3-Dimensional liver volume assessment in patients with hepatitis B virus-related liver cirrhosis during long-term oral nucleos(t)ide analogues therapy

AIM To assess the effect of long-term oral nucleos(t)ide analogues(NUCs) therapy on liver volume change in patients with suppress hepatitis B virus(HBV)-related liver cirrhosis.METHODS We reviewed the data of na?ve patients with HBVrelated liver cirrhosis, who had taken oral NUCs therapy, between 2003 and 2007 at Chonbuk University Hospital. We analyzed two consecutive sets of abdominal computerized tomography scans-one at the time oftreatment initiation and another at the second-year follow-up. Liver volume was calculated by 3-dimensional liver extraction volumetry program.RESULTS A total of 55 patients(34 males) were included. There was 114.3 m L ± 167.8 m L(12.9% ± 17.9%) of increase in liver volume during the two years of NUCs therapy(993.8 m L ± 242.8 m L at baseline vs 1108.1 m L ± 263.3 m L at two-year follow-up, P < 0.001). The ratio of the measured baseline liver volume to the estimated standard liver volume was improved from 70.8% to 78.0%. An increase in liver volume was shown not only in patients with compensated cirrhosis(P = 0.046) but also in those with decompensated cirrhosis(P < 0.001). Significant factors for volume increases were Child-Turcotte-Pugh grade and model for end-stage liver disease score improvement without virological breakthrough. In multiple linear regression analysis, delta albumin and delta alanine aminotransferase levels showed a significant association with the increase in liver volume(P = 0.002 and 0.005, respectively).CONCLUSION Long-term oral NUCs therapy in patients with HBVrelated liver cirrhosis lead to significant increase in liver volume assessed with 3-dimensional liver extraction volumetry program.

Ischemic colitis secondary to inferior mesenteric arteriovenous fistula and portal vein stenosis in a liver transplant recipient

Arteriovenous fistula (AVF) involving the inferior mesenteric vessels is rare, and the affected patients usually present with abdominal pain, mass, or features of established portal hypertension. Colonic ischemia is a less common and more serious manifestation of AVF. We report a case of ischemic colitis secondary to inferior mesenteric AVF in a patient who underwent a previous liver transplantation, subsequently developed portal vein stenosis, and then presented with acute lower gastrointestinal bleeding. He underwent percutaneous transhepatic placement of a portal vein stent and left colectomy.

Delayed pseudoaneurysm formation of the carotid artery following the oral cavity injury in a child:A case report

BACKGROUND An impalement injury of the oral cavity is a common traumatic injury in children.In most cases,it is not accompanied by sequelae,but if foreign body residues are not found due to a minor injury,they may result in inflammatory responses and delayed vascular injuries in the surrounding tissues.Without early diagnosis and appropriate initial management,residual foreign bodies can cause serious complications and even mortality in some cases.CASE SUMMARY A 9-year-old boy suffered an intra-oral injury by a wooden chopstick,and the patient was discharged from the hospital after receiving conservative treatment for the injury.However,the patient was readmitted to the hospital due to intraoral bleeding,and since neck hematoma and right internal carotid artery pseudoaneurysm formation were detected on computed tomography,emergency surgery was performed.A remnant fragment of a wooden chopstick was found during the operation,and a delayed rupture of the internal carotid artery caused by the foreign body was also found.CONCLUSION The failure of early detection and diagnosis of a residual foreign body may result in delayed vascular rupture.

New-onset diabetes after adult liver transplantation in the Korean Organ Transplantation Registry (KOTRY) study

Background:New-onset diabetes after transplantation(NODAT)is a serious complication following liver transplantation(LT).The present study aimed to investigate the incidence of and risk factors for NODAT using the Korean Organ Transplantation Registry(KOTRY)database.Methods:Patients with history of pediatric transplantation(age≤18 years),re-transplantation,multi-organ transplantation,or pre-existing diabetes mellitus were excluded.A total of 1,919 non-diabetic adult patients who underwent a primary LT between May 2014 and December 2017 were included.Risk factors were identified using Cox regression analysis.Results:NODAT occurred in 19.7%(n=377)of adult liver transplant recipients.Multivariate analysis showed steroid use,increased age,and high body mass index(BMI)in recipients,and implantation of a left-side liver graft was closely associated with NODAT in adult LT.In living donor liver transplant(LDLT)patients(n=1,473),open donor hepatectomy in the living donors,steroid use,small for size liver graft(graft to recipient weight ratio≤0.8),increased age,and high BMI in the recipient were predictive factors for NODAT.The use of antimetabolite and basiliximab induction reduced the incidence of NODAT in adult LT and in adult LDLT.Conclusions:Basiliximab induction,early steroid withdrawal,and antimetabolite therapy may prevent NODAT after adult LT.High BMI or advanced age in liver recipients,open donor hepatectomy in living donors,and small size liver graft can predict the occurrence of NODAT after adult LT or LDLT.