A review of the literature on ligation of the portal vein has been presented. A brief survey of the literature on the ligation of the hepatic veins and the hepatic artery has been included. The review reveals that while there is no disagreement that the result of sudden acute ligation of the portal vein in dogs is inevitably death, there is disagreement as to the cause of death. The main theories are (i) that exsanguination into the splanchnic vascular bed occurs, (ii) that the loss of blood is insufficient to cause death, and that other factors must be implicated, the "toxic" theory. The species difference in the effects of ligation appears to lie in the degree of porto-systemic venous anastomoses. The experiments described in this thesis were performed with the dog as the experimental animal. A measurement of the decrease in circulating blood volume following ligation of the portal vein, using the "labelled" red cell method, was made. It was considered that valid consecutive estimations of blood volume could be made using the "labelled" red cell method. With 11 dogs, 30 minutes after portal vein ligation, the decrease amounted to 57.9% of the original blood volume. The measurement of the normal splanchnic vascular blood volume was made using 10 dogs. This amounted to 21.7% of the circulating blood volume, or 17.7 ml. per kilogram body weight. As the total vascular bed had been reduced by the exclusion of this splanchnic portion, the smaller circulating blood volume was required to serve a smaller vascular area, and it was considered that the true decrease in circulating blood volume was therefore 44.8%. It was considered that this amount of blood loss was not adequate to account for the inevitability of death, or the short period of survival (79.7 minutes) when compared to the effects of bleeding comparable quantities of blood, or bleeding to comparable levels of blood pressure. Haematocrit estimations were made on the systemic arterial blood and portal venous blood before and after ligation of the portal vein. There was a significant decrease in the systemic arterial haematocrit, and rise in the portal venous haematocrit. By the injection of latex into the portal vein of 3 dogs, the main porto-systemic venous anastomoses were found to occur in relation to the vagus nerves at the lower end of the oesophagus. Other porto-systemic venous anastomoses were of minor importance. It was not possible to influence the outcome of acute portal vein ligation by splenectomy, or by antibiotics under the conditions of the experiments. / Medicine, Faculty of / Graduate

The main use of sildenafil in human medicine is to treat erectile dysfunction. In veterinary medicine, sildenafil is most frequently used to treat pulmonary hypertension. The effects of sildenafil on the portal vasculature in the dog have not been previously evaluated. The purpose of this study was to evaluate the effects sildenafil has on the portal vasculature. The cross-sectional area of the aorta, cross-sectional area of the portal vein, and portal vein velocity were acquired in thirteen dogs prior to administration, 45 minutes, 90 minutes, and 120 minutes after the oral administration of sildenafil for the treatment of pulmonary hypertension. No statistically significant difference was detected between all measured values at all time points. Although this study had a small sample size, sildenafil does not have a significant effect on the size of the portal vasculature. Further studies with a larger sample size will be required to further evaluate the effects.

Akademisk avhandling--Göteborgs universitet. / Extra t.p. with thesis statement inserted. Bibliography: leaves 45-47.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22361号 / 医博第4602号 / 新制||医||1043(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 上本 伸二, 教授 小西 靖彦, 教授 黒田 知宏 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23573号 / 医博第4787号 / 新制||医||1054(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中本 裕士, 教授 花川 隆, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

La technique d'une DPC pour adénocarcinome a évolué ces dernières années tant au niveau sécurité qu'au niveau carcinologique mais cela n'a pas suffit à faire progresser la survie. On peut se demander si la modification de la technique chirurgicale pourrait avoir un impact significatif sur la survie.A) Nous avons recherché, sur 23 pièces de DPC encrées, la présence de la mutation K-ras au niveau de la marge veineuse affirmée R0 en analyse histologique : 13 spécimens (groupe kras+) exprimaient une mutation K-ras au sein de la marge veineuse versus 10 spécimens (groupe kras-) ne l'exprimant pas. Les tumeurs des 2 groupes étaient comparables (taille, envahissement ganglionnaire, engainement périnerveux…). La survie globale à 1 an et 3 ans des groupes kras- versus kras+ étaient de 80% versus 84,6% et 16,7% versus 0% (p=0,03), respectivement. Les médianes de survie des groupes kras- versus kras+ étaient de 24 mois versus 16 mois (p=0,04), respectivement.B) Nous avons comparé, après appariement, 19 patients ayant eu une DPC avec résection « par excès » de la veine porte (groupe VP) avec 19 patients ayant eu une DPC sans résection de la veine porte (groupe contrôle). Les survies médianes et à 3 ans du groupe VP versus groupe contrôle étaient 42 mois versus 22 mois (p=0,04) et 60% versus 31% (p=0,03), respectivement.En conclusion, notre travail a montré qu'au-delà de la marge déterminée par le chirurgien pendant la chirurgie, de celle de l'anatomopathologiste déterminée par l'analyse microscopique, il existait une marge génique. La résection systématique de la veine porte semblait bénéfique car elle permettait sans doute de passer au-delà de cette marge génique. / Pancreticoduodenectomy (PD) for adenocarcinoma was safer during the last decades but did not improve survival. We sought to determine if technical changes during PD could improve survival.A) In a first study, we determine the presence of K-ras mutation in the venous margin of 23 PD's specimens. Thirteen specimens had K-ras mutation (kras+ group) and 10 specimens did not (kras- group). Except K-ras mutation status, tumors of the 2 groups were not different when comparing major histological findings (margin status, lymph node invasion, perineural invasion…). Overall 1- and 3-years survival of patients of kras- group versus kras+ group were 80% versus 84,6% and 16,7% versus 0% (p=0,03), respectively. Median survival of patients of kras- group versus kras+ group were 24 months versus 16 months (p=0,04), respectively.B) In a second study, we compared 19 patients with “excessive” portal vein resection during PD (PV group) with 19 matched patients who underwent PD without venous resection (control group). Median survival of patients of PV group versus control group were 42 months versus 22 months (p=0,04), respectively.In conclusion, we showed that the « genic margin » concept was consistent. Systematic portal vein resection could avoid positive genic margin and might be benefic for patient who underwent PD for resecable adenocarcinoma.

Foi realizado o estudo morfométrico e o estudo hemodinâmico da veia porta em vinte cães normais, de idade igual e inferior a 120 dias, e em cinco cães portadores de desvio portossistêmico, de idades entre 90 e 360 dias. Dois animais do grupo de cães portadores de desvio portossistêmico foram submetidos ao tratamento cirúrgico (colocação de anel ameróide) e avaliações subseqüentes ao procedimento cirúrgico foram realizados. Nos cães do grupo normal, as margens hepáticas apresentaram-se entre 1,50cm e 3,00cm depois da margem costal. As médias dos diâmetros médios da veia porta (VP), veia cava caudal (VCC) e aorta abdominal (AO) obtidas foram respectivamente, 0,38cm, 0,37cm e 0,41cm. As proporções entre os diâmetros médios VP/VCC e VP/AO apresentaram médias de 1,10 e 0,94, respectivamente. As médias das áreas de VP, VCC e AO mediram respectivamente, 0,12cm2, 0,11cm2 e 0,14cm2. No estudo hemodinâmico de VP destes animais, utilizando-se o ultra-som Doppler, a velocidade média de fluxo sangüíneo portal (VMFSP) mediu 17,77cm/s. A média de fluxo sangüíneo portal (FSP) mediu 83,11ml/min/kg. O índice de congestão (IC) apresentou média de 0,009. Para o grupo de cães portadores de desvio portossistêmico, o fígado apresentou redução de seu volume, sendo visibilizado entre 1,00cm e 2,00cm antes da margem costal. No estudo morfométrico, as médias dos diâmetros médios obtidos de VP, VCC e AO mensuraram respectivamente, 0,52cm, 0,79cm e 0,58cm. As proporções entre os diâmetros médios VP/VCC e VP/AO mediram respectivamente, 0,62 e 0,84. As médias das áreas de VP, VCC e AO mediram respectivamente, 0,22cm2, 0,56cm2 e 0,27cm2. Ao ultra-som Doppler a VMFSP mediu 26,10cm/s e a média do IC obtido foi de 0,009. Nos animais do grupo de cães portadores de desvio portossistêmico submetidos ao procedimento cirúrgico, foi observado aumento de volume hepático na semana seguinte à colocação do anel ameróide e a VMFSP manteve-se inferior a 19,50cm/s em todos exames subseqüentes à cirurgia no cão 1. / The morphometry and haemodynamic aspects of portal vein were studied in 20 normal dogs with less than 120 days of age and in 5 dogs presenting portosystemic shunting with ages between 90 and 360 days. 2 dogs of the group of animals with portosystemic shunting were submitted to surgical treatment, using a specialized device (ameroid constrictor). Subsequent evaluations were made after the surgical procedure. In the normal group the hepatic margins were seen 1.50cm to 3.00cm below de costal margin. Collected data indicated that the mean diameter of portal vein (VP), caudal vena cava (VCC) and abdominal aorta (AO) measured respectively, 0.38cm, 0.37cm and 0.41cm. The VP/VCC and VP/AO mean ratios were respectively, 1.10 and 0.94. The average of VP, VCC and AO areas were respectively, 0.12cm2, 0.11cm2 and 0.14cm2. The haemodynamic of portal vein was studied by ultrasound Doppler and the mean velocity of portal blood flow (VMFSP) measured was 17.77cm/s. It was verified that portal blood flow (FSP) average was 83.11ml/min/kg and the congestion index (IC) average was 0.009. In the group of animals presenting portosystemic shunting, the hepatic margins were seen 1.00cm to 2.00cm above the costal margin. The morphometry of VP, VCC and AO presented a mean diameter of 0.52cm, 0.79cm and 0.59cm, respectively. The VP/VCC and VP/AO mean ratios were respectively, 0.62 and 0.84. The average of VP, VCC and AO areas were respectively, 0.22cm2, 0.56cm2 and 0.27cm2. The haemodynamic study demonstrated that the VMFSP measured was 26.10cm/s and de IC average was 0.009. In the group of animals with portosystemic shunting which were submitted to surgical treatment, an increase of the liver size was seen from the first ultrasonographic evaluation. The measurements of VMFSP collected in the post surgical period were <= 19.50cm/s in dog 1.

No description available.

Introduction: The reason for the inability of performing the liver resection for colorectal carcinoma metastasis is usually insufficient remnant liver parenchyma after liver resection (future liver remnant volume - FLRV). The current standard method of increasing FLRV is the embolization of the branch of portal vein (portal vein embolization - PVE) on the side of the tumor, and then suspended after hypertrophy of the non-embolised lobe liver resection. Unfortunately, there are some patients who do not increase liver volume despite perfectly executed PVE. Besides that, FLRV occurs during the time necessary for hypertrophy progression of metastatic disease. Therefore, we are trying to find the appropriate way to encourage the growth of remaining liver parenchyma and accelerate hypertrophy of the contralateral liver lobe. From our previous experience (IGA MZ NS 10240), it is possible to be optimistic that there hope is the way of hematopoietic progenitor cells (HPC - adult stem cells) after previous PVE to non-embolised branches of the portal vein. These cells do not only accelerate liver regeneration, but are also able to improve its function (function of the liver) which is especially important for patients after neoadjuvant chemotherapy (steatohepatitis or steatofibrosis), and for patients with...

Foi realizado o estudo morfométrico e o estudo hemodinâmico da veia porta em vinte cães normais, de idade igual e inferior a 120 dias, e em cinco cães portadores de desvio portossistêmico, de idades entre 90 e 360 dias. Dois animais do grupo de cães portadores de desvio portossistêmico foram submetidos ao tratamento cirúrgico (colocação de anel ameróide) e avaliações subseqüentes ao procedimento cirúrgico foram realizados. Nos cães do grupo normal, as margens hepáticas apresentaram-se entre 1,50cm e 3,00cm depois da margem costal. As médias dos diâmetros médios da veia porta (VP), veia cava caudal (VCC) e aorta abdominal (AO) obtidas foram respectivamente, 0,38cm, 0,37cm e 0,41cm. As proporções entre os diâmetros médios VP/VCC e VP/AO apresentaram médias de 1,10 e 0,94, respectivamente. As médias das áreas de VP, VCC e AO mediram respectivamente, 0,12cm2, 0,11cm2 e 0,14cm2. No estudo hemodinâmico de VP destes animais, utilizando-se o ultra-som Doppler, a velocidade média de fluxo sangüíneo portal (VMFSP) mediu 17,77cm/s. A média de fluxo sangüíneo portal (FSP) mediu 83,11ml/min/kg. O índice de congestão (IC) apresentou média de 0,009. Para o grupo de cães portadores de desvio portossistêmico, o fígado apresentou redução de seu volume, sendo visibilizado entre 1,00cm e 2,00cm antes da margem costal. No estudo morfométrico, as médias dos diâmetros médios obtidos de VP, VCC e AO mensuraram respectivamente, 0,52cm, 0,79cm e 0,58cm. As proporções entre os diâmetros médios VP/VCC e VP/AO mediram respectivamente, 0,62 e 0,84. As médias das áreas de VP, VCC e AO mediram respectivamente, 0,22cm2, 0,56cm2 e 0,27cm2. Ao ultra-som Doppler a VMFSP mediu 26,10cm/s e a média do IC obtido foi de 0,009. Nos animais do grupo de cães portadores de desvio portossistêmico submetidos ao procedimento cirúrgico, foi observado aumento de volume hepático na semana seguinte à colocação do anel ameróide e a VMFSP manteve-se inferior a 19,50cm/s em todos exames subseqüentes à cirurgia no cão 1. / The morphometry and haemodynamic aspects of portal vein were studied in 20 normal dogs with less than 120 days of age and in 5 dogs presenting portosystemic shunting with ages between 90 and 360 days. 2 dogs of the group of animals with portosystemic shunting were submitted to surgical treatment, using a specialized device (ameroid constrictor). Subsequent evaluations were made after the surgical procedure. In the normal group the hepatic margins were seen 1.50cm to 3.00cm below de costal margin. Collected data indicated that the mean diameter of portal vein (VP), caudal vena cava (VCC) and abdominal aorta (AO) measured respectively, 0.38cm, 0.37cm and 0.41cm. The VP/VCC and VP/AO mean ratios were respectively, 1.10 and 0.94. The average of VP, VCC and AO areas were respectively, 0.12cm2, 0.11cm2 and 0.14cm2. The haemodynamic of portal vein was studied by ultrasound Doppler and the mean velocity of portal blood flow (VMFSP) measured was 17.77cm/s. It was verified that portal blood flow (FSP) average was 83.11ml/min/kg and the congestion index (IC) average was 0.009. In the group of animals presenting portosystemic shunting, the hepatic margins were seen 1.00cm to 2.00cm above the costal margin. The morphometry of VP, VCC and AO presented a mean diameter of 0.52cm, 0.79cm and 0.59cm, respectively. The VP/VCC and VP/AO mean ratios were respectively, 0.62 and 0.84. The average of VP, VCC and AO areas were respectively, 0.22cm2, 0.56cm2 and 0.27cm2. The haemodynamic study demonstrated that the VMFSP measured was 26.10cm/s and de IC average was 0.009. In the group of animals with portosystemic shunting which were submitted to surgical treatment, an increase of the liver size was seen from the first ultrasonographic evaluation. The measurements of VMFSP collected in the post surgical period were <= 19.50cm/s in dog 1.