Morphometry of terminal hepatic veins

Summary In the present study, hepatic venous distribution per unit of liver surface area on normal wedge biopsies from man (n=11) and baboon (n=8) were analysed and compared. Terminal hepatic veins (THV - man:n=100; baboon:n=200) morphometric size variables were obtained with a Leitz ASM 68K morphometric equipment. THV, defined as hepatic veins up to 150 m in internal diameter (ID), in the centrolobular position and with sinusoidal openings, represented 84% and 74% of hepatic veins of man and baboon, respectively. Four or more THV were generally found on 8 mm² of liver surface. Transversely sectioned THV selected by the ratio IDminimum/IDmaximum >0.67, was found to be only 25% of the total THV. In baboon, THV merge with other terminal veins and the interlobular veins present sinusoidal inlets. The baboon THV wall surface (WS) and wall thickness (WT) values were higher than in man. Positive correlations between the number of mesenchymal cells (Mc) in the vein wall and wall surface of terminal hepatic veins (man: r= 0.79; baboon: r=0.83) and between wall surface and internal surface (IS) (man: r=0.80; baboon: r=0.72) were found. Two ratios were selected as the most reliable parameters: (1) for the THV wall rim, wall surface/internal surface (WS/IS - man: 0.43±0.16; baboon: 0.63±0.23), regarding transversely sectioned THV; and (2) for the evaluation of wall cell density (WS/Mc-man: 550±231; baboon: 558±183 m²/cell) as they did not depend on THV caliber.Dr. Porto was supported by a fellowship from MEC-CAPES, Brazil. A grant for morphometric equipment was obtained from the Fondation pour la Recherche Médicale and from the Societé d'Hépatologie Expérimentale, 77 rue Pasteur, Lyon, France     

Hepatic arterial variations and liver-related diseases of 100 consecutive donors

We prospectively studied anatomical variations and diseases of the liver in 100 consecutive donor operations during a period of 1 year. The normal arterial anatomy with a single hepatic artery (HA) from the celiac trunk was seen in 76% of all cases. Seven of twelve different major variations of the HA may be considered as rare, one of which cannot be found in the earlier literature. During harvesting, 6% of the livers were discarded, 3% on the basis of infection and 1% because of a polycystic disease. Two cases were rejected as the liver was found to be severely hypoperfused or hypoxic in an otherwise stable donor. Severe steatosis was macroscopically and histologically diagnosed in 3% of the cases, and in three donors a benign tumour was found in the liver or in the gall bladder. Two primarily nonfunctioning livers in the present series of 94 recipient operations were retrieved from this group of severely steatotic livers. As the donor liver was totally normal in only 2 out of 3 of the cases, the present study underlines the importance of searching for extremely variable anomalies of the HA and for liver-related diseases during organ harvesting.     

Progressive tubulointerstitial nephritis and chronic cholestatic liver disease

We report the clinical and morphological features of a distinctive hepatorenal disorder in four patients and review the five similar patients in the literature. The main clinical characteristics were early onset of cholestatic liver disease and progressive tubulointerstitial nephritis leading to renal death in early childhood. Liver histology showed disturbed architecture with nodular and acinar formations and portal fibrosis and bile duct proliferation. Histological abnormalities in the kidney were severe interstitial fibrosis and tubular atrophy and dilatation, while the typical features of nephronophthisis were lacking. These clinical and morphological characteristics distinguish our patients from the majority described, as having nephronophthisis and congenital hepatic fibrosis or any other known syndrome with concomitant hepatorenel involvement. We suggest that the association of cholestatic liver disease and progressive tubulointerstitial nephritis represents a new syndrome.     

Hepatic Steatosis and Morbid Obesity

One hundred and twenty-seven consecutive morbidly obese patients who presented for bariatric surgery underwent open wedge liver biopsy at the completion of their gastric restrictive procedure. All hepatic specimens were graded histologically for degrees of steatosis. Three-quarters of the patients had histological evidence of hepatic steatosis and in one-fifth this was severe and diffuse. No patient had histological evidence of fatty hepatitis, portal fibrosis, or cirrhosis. There was no significant correlation between the degree of obesity (measured as percentage over ideal weight), age, sex, or preoperative liver function tests and the degree of fatty change observed. Insufficient data were available to implicate alcohol and poor protein nutrition in the aetiology of the observed fatty liver change. Other factors such as diabetes mellitus or drugs were not aetiological factors in this series of patients.     

肝性脂酶及脂蛋白脂酶在兔胆囊结石形成过程中的变化及意义

为研究肝脂酶及脂蛋白脂酶在胆固醇结石成石过程中的变化及其对成石的影响,采用高胆固醇膳食诱发兔胆囊胆固醇结石模型,观测对照组及高胆固醇膳食1、2 、3、4周组动物血浆脂蛋白脂酶(LPL)、肝脂酶(HL)活性、血浆脂蛋白胆固醇及胆汁中甘氨胆酸(GCA)、甘氨脱氧胆酸(GDCA)、胆固醇的变化.结果显示:随着进食高胆固醇膳食时间的增加,血中LPL活性增高明显(P＜0.05);HL活性也逐渐升高,3周组及4 周组与对照组差异显著(P＜0.05);血中VLDL-C、LDL-C及胆汁中胆固醇也明显升高(P ＜0.05);而血中 HDL-C、HDL2-C及HDL3-C以及胆汁中GCA、GDCA无明显变化(P＞0.05).结果表明:LPL及HL活性升高可能使肝脏摄取及向胆汁中排泌胆固醇增加,进而影响结石形成.     

生长抑素对肝硬化食道胃底静脉曲张破裂出血作用的临床研究

目的 观察生长抑素制剂（施他宁、善得定）对于肝硬化食道胃底静脉曲张破裂出血的治疗效果,并与垂体后叶素进行比较。方法 ６４例患者随机分为垂体后叶素组（ｎ＝２１）、施他宁组（ｎ＝２０）、盖得定组（ｎ＝２３）进行治疗。结果 垂体后叶素组、施他宁组和善意得定组患者自接诊后至完全止血时的出血量,及接诊后至止血后４８小时生命 体征基本平稳时的输血量无显著性差异（Ｐ〉０．０５）。各治疗组２４小时内的止血率均为８     

肝星形细胞表达转化生长因子α与成纤维细胞生长因子

目的 研究肝星形细胞（ＨＳＣ）转化生长因子α（ＦＧＦα）与成纤维细胞生长因子（ａＦＧＦ）的表达。方法 分别从正常与ＣＣＬ４肝纤维化大鼠肝脏分离ＨＳＣ,提取ＲＮＡ,用ＲＴ－ＰＣＲ测定ＴＧＦα和ａＦＧＦｍＲＮＡ。结果 正常ＨＳＣ表达ＴＧＦα和ａＦＧＦ,肝纤维化时ＴＧＦα与ａＦＧＦｍＲＮＡ水平均显著升高（Ｐ〈０．０５）。结论 ＨＳＣ自分泌ＴＧＦα和ａＦＧＦ,对肝纤维化具有重要促进作用。     

扑热息痛所致狗急性肝功能衰竭时血浆5-羟色胺变化及肝脏血流动力学改变的实验研究

目的;通过扑热息痛所致急性肝功能衰竭的动物模型,以期探讨门静脉,肝静脉,腹主动脉,下腔静脉血浆５－羟色胺浓度变化和肝脏血流动力学改变。方法：成年杂种狗１２只,在戊巴比妥钠静脉麻醉下,作上腹正中切口,从门静脉,肝静脉,腹主动脉,下腔静脉各采血２ｍｌ,作血浆５－羟色胺含量检测,作楔形肝组织活检,关腹。     

胆道闭锁手术空肠胆支造瘘与防返流瓣的比较研究

目的为对肝门空肠吻合加空肠胆支造瘘术与加胆支防返流瓣成形术,这两种术式的优缺点进行比较.方法48例胆道闭锁分为两组.A组24例胆道闭锁行肝门空肠Roux-Y吻合,空肠胆支造瘘术.B组为另外24例行肝门空肠Roux-Y吻合,空肠胆支防返流瓣成形术.对这两组术后情况进行回顾性分析.结果A组9例存活,均无黄疸,最长的已9年,1例出现肝脾肿大、食道静脉曲张.现已8岁.B组存活10例,其中无黄疸存活8例.结论两组病例术后排胆汁(或排黄绿色大便)时间、胆管炎发生次数等临床表现进行比较.排胆汁时间相似,无显著差异.术后胆管炎发生率也无显著差异.     

Bolusvs. continuous hepatic arterial infusion of cisplatin plus intravenous 5-fluorouracil chemotherapy for unresectable colorectal metastases

A multicenter, randomized Phase 2 study that compared patients, affected by colorectal liver metastases, who received intrahepatic arterial infusion with two different schedules of cisplatin, bolusvs. continuous infusion, and systemic 5-fluorouracil. PURPOSE: The aim of this study was to validate results of a previous Phase 2 trial on bolus cisplatin intrahepatic arterial infusion, which reported a 47 percent response rate and a 32 percent 4-year survival rate for Gennari's Stage 2 patients, with a high rate of neurologic, gastrointestinal, and hematologic toxicity. METHODS: One hundred nine patients were randomized in a Phase 2 study to receive cisplatin intrahepatic arterial infusion (24 mg/m²/day, 15, bolusvs. continuous infusion) and systemic intravenous 5-fluorouracil (250, 375, or 500 mg/m²/day, 15; escalating doses, respectively, at cycles I, II, III, and VI). To avoid neurotoxicity a maximum of six cycles was administered. RESULTS: Preliminary results for the 78 evaluable patients are similar to those of the previous study: response rate 46 percent and at a median follow-up of 16.5 months, the overall survival was 16.5 months, with 45 percent of the patients who received more than 3 cycles alive at 3 years. Toxicity, evaluable in 99 patients, showed a decreased incidence of neurotoxicity and a tolerable gastrointestinal and hematologic toxicity, lower in the cisplatin continuous infusion arm. CONCLUSION: This study clearly shows that cisplatin intrahepatic arterial infusion is able to provide a good palliative effect with a tolerable toxicity.This study was supported in part by Pharmacia-Deltec, Italy.