Standard therapy for variceal bleeding includes endoscopic sclerotherapy and esophageal balloon tamponade. In addition, pharmacologic therapies, including arginine vasopressin (AVP), are frequently used in hemodynamically unstable patients or where sclerotherapy has been unsuccessful. A case is described herein of a 30-year-old woman with a history of ethanol abuse, hematemeisis, and ...

The objective of the investigation was to characterize the hepatic cryolesion formed with an implantable needle (3 x 100 mm) cryoprobe. This was used to produce cryolesions in isolated porcine liver tissue equilibrated to 37 degrees C in a water bath. The shape, size, and temperature zones within the cryolesion ...

BACKGROUND: Intra-abdominal hypertension is known to decrease hepatic blood flow, but its effect on hepatic energy level has not described. METHODS: Fifty-three rabbits were mechanically ventilated and divided into five groups. Intra-abdominal hypertension was induced by saline infusion and maintained for 30 minutes. Hepatic sinusoidal functional blood flow was evaluated ...

BACKGROUND: Blood loss and transfusion requirement are major determinants of mortality and morbidity following liver resection. This study was prompted by the observation that blood loss was excessive when the inferior vena cava (IVC) was distended, and determined whether a correlation exists between blood loss and pressure within the IVC ...

STUDY OBJECTIVE: To determine changes in the cross-sectional area of the right internal jugular vein (RIJV) in response to positive intrathoracic pressure and hepatic compression in mechanically ventilated patients during general anesthesia. DESIGN: Prospective, nonrandomized study. SETTING: A university medical center. PATIENTS: 15 ASA physical status II and III adult ...

Veno-venous bypass under total vascular exclusion is a useful technique to permit safer resection of hepatic malignancy. We describe here a retrospective study of two modified venous bypass techniques as alternatives to the conventional end-on portal cannulation technique. Portal decompression via inferior mesenteric vein access was performed in eight patients ...

In healthy subjects octreotide is largely metabolised by the liver suggesting that the plasma half-life of the somatostatin analogue may be prolonged in patients with hepatic dysfunction. The aim of this study was therefore (a) to determine the pharmacokinetics of octreotide following its subcutaneous injection in 6 patients with cirrhosis ...

The perfusion of human donor livers was studied during organ retrieval using laser Doppler flowmetry to assess the microcirculatory alteration caused by fatty infiltration (steatosis). Using a multichannel laser Doppler flowmeter, we measured the hepatic perfusion as flux units in 21 liver donors, eight of which were macroscopically fatty. Perfusion ...

The effects of a continuous infusion of E. coli endotoxin on liver blood chemistry, plasma TNFalpha and blood pressure were evaluated in relation to survival in 18 anaesthetized pigs. The endotoxin infusion cause both unconjugated and conjugated bilirubin to increase (both p < 0.001), as compared to 6 saline-infused controls. ...

A common stump of the three hepatic veins has always been used to fashion the upper vena cava anastomosis in 205 liver transplantations with the piggyback (PGB) technique performed in our Unit, to avoid outflow problems. The aim was to study the repercussion of lateral inferior vena cava (IVC) clamping ...

The relationship between the various haemodynamic abnormalities observed in cirrhosis and their prognostic value remains unclear. We report haemodynamic measurements on 96 patients with alcoholic cirrhosis (mean Childs-Pugh Score, CPS, 9.0 +/- 0.2, mean age 55.6 +/- 1.0 years) and assess their value in predicting variceal bleeding and death during ...

OBJECTIVE: The purposes of this study were to determine if splenic perfusion measurements obtained using dynamic CT are useful in the evaluation of portal hypertension. MATERIALS AND METHODS: Forty-four patients with chronic liver disease (29 men and 15 women, 49-81 years old) and 38 control subjects (17 men and 21 ...

The treatment of irresectable hepatic metastases is limited by the systemic toxicity of anticancer agents. Isolated hyperthermic liver perfusion (IHLP) with anticancer agents is a new therapy for irresectable liver tumors. The risks of this therapy lie in the extended operation, the anhepatic phase and the possibility of liver damage ...

The model of fulminant hepatic failure induced by acetaminophen was established in dogs to observe the changes of hepatic hemodynamics and plasma histamine levels in portal vein (PV), hepatic vein (HV), abdominal aorta (AA) and inferior vena cava (ICV). The results showed that the portal vein resistance (PVR) was elevated ...

The effects of prostaglandin E1 (PGE1) on hepatic sinusoidal endothelial cells (SEC) in the xenogeneic immunoreaction were investigated. Porcine livers were perfused with fresh human blood via the portal vein (PV) and the hepatic artery (HA) either with the administration of PGE1 (Group PG) or without PGE1 (Group C). The ...

Increased intracranial pressure and cerebral oedema in patients with chronic liver disease is rare and is more typical of acute liver failure. Transjugular intrahepatic portosystemic stent-shunt is being increasingly used in the management of uncontrolled variceal haemorrhage in patients with cirrhosis. In our institution, a total of 160 patients has ...

Hemodynamics and oxygen variables, plasma cytokines, and histological features of a liver tissue sample obtained by transvenous biopsy were evaluated during 65 episodes of acute rejection. The hepatic venous pressure gradient was significantly higher in patients with acute rejection than in those without (5.1+/-0.3 vs. 3.1+/-0.2 mmHg, P<0.01). The increase ...

BACKGROUND/AIMS: The portal pressure response to propranolol varies significantly in individual patients with cirrhosis. At present, propranolol responders can be identified only by measuring the hepatic venous pressure gradient. The aims of this study were: 1) to investigate whether the noninvasive monitoring of portal blood flow by pulsed Doppler ultrasound ...

We determined the effects of platelet-activating factor (PAF), a potent vasoactive autacoid phospholipid, on the capillary pressure and liver weight (Wt) in isolated canine livers perfused with blood bivascularly via the portal vein and hepatic artery. PAF (0.01-33 microg) administered intraportally produced dose-dependent increases in the hepatic capillary pressure, as ...

BACKGROUND & AIMS: Therapeutic paracentesis may be associated with a circulatory dysfunction, manifested by a marked increase of the plasma renin activity and plasma norepinephrine. The aim of the study was to characterize the systemic and hepatic hemodynamic changes associated with paracentesis-induced circulatory dysfunction. METHODS: Changes in plasma renin, aldosterone, ...

This study was performed to investigate factors determining tumor pressure (TP) in hepatocellular carcinoma (HCC) and a correlation of pressure gradient between TP and portal vein pressure (PVP) with tumor spread. TP and hepatic tissue pressure (HTP) were measured in 70 patients who underwent hepatic resection for HCC. Changes in ...

BACKGROUND/AIMS: Low arterial blood pressure is recognised as a distinctive factor in the hyperdynamic circulation in cirrhosis. 24-hour monitoring of the blood pressure and heart rate has recently revealed a reduced circadian variation with relation to liver function. However, associations with other clinical and haemodynamic characteristics have not been investigated ...

BACKGROUND/AIMS: Patients with cirrhosis and ascites usually show alterations of systemic hemodynamics and are thus prone to develop arterial hypotension, which might result in cerebral hypoperfusion if cerebral autoregulation is impaired. METHODS: We evaluated cerebral autoregulation in 15 patients with cirrhosis and ascites and 15 healthy subjects by monitoring mean ...

We undertook this prospective evaluation to define the direct hemodynamic impact of vein graft stenoses and to correlate intraoperative hemodynamic findings with the preoperative duplex scan. Twelve consecutive isolated vein graft stenoses were identified in the vascular laboratory during our routine duplex scanning surveillance protocol over 10 months. Peak systolic ...

To test the hypothesis that the hepatic sinusoidal pressure is virtually identical to the portal venous pressure (Ppv) or the abdominal vena caval pressure (Pave), microvascular pressures were measured in liver vascular networks supplied by a single portal venule near the liver surface of alpha-chloralose-urethan-anesthetized rabbits. With the use of ...

STUDY OBJECTIVE: To evaluate the safety and efficacy of monitored anesthesia care (MAC) in patients who undergo a novel treatment for hepatocellular cancer in which procedure-related hemodynamic instability is problematic. DESIGN: Nonrandomized open study. SETTING: University cancer center operating room. PATIENTS: Nine patients scheduled for hepatic arterial infusion of doxorubicin ...

To investigate the potential for neural regulation of liver function, we sought to determine whether hepatic sympathetic nerves are activated during stress. Hepatic norepinephrine spillover (HNESO) was measured in halothane-anesthetized dogs before, during and after glucopenia, hypoxia and hemorrhage. HNESO increased during 2-deoxyglucose (2-DG, 600 mg/kg plus 13.5 mg/kg/min, IV)-induced ...

To enhance the portal hypotensive effect of nonselective beta-blockers, combinations of vasoactive agents with different mechanisms should be considered. The effect of carvedilol (CAS 72956-09-3, Artist), and alpha-/beta-blocking agent, on hepatic and systemic hemodynamics in 10 patients with portal hypertension was evaluated. After administration of carvedilol, the hepatic venous pressure ...

BACKGROUND/AIMS: The antithyroid drug propylthiouracil has been suggested for the treatment of alcoholic liver disease. Its beneficial effects could be due to either a decrease in hepatic oxygen consumption or an increase in hepatic blood flow. The aim of this study was to test these two hypotheses in patients with ...

Combined effects of prolonged prostaglandin E1 (PGE1)-induced hypotension and haemodilution on hepatic function were studied in 30 patients undergoing hip surgery. The patients were randomly allocated to one of three groups; those in group A (n = 10) were subjected to controlled hypotension alone, those in group B (n = ...

Postreperfusion syndrome (PRS) is an important cause of hemodynamic deterioration during orthotopic liver transplantation (OLT). We retrospectively studied 94 patients who had undergone OLT in an effort to establish whether the hemodynamic response to clamping of the inferior vena cava (IVC) could be used to predict hemodynamic behavior on reperfusion ...

BACKGROUND AND HYPOTHESIS: Multiple contrast-enhanced echocardiographic studies are to be expected in patients with cardiac ischemic disease, but the sonication process used to produce the echocontrast agent Albunex may result in new epitopes that could cause an immunogenic response. METHODS: Repeated exposures to intravenous Albunex over a period of time ...

OBJECTIVE: To document presence of endotoxin in portal and systemic blood in a model of canine multiple portosystemic shunts (PSS), and compare values in clinically normal dogs, before and after vena caval banding. ANIMALS: 6 control dogs and 10 dogs with dimethylnitrosamine-induced multiple PSS that were subjected to vena caval ...

Much progress has been made in the recognition of factors involved in the pathogenesis of the abnormal regulation of extracellular fluid volume in cirrhosis. It is now well established that cirrhosis induces modifications in the activity of several systemic vasoactive factors which then play a major role in the development ...

We examined animal models and studied patients with chronic liver disease to evaluate phase shift of the flow-velocity waveform of the hepatic vein (HV). We decided the Doppler-Pressure (DP) ratio using electrocardiography, the HV Doppler waveform and HV pressure curves, and we calculated the DP ratios. In animal models, the ...

BACKGROUND/AIMS: Combinations of beta-blockers and vasodilators have been assessed for their ability to lower portal pressure and so prevent variceal haemorrhage. However, reservations have been raised particularly with respect to renal function and perfusion after the use of these medicines in patients with chronic liver disease. We studied the acute ...

We determined whether the triple vascular occlusion pressure (Pto), the equilibration pressure obtained when the hepatic artery, portal, and hepatic veins were occluded simultaneously, represented the capillary pressure (Pc) in isolated bivascularly blood-perfused canine livers. Effects of a bolus injection of histamine (0.1-60 micrograms), norepinephrine (NE; 1-600 micrograms), or acetylcholine ...

Orthotopic liver transplantation (OLT) in patients with end-stage liver disease is a procedure associated with high cardiac output, low systemic vascular resistance (SVR), coagulopathy and the potential for significant blood loss. A feature of hypertrophic obstructive cardiomyopathy (HOCM) is left ventricular outflow tract obstruction which may be exacerbated by reduced ...

Our objective was to determine the effects of vasodilatory treatment with epoprostenol (PGI2) and nitroglycerin (NTG) on systemic oxygen delivery index (DO2) and hepatic venous oxygen saturation (SvhO2) after liver transplantation. This prospective study used repeated-measures design. Fifteen adult patients undergoing orthotopic liver transplantation (OLT) were enrolled. Postoperatively, a fiberoptic ...

BACKGROUND: This study was conducted to clarify the cardiovascular effects of a new NO-releasing compound, NOC-7, and to compare it with other nitrovasodilators, sodium nitroprusside (SNP) and nitroglycerin, in dogs anesthetized with pentobarbital. METHODS AND RESULTS: A bolus injection of NOC-7 decreased mean aortic blood pressure in a dose-dependent manner. ...

BACKGROUND & AIMS: Although resection of hepatocellular carcinoma complicating cirrhosis is restricted to patients with preserved liver function, postoperative hepatic decompensation develops in some patients. The aim of this study was to determine the value of increased portal pressure in the development of postoperative hepatic decompensation. METHODS: Twenty-nine cirrhotic patients ...

A 31-year-old man with Child's class A micronodular cirrhosis, left lobe hypertrophy, and a transjugular intrahepatic portosystemic shunt (TIPS) which had been placed 6 months earlier, was admitted for recurrent esophageal bleeding and a portosystemic gradient of 42 mmHg. Balloon occlusion portography documented unsuspected ostial thrombosis of the previously patent ...

Using a recently developed gas chromatography and mass spectrometry method to determine whole-blood cyclophosphamide (CP) and 4-hydroxycyclophosphamide/aldophosphamide (4-HO-CP/AP) concentrations, we investigated their pharmacokinetics in women receiving CP therapy. Patients (n = 18) received one or two courses of CP: (a) a 90-min i.v. infusion (4 g/m2) followed by a 96-h ...

OBJECTIVE: Study on simultaneous O2 supply/uptake relationships in liver and gut during endotoxaemia, to determine whether signs of dysoxia develop uniformly in the splanchnic region. DESIGN: Animal study to assess the early effects of endotoxaemia on oxygenation of both liver and small intestine. INTERVENTIONS: Eight anaesthetized pigs received a continuous ...

This randomized, double-blind, placebo-controlled study on the hemodynamic effect of two different doses of octreotide administered subcutaneously was conducted among 20 cirrhotic portal hypertensive patients. The wedged hepatic venous pressure, the hepatic venous pressure gradient, the mean portal venous flow velocity, the resistive index of the superior mesenteric artery, the ...

Intravital epifluorescent microscopy was used to quantitate microvascular parameters in the single-pass, dually perfused rat liver preparation. Livers perfused via the hepatic artery (HA) and portal vein (PV) at physiological pressures and perfusion rates responded to vasoactive agents and exhibited the HA buffer response. The distribution of arterial blood was ...

We administered liposome-encapsulated antisense oligodeoxynucleotide targeted to angiotensinogen mRNA peripherally to spontaneously hypertensive rats to test whether peripheral angiotensinogen reduction would lower their hypertensive blood pressures and to determine the role of peripheral angiotensinogen in the modulation of hypertension. Using in vitro translation techniques, we tested the sequence specificity of ...

Propranolol and molsidomine have both been shown to decrease the hepatic venous pressure gradient in patients with cirrhosis. The present study aimed at assessing the effects of the combination of these two drugs on splanchnic and systemic haemodynamics of cirrhotic patients. Fifteen patients with biopsy proven alcoholic cirrhosis had haemodynamic ...

Nodular regenerative hyperplasia of the liver is an uncommon condition. Approximately 50% of these patients develop portal hypertension. Few previous reports document the site of increased resistance to blood flow within the liver in this disorder. We measured Doppler waveform patterns of the right hepatic vein by pulsed Doppler ultrasonography ...

In a previous study, we showed that plasma concentrations of catecholamines were increased during the anhepatic phase in pigs. In this study, we investigated if a constant depth of anaesthesia would prevent these changes and, if not, if the changes were caused by impaired extraction of catecholamines. We measured arterial ...