Hepatic artery stenosis angioplasty and implantation of Wingspan neurovascular stent: A case report and discussion of stenting in tortuous vessels

BACKGROUND Hepatic artery stenosis is a complication of orthotopic liver transplant occurring in 3.1%-7.4%of patients that can result in graft failure and need for retransplantation.Endovascular therapy with angioplasty and stenting has been used with a high degree of technical success and good clinical outcomes,but tortuous hepatic arteries present a unique challenge for intervention.Suitable stents for this application should be maneuverable and conformable while also exerting adequate radial force to maintain a patent lumen.CASE SUMMARY Herein we report our experience with a neurovascular Wingspan stent system in a challenging case of recurrent hepatic artery stenosis and discuss the literature of stenting in tortuous transplant hepatic arteries.CONCLUSION Wingspan neurovascular stent is self-expanding,has good conformability,and adequate radial resistance and as such it could be added to the armamentarium of interventionalists in the setting of a tortuous and stenotic transplant hepatic artery.     

Hepatoprotective actions of melatonin: possible mediation by melatonin receptors

Melatonin,the hormone of darkness and messenger of the photoperiod,is also well known to exhibit strong direct and indirect antioxidant properties. Melatonin has previously been demonstrated to be a powerful organ protective substance in numerous models of injury; these beneficial effects have been attributed to the hormone’s intense radical scavenging capacity. The present report reviews the hepatoprotective potential of the pineal hormone in various models of oxidative stress in vivo,and summarizes the extensive literature showing that melatonin may be a suitable experimental substance to reduce liver damage after sepsis,hemorrhagic shock,ischemia/reperfusion,and in numerous models of toxic liver injury. Melatonin’s influence on hepatic antioxidant enzymes and other potentially relevant pathways,such as nitric oxide signaling,hepatic cytokine and heat shock protein expression,are evaluated. Based on recent literature demonstrating the functional relevance of melatonin receptor activation for hepatic organ protection,this article finally suggests that melatonin receptors could mediate the hepatoprotective actions of melatonin therapy.     

Parvovirus B19 induced hepatic failure in an adult requiring liver transplantation

Parvovirus B19 induced acute hepatitis and hepatic failure have been previously reported, mainly in children. Very few cases of parvovirus induced hepatic failure have been reported in adults and fewer still have required liver transplantation. We report the case of a 55-year-old immunocompetent woman who developed fulminant hepatic failure after acute infection with Parvovirus B19 who subsequently underwent orthotopic liver transplantation. This is believed to be the first reported case in the literature in which an adult patient with fulminant hepatic failure associated with acute parvovirus B19 infection and without hematologic abnormalities has been identified prior to undergoing liver transplantation. This case suggests that Parvovirus B19 induced liver disease can affect adults, can occur in the absence of hematologic abnormalities and can be severe enough to require liver transplantation.     

Synchronous occurrence of a hepatic myelolipoma and two hepatocellular carcinomas

Myelolipoma is a rare tumor composed of fat and bone marrow components, most of which are located in the adrenal gland. Myelolipoma in the liver is extremely rare. To date, only 10 cases have been reported in the English-language medical literature. In one of these cases, the hepatic myelolipoma was found within a hepatocellular carcinoma(HCC). In the present study, we report the first case of the synchronous occurrence of hepatic myelolipoma and HCCs in different liver sections of one patient, a 26-year-old female who was admitted to our hospital because of a 4-d history of upper abdominal pain. The unenhanced computed tomography(CT) images showed a well-defined lowdensity mass with adipose components in the right liver lobe, 4.2 cm × 4.1 cm in size. Two inhomogeneous low-density masses were found in the left liver lobe, 8.6 cm × 7.7 cm and 2.6 cm × 2.6 cm in size. The masses in both the right and left liver lobes were heterogeneously enhanced in the contrast-enhanced CT images. Based on the results of the imaging examination, the mass in the right liver lobe was preliminarily considered to be a hamartoma, and the two masses in the left liver were preliminarily considered to be HCCs. We performed a right hepatectomy, a left hepatic lobectomy, and a cholecystectomy. Microscopic and immunohistochemical results revealed that the tumor in the right liver lobe was a hepatic myelolipoma, and that the two tumors in the left liver lobe were HCCs.     

Hepatic osteodystrophy complicated with bone fracture in early infants with biliary atresia

Biliary atresia(BA) is one of the major hepatobiliary abnormalities in infants and one of the causes of hepatic osteodystrophy.Bone disease may be caused by the malabsorption of calcium and magnesium by vitamin D in hepatobiliary diseases in which bile flow into the intestines is deficient or absent.Bone fracture before Kasai hepatic portoenterostomy or within one month after the procedure in an infant with BA is very rare.We herein report two infants:one infant with BA who initially presented with a bone fracture before Kasai hepatic portoenterostomy,and the other at 4 wk after Kasai hepatic portoenterostomy,and also provide a review of the literature.Moreover,we conclude that clinicians should consider BA in infants with bone fracture during early infancy.     

Foreign body retained in liver long after gauze packing

This case report describes a foreign body retained in the liver long after perihepatic gauze packing. A 64-year-old female patient had suffered a rib fracture and liver rupture during a traffic accident in 1973. She discovered a mass in her right hypochondrium. Her hepatic ultrasonography showed a round mass (20.3 cm × 17.3 cm × 16.0 cm in size) with fluid echogenicity in the right lobe of her liver, and a hepatic cystic-solid mass (19.7 cm × 18.5 cm × 15.6 cm in size) was identified in an abdominal computerized tomography scan. Several pieces of gauze were extracted, and brown pus from the hepatic mass was suctioned during her exploratory laparotomy. Histology documented gauze remnants with necrotic material inclusions and fibrotic capsules. To our knowledge, this patient’s case represents the longest time for which a foreign body has been retained in the liver. In addition, we conducted a comprehensive literature review of foreign bodies retained in the liver. Foreign bodies may be introduced into the liver via penetrating trauma, surgical procedures or the ingestion of foreign bodies (which then migrate from the gut). Thus, they can be classified into the following three categories: penetrating, medical and migrated foreign bodies. The details of the case are thoroughly described.     

Case report and review of esophageal lichen planus treated with fluticasone

Lichen planus is a fairly common chronic idiopathic disorder of the skin,nails and mucosal surfaces.Esophageal involvement of this disease on the other hand is rare and only about 50 cases have been reported in literature.Given its rarity,it can be difficult to diagnose and may be easily misdiagnosed as reflux esophagitis.Currently,there are no clear recommendations on the optimal management of this disease and little is known about the best treatment approach.Systemic steroids are usually the first line treatment and offer a favorable response.In this report,we would like to present a novel approach in the management of esophageal lichen planus in a middle-aged woman treated successfully with swallowed fluticasone propionate 220 mcg twice a day for 6 wk,as evidenced by objective clinical findings.Based on our review of related literature and experience in this patient,we feel that a trial of swallowed fluticasone may be a prudent approach in the management of these patients since it has a more favorable side effect profile than systemic treatment.     

Rapunzel syndrome：The unsuspected culprit

Trichobezoar is a rare intriguing disorder in which swallowed hairs accumulates in the stomach. Being indigestible and slippery, it could not be propulsed and becomes entrapped within the stomach. Large amounts can thus accumulate over the years forming a hair ball. Rapunzel syndrome is a variant where hair accumulation reaches the small gut and beyond in some cases. Although the syndrome has been known for many years, only 24 cases have been reported in the literature and the discovery of a new case is always surprising. In this report, we present two cases discovered within a period of three months. One of them was pregnant and had small bowel intussusception and perforation, a very rare combination. We hereby add two more cases to the literature. To our knowledge, this is the first report on two cases of Rapunzel syndrome, the diagnosis of which demands a high index of suspicion.     

A case report of hepatic veno-occlusive disease after ingesting dainties

INTRODUCTION Hepatic veno-occlusive disease (HVOD) is a rarely encountered ailment in the literature[1,2]. The establishment of the diagnosis of this condition can be very difficult because there is no specificity in the clinical manifestations and some c…     

土三七水煎剂所致肝小静脉闭塞病大鼠模型的建立

目的通过观察不同浓度土三七水煎剂所致的大鼠肝脏病理学变化，建立一种模拟临床患者服药所致肝小静脉闭塞病（HVOD）的动物模型。方法土三七2100g水煎制成浓度为1．5g/ml土三七生药煎剂，SD大鼠76只随机分为A、B、C、D四组，A、B、C组每组20只，分别以土三七水煎剂高（15g·kg^-1·d^-1）、中（7．5g·kg^-1·d^-1）、低（3．75g·kg^-1·d^-1）浓度灌胃，D组16只以温开水灌胃作为对照，各组大鼠雌、雄各半。每日测量大鼠体重并记录异常表现，灌胃1周和2周后各组大鼠分别处死各半，肝脏标本行病理检查，HE及Masson染色，光镜下参照Deleve评分标准判定病变及严重程度。结果土三七高、中、低浓度组分别有83．3％（15／18）、75．0％（15／20）、40．0％（5／20）出现了肝小静脉闭塞病病理表现；相同剂量下雌性较雄性更易发病，雌、雄鼠造模成功率分别为79．3％（23／29）和41．3％（12／29）（P=0．003）。结论土三七水煎剂灌胃可以成功建立HVOD大鼠模型，剂量和大鼠性别与造模成功率直接相关。     

土三七所致肝小静脉闭塞病102例临床分析

目的总结分析土三七所致肝小静脉闭塞病（HVOD）的临床特点,提高对本病的认识。方法对1980年1月至2009年12月国内报道的土三七所致HVOD病例102例进行综合分析,并对国内外相关文献进行复习。结果患者土三七使用量150～5000 g（中位数500 g）,服药时间4 d～1年（中位时间30 d）,临床主要表现为腹胀（99.0%）、腹痛（69.6%）、肝大（93.5%）、腹水（97.7%）、黄疸（63.5%）,有不同程度的肝功能受损。B超检查见肝静脉显示不清,肝段下腔静脉外形变细,但无明显栓塞物,彩色多普勒提示门脉血流减慢或逆向,增强CT示肝脏呈＂地图状＂强化不均匀。病理学表现为肝窦淤血、扩张,流出道受阻,肝细胞不同程度变性、坏死,小叶中央静脉内皮水肿或纤维增生。经内科治疗好转69.7%（62/89）,未愈或死亡30.3%（27/89）,另13例转归不详。使用抗凝或活血化瘀者有效率为81.0%,较未用者（47.8%）,疗效差异有统计学意义（P=0.002）。结论土三七是导致HVOD的一个重要原因,影像和病理检查具有特征性,早期诊断及使用抗凝、活血治疗对改善预后有一定作用。     

内皮损伤相关因子在小鼠肝小静脉闭塞病模型中的表达

随着中草药的广泛应用,近年我国因误服含吡咯烷类生物碱（PAs）的中草药致肝小静脉闭塞病（HVOD）的报道逐渐增多.目的：探讨内皮细胞损伤及其相关因子在HVOD发病中的作用.方法：分别以土三七灌胃30 d和野百合碱灌胃7 d诱导小鼠HVOD模型.动物处死后行血清肝功能指标榆测和全血细胞计数;肝组织切片HE染色、Masson三色染色,行组织学评分;RT-PCR检测肝组织内皮损伤相关因子内皮素-1（ET-1）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）以及纤溶酶原激活物抑制剂-1（PAI-1）的表达.结果：土三七组和野百合碱组成模率分别为80.0%和92.0%.两模型组小鼠体质量、肝指数、血清肝功能指标和全血细胞计数的变化以及肝组织学改变符合人类HVOD的临床和病理特征,肝组织ET-1、TNF-α、IL-1β和PAI-1 mRNA表达较正常对照组显著增高（P〈0.05）,其中土三七组PAI-1 mRNA表达显著高于野百合碱组（P〈0.05）.结论：土三七和野百合碱均可成功诱导小鼠HVOD模型,模型小鼠肝组织内皮损伤相关因子表达显著增高,提示内皮细胞损伤后内皮损伤相关因子的释放参与了HVOD的发生过程.     

中草药致肝小静脉闭塞病11例临床分析

目的评估各种常规临床检测方法对中草药所致肝小静脉闭塞病（HVOD）的诊断价值,并探寻评价疾病转归及预后的方法。方法采用回顾性研究方法,分析我院近3年间服用中草药所致11例HVOD的临床表现、生化指标和影像学特点。结果所有患者均有明确用药史,7例患者服用土三七,2例患者服用雷公藤,2例患者服用不明中草药,CT对HVOD的诊断有重要意义,死亡4例患者均为重型患者。结论我国肝小静脉闭塞病的诊断应重视患者用药史,HVOD患者的疾病分型对病情评估有重要意义。     

土三七致肝小静脉闭塞病诊断及治疗体会

目的 探讨肝小静脉闭塞病(hepatic veno-occlusive disesse,HVOD)的诊断及治疗效果.方法 回顾性分析我院3例土三七致HVOD患者的临床和病理特征.结果 所有患者以腹胀、腹水和肝肿大为主要表现.2例患者的组织病理学表现为肝窦扩张、瘀血、肝索挤压、萎缩、肝细胞变性坏死.结论 土三七所致肝小静脉闭塞病临床表现无特殊性,肝穿是重要的诊断方法.     

肝静脉闭塞病的临床和病理研究

目的通过对肝静脉闭塞病（HVOD）的临床和病理特点研究,提高对该病的认识.方法回顾性分析因骨髓移植和服用土三七所致12例HVOD的临床和病理特征.结果骨髓移植所致HVOD常表现为急性起病,且病情较重;而土三七所致HVOD除急性起病外,也可以表现为亚急性、慢性起病,且病情轻重不一,可能与土三七的剂量和疗程以及个体差异相关.抗凝疗法治疗急性和亚急性HVOD疗效优于慢性HVOD.两者所致HVOD的病理均表现为肝窦扩张、瘀血,肝索挤压、萎缩,肝细胞坏死,胆汁淤积,而肝小静脉缩窄甚至闭塞等典型表现并不常见,可能与经皮肝穿刺活检术有很大局限性有关.结论骨髓移植和应用土三七应警惕HVOD的发生,争取早期诊断和及时治疗.     

肝小静脉闭塞病的临床现状及研究进展

肝小静脉闭塞病(hepatic veno-occlusive disease,HVOD)是造血干细胞移植(hematopoietic stemcell transplantation,HSCT)的主要并发症之一.其发病机制主要是局部高凝状态,主要病理改变是终末肝小静脉的闭塞及肝细胞的坏死.HVOD的确诊依靠肝组织活检.明确并避免危险因素是降低HVOD的发病率及死亡率的主要措施,药物预防效果尚不确切并且多有不良反应.HVOD的治疗以去纤苷的效果最为肯定,其他药物的疗效仍需验证.本文就HVOD的临床现状及研究进展作一综述.     

17例肝小静脉闭塞病患者的诊断和治疗

目的 总结肝小静脉闭塞病(HVOD)的诊断和治疗方法.方法 回顾性分析17例肝小静脉闭塞病的临床和病理资料. 结果根据影像学检查结果和临床及病理学资料,将肝小静脉闭塞病分为急性进展型和慢性型.其中急性进展型11例,经内科保守治疗,5例临床治愈,2例好转,2例死亡,手术治疗2例死亡,慢性型6例,经内科保守治疗1例,手术治疗5例,均达到临床治愈.结论 病理活组织检查是确诊肝小静脉闭塞病的有效方法.急性进展型的肝小静脉闭塞病宜内科保守治疗,慢性型在内科治疗无效的情况下可行手术治疗.     

Successful treatment with danhong injection for hepatic veno-occlusive disease

Hepatic veno-occlusive disease (HVOD) is a clinical syndrome characterized as hepatomegaly, ascites, jaundice and elevation of hepatic enzymes as an outcome from fibrous obliteration of small centrilobular hepatic venules. It is recognized as a rare but life-threatening complication of organ transplantation, tumor eradication chemotherapy and is associated with haematopoietic stem cell transplantation (SCT). Recent researches report that ingestion of plants which contain pyrrolizidine alkaloids (PAs) is associated with the onset of HVOD with unclear pathogenesis. Nowadays, there is no effective therapeutic strategy for HVOD besides supportive care using diuretics or albumin. In our case, a 42-year-old woman administered a concoction of Chinese traditional medicine supposed to contain PAs, was found to develop HVOD confirmed by liver biopsy. A therapeutic strategy was developed using Danhong injection, accompanied with supportive care, and obtained a favorable response manifesting as regression of symptoms and decline of hepatic enzymes. Danhong injection, a Chinese medical product exerting a milder anticoagulation and antithrombotic effect, is beneficial to HVOD probably by promoting microcirculation, ameliorating liver function and inhibiting hepatic fibrosis.