1/32. Hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones.We present a patient with complication of huge hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic lithotripsy. The hematoma measured 78-110mm. angiography showed a subcapsular hematoma, rather than a hematoma in the liver. In the arterial phase, the distal end of the small vessel showed spotty opacification similar to microaneurysma, suggesting that it was an injury caused by separation of the liver and its capsule, caused by the shock waves. The portal vein and hepatic vein were normal. After 8 weeks of conservative therapy, the hematoma was gradually absorbed and the patient was discharged. Eight months after the accident, the hematoma had decreased to 40mm in size. After 20 months, it was completely absorbed. The reported rate of renal subcapsular hematoma after ESWL for renal or ureter stones is 0.1%-0.7%. To date, however, only five cases of hepatic subcapsular hematoma after right renal stone disintegration have been reported. This is the first report of hepatic subcapsular hematoma after ESWL for pancreatic stones.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/32. The liver in hereditary hemorrhagic telangiectasia (Weber-Rendu-Osler disease).BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT, Osler disease) is an inborn error in the structure of different vessels. This leads to vascular malformations in multiple organ systems. In the liver vascular abnormalities are associated with a marked fibrosis and/or cirrhosis. methods AND RESULTS: We found hepatic manifestation of Osler disease in four women and one man (51-63 years old) presenting initially with slight disturbances of liver function. In three patients progressive liver insufficiency developed. The characteristic histologic and sonographic findings are described and discussed. CONCLUSION: ultrasonography with color and Doppler analysis is diagnostic, replacing more extensive procedures like angiography, computer tomography, or magnetic resonance tomography.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/32. polyarteritis nodosa involving the hepatobiliary system in an eight-year-old girl with a previous diagnosis of familial mediterranean fever.polyarteritis nodosa (PAN) is a vasculitis of small- and medium-sized muscular arteries with deposition of immune complex in the vessel wall. Although gastrointestinal involvement is common, the symptomatic involvement of the hepatobiliary system is rare. An eight-year old female patient with a previous diagnosis of familial mediterranean fever (FMF) was hospitalized for right upper quadrant pain and fever. The thickened gall bladder wall by ultrasonography, called for exploration. Histopathological evaluations of the liver biopsy and gall bladder revealed PAN. Corticosteroid therapy was initiated and the patient recovered fully. This case represents one of the rarest forms of PAN in childhood.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/32. Livers from patients with apolipoprotein a-i amyloidosis are not suitable as "domino" donors.Orthotopic liver transplantation, by eliminating the major site of amyloidogenic protein synthesis, is currently the only definitive treatment of most hereditary amyloidoses. Because of the minimal parenchymal involvement, the explanted livers from familial amyloidotic polyneuropathy (FAP) patients have been transplanted into non-FAP patients in a "domino" fashion. The aim of this study was to evaluate the extent of amyloid deposits in explanted livers from two patients with apolipoprotein a-i amyloidosis, with the Arg26 mutation, to determine their suitability as domino donors. A detailed histologic review of the explanted livers from two patients was performed and assessed for the extent of amyloid deposition by routine and congo red stains. Both patients had identical histopathologic features. The liver parenchymal involvement was strikingly severe. Large patches of amyloid separated hepatic cords, with accentuation around the central veins. All portal triads were consistently and markedly involved with amorphous eosinophilic deposits within the connective tissue compressing the bile ducts and vascular structures. Hilar vessels had patchy deposits. No involvement of hilar nerve branches was seen. The hepatic parenchyma is extensively involved in hereditary apolipoprotein a-i amyloidosis, with the Arg26 mutation. These livers, removed at orthotopic liver transplantation, are not suitable for domino donation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/32. Thrombotic thrombocytopenic purpura without any evidence of thrombotic lesions at autopsy.diagnosis of thrombotic thrombocytopenic purpura (TTP) is usually based upon the clinical features, and does not always involve histopathological evidence. We recently had experience with a patient who developed the five signs characteristic for TTP. He had been treated for liver cirrhosis associated with chronic hepatitis b infection, and the hepatic function was severely impaired at admission. Blood levels of vWF (von willebrand factor) and factor viii were highly elevated to 506% and 632%, respectively. These findings suggested severe endothelial damage. Thus, the patient was diagnosed as having TTP secondary to severe hepatic damage, and plasma exchanges were initiated immediately. He responded poorly to the treatment, and finally died of pulmonary hemorrhage. At autopsy, hepatocellular carcinoma was identified in the cirrhotic liver, but it was surprising that thorough postmortem examination failed to show any evidence of thrombotic lesions. Our experience suggests that secondary TTP does not always involve pathological evidence of the thrombotic lesions, and that the formation of thrombi causing vessel occlusion might not be essential in the pathogenesis of some secondary TTP.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/32. Unusual hepatic tumor with features of mesenchymal hamartoma and congenital solitary nonparasitic cyst.We report a hepatic tumor in an adolescent that does not fit into any of the described categories of liver tumors. The patient presented with hepatomegaly, abdominal pain, and normal liver function test; the tumor was cystic in imaging studies. The resected specimen, result of a partial hepatectomy, measured 21 cm and was multicystic with solid areas. Microscopically, the cysts were lined by a mucous-producing or intestinal-type epithelium, associated with smooth muscle and small mucous-producing glands. The solid component contained fibrous and adipose tissue, smooth muscle and thick-walled vessels. aneuploidy was demonstrated by flow cytometry. We interpreted the tumor as having features of a mesenchymal hamartoma and congenital solitary nonparasitic cyst. It is conceivable that the lesions originated with small peribiliary glands with dilatation and intestinal metaplasia.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/32. Features of cell death in brain and liver, the target tissues of progressive neuronal degeneration of childhood with liver disease (Alpers-Huttenlocher disease).Alpers-Huttenlocher disease (AHD) is a rare encephalopathy of infancy and childhood characterized by myoclonic seizures and progressive neurological deterioration, usually associated with signs and symptoms of liver dysfunction. There is no biological marker of the disease, and ultimate diagnosis still relies on pathological examination. Features of clinical progression and pathological findings suggest AHD to be secondary to a genetically determined disorder of mitochondrial function. We report on four AHD patients and focus on their pathological features in brain, liver and muscle. Liver and muscle biopsy specimens were examined using histochemical markers of the oxidative pathways, probes to immunodetect molecules of the apoptotic cascades and electron microscopy. In liver (but not in muscle) biopsy samples, activated caspases were detected by immunohistochemistry: foci of caspase-9-positive cells were seen in a child affected with chronic, progressive fibrosis. In an 18-year-old boy, who suffered from valproic acid-associated acute hepatitis, caspase-3 cells were clustered among the necrotic foci and the foamy cells. In both patients electron microscopy revealed apoptotic nuclei. Normal muscle biopsy specimens were observed in two children, 2 and 8 years-old respectively; in the 18-year-old patient cytochrome oxidase-negative fibers as well as ultrastructural findings of mitochondrial abnormalities were observed. In no patient was there biochemical evidence of impaired oxidative metabolism. Neuropathological examination of the brains of two patients (13 months and 19 years old, respectively) showed focal distribution of the lesions affecting the telencephalic cortex and, to a lesser extent, subcortical gray nuclei. Along with the necrotizing lesions, characterized by neuronal loss, neuropil microcysts and newly formed vessels, we also observed acutely shrunken neurons and features of apoptotic cell death in the cerebral cortex only. Severe neuronal loss without necrotizing features was observed in the cerebellar cortex. The presence of both anoxic and apoptotic nuclei in brain and liver, the target tissues of the disease, is consistent with the hypothesis that abnormal activation of mitochondrion-related cell death pathways might be involved in the pathogenesis of AHD.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/32. Hepatic vascular anomalies in nonparasitic cysts of the liver.Vascular abnormalities demonstrated by angiography in 3 patients with nonparasitic liver cyst are described. In two cases of polycystic liver, dilated and mutually anastomosing hepatic vein branches were seen around a cyst as opacified by hepatic venography, and in one case of solitary liver cyst, anastomoses between large portal branches and a right hepatic vein was demonstrated by celiac angiography. These vascular abnormalities most likely represent developmental malformation along with aberrant bile duct formation expressed in the form of cystic liver. To exclude the possibility of these changes being secondary to expansion of the cyst, an angiographic study of excised polycystic liver was carried out, and it was found that cyst enlargement produced displacement and thinning but no anastomosis of the intrahepatic blood vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/32. Laparoscopic right hemihepatectomy for a case of polycystic liver disease with right predominance.BACKGROUND/PURPOSE: A case of polycystic liver disease with right predominance treated with laparoscopic right hemihepatectomy is described. PATIENT: A 43-year-old woman complaining of right upper abdominal pain came in for consultation. Abdominal ultrasonography and computed tomography studies showed multiple liver cysts occupying mainly the right lobe, renal cysts, and splenomegaly. methods: Four trocars were used. A 12-mm trocar placed under the umbilicus was used for abdominal exploration. The other three trocars, two 12-mm trocars and one 5-mm trocar, were used as working ports. The liver was transected with ultrasound scissors and LigaSure. Major vessels such as the right portal vein, the right bile duct, and the hepatic vein were divided with a vascular endostapler. Operation time was 320 min, intraoperative blood loss was 120 ml, and postoperative oral intake occurred on day 3. RESULTS: No complication was observed during the perioperative period. CONCLUSIONS: Laparoscopic right hemihepatectomy is generally considered to cause excessive intraoperative bleeding and a long operation time. For our patient with multiple liver cysts, the procedure was a safe and minimally invasive option because little hepatic parenchymal resection was necessary for the multiple cysts.A case of polycystic liver disease with right predominance treated with laparoscopic right hemihepatectomy is described.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/32. focal nodular hyperplasia of the liver: arterial angio-CT and microangiography.To differentiate focal nodular hyperplasia (FNH) from other hepatic tumors, especially hepatocellular carcinoma, we evaluated the hemodynamics of histologically proved FNH in three patients, two by arterial angio-CT and one by microangiography of the resected specimen. These studies demonstrated the centrifugal blood supply of FNH (early filling of central tumor vessels radiating to periphery, and lobulated tumor stains with central low density area in the late phase), which could not be demonstrated by dynamic CT or hepatic angiography. Arterial angio-CT is useful as a further study, when differential diagnosis of FNH is uncertain by other imaging techniques.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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