Changes of duplex parameters and splenic size in liver transplant recipients during a long period of observation

AIM: To assess the changes of portal and arterial velocities, resistance index, spleen and liver size during a long observation period (13.7 years) after orthotopic liver transplantation (OLT).METHODS: Two hundred and sixty patients were recruited retrospectively for this study and divided into groups with defined time intervals after OLT. The cross-sectional changes of portal and arterial velocities,resistance index, spleen and liver size between the defined time intervals were studied. The complications detected by ultrasound were compared to gold standard methods.RESULTS: The mean values for liver size were all within the normal range. The splenic size decreased between the time intervals 100 and 1 000 d after OLT (t;P＜0.01).While portal and arterial flow velocities decreased up to 5.5 years (t; portal velocity P＜0.01, maximal systolic velocity P=0.05, maximal end diastolic velocity P＜0.01),RI increased during this interval (t:P＜0.01). Higher RIvalues were found in older patients (r = 0.24, P＜0.001).CONCLUSION: The arterial and portal velocities show adaptation processes continuing over the course of many years after OLT and are reported for the first time. The vascular complications detected by ultrasound occur mostly up to 100 d after OLT.

Liver resections can be performed safely without Pringle maneuver: A prospective study

AIM To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad. METHODS Between 9/2002 and 7/2013, 175 consecutive liver resections(n = 101 major anatomical and n = 74 large atypical > 5 cm) without Pringle maneuver were performed in 127 patients(143 surgeries). Accompanying, 37 wedge resections(specimens < 5 cm) and 43 radiofrequency ablations were performed. Preoperative volumetric calculation of the liver remnant preceeded all anatomical resections. The liver parenchyma was dissected by waterjet. The median central venous pressure was 4 mmH g(range: 5-14). Data was collected prospectively. RESULTS The median age of patients was 60 years(range: 16-85). Preoperative chemotherapy was used in 70 cases(49.0%). Liver cirrhosis was present in 6.3%, and liver steatosis of ≥ 10% in 28.0%. Blood loss was median 400 mL(range 50-5000 mL). Perioperative blood transfusions were given in 22/143 procedures(15%). The median weight of anatomically resected liver specimens was 525 g(range: 51-1850 g). One patient died postoperatively. Biliary leakages(n = 5) were treated conservatively. Temporary liver failure occurred in two patients.CONCLUSION Major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay.

PET/CT联合应用对胆囊癌和胆管癌分期及治疗的影响

Background/Aims: (1) To evaluate the diagnostic value of integrated positron emission and computed tomography (PET/CT) in comparison with contrast-enhanced CT (ceCT) to detect biliary tract tumors and associated distant and regional lymph node metastases and (2) to evaluate the impact of PET/CT on therapy management. Methods: From January 2001 to March 2005, each patient who was treated for a malignancy of the biliary tract underwent PET/CT examination in addition to the standard work-up imaging. Data were prospectively collected and analyzed in comparison with ceCT. Results: Sixty-one patients with malignancies of the biliary tract were included into the study. Diagnosis was proven in all patients either by histology or cytology. PET/CT detected all gallbladder cancers (n = 14). PET/CT and ceCT provided a comparable accuracy for the primary intra-(n = 14) and extra-hepatic cholangiocarcinomas (n = 33). All distant metastases (12/12) were detected by PET/CT, but only 3/12 by ceCT (p < 0.001). Regional lymph node metastases were detected by PET/CT and ceCT in only 12%vs. 24%. PET/CT findings resulted in a change of management in 17%of patients deemed resectable after standard work-up. Conclusions: PET/CT is particularly valuable in detecting unsuspected distant metastases which are not diagnosed by standard imaging. Thus, PET/CT staging has an important impact on selection of adequate therapy.

Tibetan herbal formula Padma Digestin modulates gastrointestinal motility in vitro

AIM:To examine the effects of Padma Digestin on the smooth muscle motility of different gastrointestinal segments in vitro . METHODS:The effects of the ethanolic extract of Padma Digestin (at 8.16 mg/mL or 81.6mg/mL) on the contractility and susceptibility to acetylcholine (ACh) of muscle strips from the cardia, antrum, pylorus, duodenum, jejunum, ileum and colon of male Wistar rats were analyzed.RESULTS:Compared with the control treatment, the Padma Digestin extract had a procontractile effect on the antral smooth muscle strips. Padma Digestin decreased ACh sensitivity in cardia muscle strips and increased it in those from the antrum and pylorus. In the intestinal segments, spontaneous contractility was inhibited in both the duodenal and jejunal strips, whereas reactivity to ACh was inhibited in the jejunal strips only. In the colonic samples, Padma Digestin inhibited spontaneous and ACh-stimulated contractility at a low dose but seems to have increasing effects at a high dose. CONCLUSION:Padma Digestin extract has regionspecific effects on the contractility and excitability of gastrointestinal smooth muscle. Our results support the traditional use of Padma Digestin for maldigestion and functional gastrointestinal disorders.

A narrative review on endopancreatic interventions: an innovative access to the pancreas

The natural connection between the duodenum and the pancreatic duct enables a minimally invasive access to the pancreas.Endoscopically this access is already regularly used,mainly for diagnostic and even for certain therapeutic purposes.With per-oral pancreatoscopy the endopancreatic approach allows the direct visualization of the pancreatic duct system potentially improving the diagnostic work-up of pancreatic cystic neoplasms,intrapancreatic strictures and removal of pancreatic duct stones.However,the endopancreatic access can equally be applied for surgical interventions.The objective of this review is to summarize endoscopic and surgical interventions using the endopancreatic access.Endopancreatic surgery stands for a further development of the endoscopic technique:a rigid endoscope is transabdominally introduced over the duodenum and the papilla to enable resections of strictures and inflamed tissue from inside the pancreas under visual control.While the orientation and localization of target structures using this minimally invasive approach is difficult,the development of an accurate image guidance system will play a key role for the clinical implementation and widespread use of endoscopic and surgical endopancreatic interventions.