AIMTo 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.METHODSWe reviewed the data of na&#...AIMTo 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.METHODSWe reviewed the data of naïve patients with HBV-related 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 of treatment initiation and another at the second-year follow-up. Liver volume was calculated by 3-dimensional liver extraction volumetry program.RESULTSA total of 55 patients (34 males) were included. There was 114.3 mL ± 167.8 mL (12.9% ± 17.9%) of increase in liver volume during the two years of NUCs therapy (993.8 mL ± 242.8 mL at baseline vs 1108.1 mL ± 263.3 mL 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).CONCLUSIONLong-term oral NUCs therapy in patients with HBV-related liver cirrhosis lead to significant increase in liver volume assessed with 3-dimensional liver extraction volumetry program.展开更多
Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination ...Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination therapy.However,its implantations carries a risk of complications including infection,device malfunction,arrhythmias,right ventricular failure,thromboembolic disease,postoperative and nonsurgical bleeding.A significant number of left ventricular assist devices(LVAD)recipients may experience recurrent gastrointestinal hemorrhage,mainly due to combination of antiplatelet and vitamin K antagonist therapy,activation of fibrinolytic pathway,acquired von Willebrand factor deficiency,and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump.Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions,extended hospital stays,multiple readmissions,and overall mortality.Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients,addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion.Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.展开更多
AIM To establish a reversible porcine model of acute liver failure(ALF) and treat it with an artificial liver system. METHODS Sixteen pigs weighing 30-35 kg were chosen and administered with acetaminophen(APAP) to ind...AIM To establish a reversible porcine model of acute liver failure(ALF) and treat it with an artificial liver system. METHODS Sixteen pigs weighing 30-35 kg were chosen and administered with acetaminophen(APAP) to induce ALF. ALF pigs were then randomly assigned to either an experimental group(n = 11), in which a treatment procedure was performed, or a control group(n = 5). Treatment was started 20 h after APAP administration and continued for 8 h. Clinical manifestations of all animals, including liver and kidney functions, serum biochemical parameters and survival times were analyzed. RESULTS Twenty hours after APAP administration, the levels of serum aspartate aminotransferase, total bilirubin, creatinine and ammonia were significantly increased, while albumin levels were decreased(P < 0.05). Prothrombin time was found to be extended with progression of ALF. After continuous treatment for 8 h(at 28 h), aspartate aminotransferase, total bilirubin, creatinine, and ammonia showed a decrease in comparison with the control group(P < 0.05). A cross-section of livers revealed signs of vacuolar degeneration, nuclear fragmentation and dissolution.Concerning survival, porcine models in the treatment group survived for longer times with artificial liver system treatment(P < 0.05). CONCLUSION This model is reproducible and allows for quantitative evaluation of new liver systems, such as a bioartificial liver. The artificial liver system(ZHj-3) is safe and effective for the APAP-induced porcine ALF model.展开更多
We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointesti...We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointestinal polyposis with ectodermal abnormalities. To our knowledge, this is the first report showing magnified intestinal lesions of CCS. A 73-year-old female visited our hospital with complaints of diarrhea and dysgeusia. The blood test showed mild anemia and hypoalbuminemia. The esophagogastroduodenoscopy and colonoscopy revealed diffuse and reddened sessile to semi-pedunculated polyps, resulting in the diagnosis of CCS. In addition to the findings of conventional balloon-assisted enteroscopy or capsule endoscopy, magnifying observation revealed tiny granular structures, non-uniformity of the villus, irregular caliber of the loop-like capillaries, scattered white spots in the villous tip, and patchy redness of the villus. Histologically, the scattered white spots and patchy redness of the villus reflect lymphangiectasia and bleeding to interstitium, respectively.展开更多
Intraabdominal lymphangiomas are uncommon;additionally,those affecting the gastrointestinal tract are rare and account for less than 1%of cases.Intussusception caused by a cystic lymphangioma of the small bowel is ext...Intraabdominal lymphangiomas are uncommon;additionally,those affecting the gastrointestinal tract are rare and account for less than 1%of cases.Intussusception caused by a cystic lymphangioma of the small bowel is extremely rare.The patient was a20-year-old woman who visited our emergency room with a complaint of abdominal pain.A computed tomography image revealed ileo-ileal intussusception with a leading hypovascular mass measuring 1 cm in a diameter.Single-incision laparoscopic-assisted ileal resection was performed.The surgical specimen consisted of a soft polycystic mass.Macroscopically,a pedunculated polyp with a convolutional pattern was found.Microscopically,the inner surfaces of the cysts were covered with a single layer of endothelial cells.On immunohistochemical examination,the endothelial cells were partially positive for D2-40 and CD34.Smooth muscle cells were also found around the cysts.The lesion was diagnosed as a cystic lymphangioma.Dozens of cases of small bowel lymphangiomas have previously been reported.Of these,cases with intussusception were very rare.This is the first case of small bowel intussusception due to lymphangioma treated by singleincision laparoscopic-assisted surgery.展开更多
文摘AIMTo 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.METHODSWe reviewed the data of naïve patients with HBV-related 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 of treatment initiation and another at the second-year follow-up. Liver volume was calculated by 3-dimensional liver extraction volumetry program.RESULTSA total of 55 patients (34 males) were included. There was 114.3 mL ± 167.8 mL (12.9% ± 17.9%) of increase in liver volume during the two years of NUCs therapy (993.8 mL ± 242.8 mL at baseline vs 1108.1 mL ± 263.3 mL 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).CONCLUSIONLong-term oral NUCs therapy in patients with HBV-related liver cirrhosis lead to significant increase in liver volume assessed with 3-dimensional liver extraction volumetry program.
文摘Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination therapy.However,its implantations carries a risk of complications including infection,device malfunction,arrhythmias,right ventricular failure,thromboembolic disease,postoperative and nonsurgical bleeding.A significant number of left ventricular assist devices(LVAD)recipients may experience recurrent gastrointestinal hemorrhage,mainly due to combination of antiplatelet and vitamin K antagonist therapy,activation of fibrinolytic pathway,acquired von Willebrand factor deficiency,and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump.Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions,extended hospital stays,multiple readmissions,and overall mortality.Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients,addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion.Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.
文摘AIM To establish a reversible porcine model of acute liver failure(ALF) and treat it with an artificial liver system. METHODS Sixteen pigs weighing 30-35 kg were chosen and administered with acetaminophen(APAP) to induce ALF. ALF pigs were then randomly assigned to either an experimental group(n = 11), in which a treatment procedure was performed, or a control group(n = 5). Treatment was started 20 h after APAP administration and continued for 8 h. Clinical manifestations of all animals, including liver and kidney functions, serum biochemical parameters and survival times were analyzed. RESULTS Twenty hours after APAP administration, the levels of serum aspartate aminotransferase, total bilirubin, creatinine and ammonia were significantly increased, while albumin levels were decreased(P < 0.05). Prothrombin time was found to be extended with progression of ALF. After continuous treatment for 8 h(at 28 h), aspartate aminotransferase, total bilirubin, creatinine, and ammonia showed a decrease in comparison with the control group(P < 0.05). A cross-section of livers revealed signs of vacuolar degeneration, nuclear fragmentation and dissolution.Concerning survival, porcine models in the treatment group survived for longer times with artificial liver system treatment(P < 0.05). CONCLUSION This model is reproducible and allows for quantitative evaluation of new liver systems, such as a bioartificial liver. The artificial liver system(ZHj-3) is safe and effective for the APAP-induced porcine ALF model.
文摘We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointestinal polyposis with ectodermal abnormalities. To our knowledge, this is the first report showing magnified intestinal lesions of CCS. A 73-year-old female visited our hospital with complaints of diarrhea and dysgeusia. The blood test showed mild anemia and hypoalbuminemia. The esophagogastroduodenoscopy and colonoscopy revealed diffuse and reddened sessile to semi-pedunculated polyps, resulting in the diagnosis of CCS. In addition to the findings of conventional balloon-assisted enteroscopy or capsule endoscopy, magnifying observation revealed tiny granular structures, non-uniformity of the villus, irregular caliber of the loop-like capillaries, scattered white spots in the villous tip, and patchy redness of the villus. Histologically, the scattered white spots and patchy redness of the villus reflect lymphangiectasia and bleeding to interstitium, respectively.
文摘Intraabdominal lymphangiomas are uncommon;additionally,those affecting the gastrointestinal tract are rare and account for less than 1%of cases.Intussusception caused by a cystic lymphangioma of the small bowel is extremely rare.The patient was a20-year-old woman who visited our emergency room with a complaint of abdominal pain.A computed tomography image revealed ileo-ileal intussusception with a leading hypovascular mass measuring 1 cm in a diameter.Single-incision laparoscopic-assisted ileal resection was performed.The surgical specimen consisted of a soft polycystic mass.Macroscopically,a pedunculated polyp with a convolutional pattern was found.Microscopically,the inner surfaces of the cysts were covered with a single layer of endothelial cells.On immunohistochemical examination,the endothelial cells were partially positive for D2-40 and CD34.Smooth muscle cells were also found around the cysts.The lesion was diagnosed as a cystic lymphangioma.Dozens of cases of small bowel lymphangiomas have previously been reported.Of these,cases with intussusception were very rare.This is the first case of small bowel intussusception due to lymphangioma treated by singleincision laparoscopic-assisted surgery.
