the clinical value of non-anatomic resection in HCC patients with cirrhosis.     

The impact of liver dysfunction on outcome in patients with multiple injuries

Multiple organ dysfunction syndrome (MODS) is the leading cause of late deaths after traumatic injury. The relative importance of dysfunction of individual organ systems in determining outcome from MODS has not been clearly defined. Some studies have suggested that hepatic dysfunction associated with MODS increases mortality, whereas others have suggested that it contributes little to outcome in trauma patients. To clarify the role of the hepatic dysfunction after traumatic injury we retrospectively reviewed all trauma patients with an Injury Severity Score > or = 14 admitted from January 1, 1994 through June 30, 1997 for the presence of hepatic dysfunction defined as a serum bilirubin > or = 2.0 mg/dL. Of the 1962 patients who met the entry criteria 154 developed hepatic dysfunction during their hospital stay. Patients with hepatic dysfunction were older (46 +/- 2 versus 41 +/- 1 years), were more severely injured (Injury Severity Score 31.5 +/- 0.9 versus 23.3 + 0.2), and had a lower prehospital blood pressure (102 +/- 3 versus 117 +/- 1 mm Hg) compared with patients who did not develop hepatic dysfunction. Patients with hepatic dysfunction were more likely to present with shock as reflected in a lower initial emergency room blood pressure (109 +/- 3 versus 128 +/- 1 mm Hg) and base deficit (-6.9 +/- 0.6 versus -3.5 +/- 0.1 mEq/L). Patients who developed hyperbilirubinemia had longer lengths of stay in the intensive care unit (15.8 +/- 1.2 versus 3.4 +/- 0.2 days) and the hospital (27.4 +/- 1.7 versus 11.1 +/- 0.2 days) and a higher in-hospital mortality (16.2% versus 2.5%). These data demonstrate that the development of hepatic dysfunction reflects the severity of injury and is associated with a significantly worse outcome after traumatic injury.     

Delayed laparoscopy facilitates the management of biliary peritonitis in patients with complex liver injuries

BACKGROUND: Nonoperative management is now regarded as the best alternative for the treatment of patients with complex blunt liver injuries. However, some patients still require surgical treatment for complications that were formerly managed with laparotomy and a combination of image-guided studies. METHODS: We reviewed the medical records of 15 patients who had complex blunt liver injuries that were managed nonoperatively and in which biliary peritonitis developed. RESULTS: Delayed laparoscopy was performed 2-9 days after admission in patients with extensive liver injuries. All 15 patients had developed local signs of peritonitis or a systemic inflammatory response. Laparoscopy was indicated to drain a large retained hemoperitoneum (eight patients), bile peritonitis (four patients), or an infected perihepatic collection (three patients). Laparoscopy was successful in all patients, and there was no need for further interventions. CONCLUSION: The data indicate that as more patients with complex liver injuries are treated nonoperatively and the criteria for nonoperative management continue to expand, more patients will need some type of interventional procedure to treat complications that historically were managed by laparotomy. At this point, laparoscopy is an excellent alternative that should become part of the armamentarium of the trauma surgeons who treat these patients.     

Outcomes of liver transplantation for patients with Alagille syndrome: the studies of pediatric liver transplantation experience

Alagille syndrome (ALGS) is a multisystem disorder that manifests as childhood cholestasis. Reports of liver transplantation (LT) for patients with ALGS have come largely from single centers, which have reported survival rates of 57% to 79%. The aim of this study was to determine LT outcomes for patients with ALGS. We performed a retrospective analysis of the Studies of Pediatric Liver Transplantation database, which contains information about 3153 pediatric LT recipients. Data were available for 91 patients with ALGS and for 236 age-matched patients with biliary atresia (BA). The frequency of complex cardiac anomalies was lower in the LT group with ALGS versus published ALGS series (5% versus 13%). The pretransplant glomerular filtration rate (GFR) was <90 mL/minute/1.73 m(2) in 18% of the LT patients with ALGS and in 5% of the LT patients with BA (P < 0.001). The height deficit at listing was worse for the ALGS patients (66%) versus the BA patients (22%). The 1-year patient survival rates were 87% for the ALGS patients and 96% for the BA patients (P = 0.002). The deaths in the ALGS group mostly occurred within the first 30 days. No pretransplant factors associated with death were identified in the ALGS group. A survival analysis revealed that biliary (P = 0.02), vascular (P < 0.001), central nervous system (CNS; P < 0.001), and renal complications (P < 0.001) after LT were associated with death in the ALGS group. Renal insufficiency in the ALGS patients worsened after LT, and at 1 year, GFR was <90 mL/minute/1.73 m(2) in 22% of the LT patients with ALGS but in only 8% of the patients with BA (P = 0.0014). More LT pediatric patients with ALGS either were currently receiving special education (50% versus 30% for BA patients, P = 0.02) or had received special education in the past (60% versus 36%, P = 0.01). Vascular, CNS, and renal complications were increased in the ALGS patients after LT, and this reflected multisystem involvement. Although the 1-year survival rate was modestly lower for the ALGS patients versus the BA patients, the clustering of deaths within the first 30 days is notable and warrants increased vigilance and further investigation.