Ex vivo hepatic venography for hepatocellular carcinoma in livers explanted for liver transplantation

<p>Abstract</p> <p>Background</p> <p>Hepatocellular carcinoma (HCC) is supposed to have a venous drainage system to a portal vein, which makes intrahepatic metastasis possible. However, the mechanism of extrahepatic recurrence, including the possibility of a direct route to the systemic circulation from the HCC nodules, remains unclear. Therefore, we performed retrograde hepatic venography for HCC in livers that had been explanted for liver transplantation in order to explore the possible direct connection between the hepatic vein and HCC nodules.</p> <p>Methods</p> <p>Of 105 living-donor liver transplantations (LDLT) performed up to July, 2009 at the Department of Surgery, Nagasaki University Hospital, dynamic hepatic venography was performed with contrast media under fluoroscopy for the most recent 13 cases with HCC. The presence of a tumor stain for each HCC case was evaluated and compared with the histological findings of HCC.</p> <p>Results</p> <p>Hepatic venography revealed a tumor stain in 2 of 13 cases (15%). Neither showed any microscopic tumor invasion of HCC into the hepatic vein. In the other 11 cases, there were 4 microscopic portal venous invasions and 2 microscopic hepatic venous invasions. No patients have shown HCC recurrence in follow-up (median period, 13 months).</p> <p>Conclusion</p> <p>Using <it>ex vivo </it>hepatic venography, a direct connection to the hepatic vein from HCC in whole liver was revealed in 2 cases without demonstrated histopathological invasion to hepatic vein for the first time in the literature. The finding suggests that there is direct spillage of HCC cells into the systemic circulation via hepatic vein.</p

Selective inhibition of hepatitis C virus replication by alpha-zam, a Nigella sativa seed formulation

Background: Hepatitis C virus (HCV) infection became curable because of the development of direct acting antivirals (DAAs). However, the high cost of DAAs has greatly impeded their potential impact on the treatment of HCV infection. As a result, hepatitis C will continue to cause substantial morbidity, and mortality among chronically infected individuals in low and middle income countries. Thus, urgent need exists for developing cheaper drugs available to hepatitis C patients in these countries.Materials and Methods: Alpha-zam, an indigenous herbal formulation from Nigella sativa seed, was examined for its anti-HCV activity and cytotoxicity in genotype 1b HCV replicon cells. The antiviral activity was determined by luciferase expression and viral RNA synthesis, while the cytotoxicity was assessed by viable cell number and glyceraldehyde-3-phosphate dehydrogenase RNA synthesis in the replicon cells.Results: Alpha-zam was found to be a selective inhibitor of HCV replication. The 50% effective dilution and 50% cytotoxic dilution of Alpha-zam were 761- and &lt; 100-fold, respectively, in the subgenomic replicon cells LucNeo#2. Its selective inhibition of HCV was also confirmed by HCV RNA levels in LucNeo#2 and in the full-genome HCV replicon cells NNC#2 using real-time reverse transcriptase polymerase chain reaction. Furthermore, the anti-HCV activity of Alpha-zam was not due to the induction of interferon.Conclusion: Alpha-zam selectively inhibits HCV replication and therefore has potential for a novel antiviral agent against HCV infection.Keywords: Alpha-zam, chronic hepatitis, hepatitis C virus, antiviral assay, Nigella sativ

A secure taping technique for a liver hanging maneuver using a surgical probe.

A liver hanging maneuver is currently being applied for various types of hepatectomies. The most difficult and important step of this technique is to encircle the liver with tape that is passed between the liver and the inferior vena cava, using a blind dissection. This report describes a secure technique for taping utilizing a surgical probe

An Evaluation of the Efficacy of Compression Therapy Using Sleeves and Stockings to Prevent Docetaxel-induced Peripheral Neuropathy in Breast Cancer Patients

Taxanes are key drugs for patients with breast cancer. A major adverse effect of taxanes is peripheral neuropathy (PN). To investigate the ability of compression therapy using sleeves and stockings to prevent PN due to the taxane docetaxel, we conducted a single-center historical control trial. Patients receiving docetaxel at 75 mg/m2 every 3 weeks for 4 cycles as first-line chemotherapy for breast cancer were eligible. PN was evaluated using the common terminology criteria for adverse events version 4.0. The primary endpoint was the incidence of allgrade PN until 3 weeks after the fourth docetaxel administration. We evaluated 26 patients in the intervention group and compared their data to those collected retrospectively from 52 patients treated with docetaxel without compression. Neither the incidence of all-grade PN until 3 weeks after the fourth docetaxel administration (63.5% in the control group vs. 76.9% in the intervention group, p=0.31) nor that of PN grade ≥ 2 (13.5% vs. 15.4%, p=0.99) differed between the groups. In this study, the efficacy of compression therapy using sleeves and stockings to prevent PN induced by docetaxel was not demonstrated. Further clinical studies including medications or intervention are needed to reduce the incidence and severity of PN induced by chemotherapy

Rapid production of engineered human primary hepatocyte/fibroblast sheets

This data article contains data related to the research article entitled "Vascularized subcutaneous human liver tissue from engineered hepatocyte/fibroblast sheets in mice," published in Biomaterials [1]. Engineered hepatocyte/fibroblast sheets (EHFSs) are used for construction of vascularized subcutaneous liver tissue without a pre-transplant vascularization procedures. Here, we described a rapid production technique of EHFSs by controlling fibroblast density and coating fetal bovine serum (FBS) onto temperature-responsive culture dishes (TRCDs). The human fibroblast monolayer formed on FBS-coated TRCDs within 1h when seeded at a high density (at least 1.56×105cells/cm2). The most rapid EHFS production was achieved soon after the adhesion of human primary hepatocytes onto the fibroblast layer

Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation. A prospective randomized study.

BACKGROUND: Although the effect of synbiotic therapy using prebiotics and probiotics has been reported in hepatobiliary surgery, there are no reports of the effect on elective living-donor liver transplantation (LDLT). METHODS: Fifty adult patients undergoing LDLT between September 2005 and June 2009 were randomized into a group receiving 2 days of preoperative and 2 weeks of postoperative synbiotic therapy (Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides [the BLO group]) and a group without synbiotic therapy (the control group). Postoperative infectious complications were recorded as well as fecal microflora before and after LDLT in each group. RESULTS: Only 1 systemic infection occurred in the BLO group (4%), whereas the control group showed 6 infectious complications (24%), with 3 cases of sepsis and 3 urinary tract infections with Enterococcus spp (P = .033 vs BLO group). No other type of complication showed any difference between the groups. CONCLUSIONS: Infectious complications after elective LDLT significantly decreased with the perioperative administration of synbiotic therapy

Transition of Serum Alkaline Phosphatase Isoenzymes during Liver Regeneration in Humans

Background/Aims: Serum alkaline phosphatase (ALP) levels tend to increase after hepatectomy, however, no previous examinations have yet focused on the relationship between liver regeneration and the individual ALP isoenzymes levels. Methodology: Forty living liver transplantation donors who underwent hemi-hepatectomy were herein investigated. We evaluated the serum ALP levels and ALP isoenzyme levels preoperatively and postoperatively. The liver regeneration rate (LRR) was calculated using volumetry. According to the LRR, we divided the donors into two groups, consisting of a high regeneration group (HG) and a low regeneration group (LG). Results: The total serum ALP levels increased gradually after hepatectomy and peaked on postoperative days (POD) 14. ALP-1 was not detected in any donor preoperatively; however it was detected after hepatectomy, peaking on POD 7. The serum ALP-2 level increased after hepatectomy, reaching a peak level on POD 14. The ALP-2 levels gradually increased after hepatectomy and reached peak levels on POD 14 in both groups. However, the ALP-2 level on POD 14 was significantly higher in HG than LG. Conclusions: The serum ALP- 2 levels after POD 14 might therefore be a useful indicator of favorable liver regeneration following hepatectomy, especially in patients who have a normal liver function

Successful Repeated Transcatheter Arterial Embolization (TAE) for Multiple Liver Metastases from Breast Cancer

A 46-year-old female was successfuly treated with repeated transcatheter arterial embolization (TAE) for multiple liver metastases from breast cancer. TAE using mitomycin C and epirubicin hydrochloride with lipiodol emulsion and gelatin sponge particles has been administered to the patient eight times over 4 years. She has also received systemic chemotherapy. She has survived for 6 years and 3 months after the detection of liver metastases

Is preservation of middle hepatic vein tributaries during right hemi-hepatectomy beneficial for live donor liver transplantation?

Background/Aims: When right hemi-hepatectomy without middle hepatic vein (MHV) is performed in a living donor (LD), MHV tributaries such as V5 and V8 may be preserved during parenchymal transection to preserve liver function and reduce the damage of the graft. However, no study has so far investigated whether this preservation of MHV tributaries during parenchymal transection has impact on live donor operation or graft function. Methodology: Of 52 hepatectomies for right lobe LD, MHV tributaries were preserved during hepatic parenchymal transection in 11 cases, while, in the remaining 41 cases MHV tributaries were sacrificed when those were encountered during hepatic parenchymal transection. Results: There was no significant difference in blood loss, operative time, zenith liver enzyme level in a donor and rate of graft failure in a recipient. Conclusions: It was demonstrated that there was no significant effect of outflow preservation from MHV tributaries on LD hepatectomy for right lobe donation and subsequent liver transplantation