BACKGROUND: Liver failure is the most common cause of mortality for patients undergoing partial hepatectomy. Given adequate liver function and remnant liver volume and absence of co-morbid illness, the cause of liver failure is frequently related to technical errors, which induces massive bleeding and ischemic damage to the liver remnant.
DATA RESOURCES: From author’s practice at Queen Mary Hospital, the University of Hong Kong.
RESULTS: To avoid technical errors leading to liver ischemia and failure, adequate exposure, control of bleeding during liver transection, and planning of transection plane are important. Ultrasonic dissector is the best instrument in liver transection. Its careful use can reduce blood loss and help recognize the hepatic vein, the exposure of which serves as an important landmark for a correct transection plane. Even without Pringle maneuver, minimum bleeding during transection could be achieved.
CONCLUSION: Protection of the liver remnant is important to patient survival after partial hepatectomy. It is achieved by meticulous surgical techniques that reduce bleeding to a minimum.

BACKGROUND: Curable outcome of unresectable hepatocellular carcinoma (HCC) was seldom encountered in the past. This study was designed to assess the role of downstaging followed by resection (downstaging-resection) in the improvement of prognosis of unresectable HCC.
METHODS: During the period of 1958-2003, a total of 1085 patients were verified surgically to be unresectable. Of these patients, 139 received downstaging-resection, with a rate of 84.2% for coexisting cirrhosis and a median tumor diameter of 11.1 cm. Resection of the right lobe, hepatic hilum and bilateral cancer accounted for 97.8% of the patients. Downstaging including hepatic artery ligation (HAL)+hepatic artery chemo-infusion (HAI) was performed in 65.5% of the patients, HAL+HAI+radiotherapy/radioimmunotherapy in 29.5%, and HAL or HAI alone in 5.0%. Retrospective analysis was made of the survival of patients with unresectable HCC, downstaging-resection rate and treatment pattern.
RESULTS: In the 139 patients with downstaging-resection, the median interval between the first and second operation was 7.2 months and the 5-year survival rate calculated from the first operation was 48.7%. In the 1085 patients with unresectable HCC, their 5-year survival was 0% in the period of 1958-1973, 11.5% in the period of 1974-1988 and 19.3% in the period of 1989-2003. These figures were correlated with the increasing downstaging-resection rate from 0%, 9.0% to 15.6%, and the increasing percentage of triple or double combination treatment from 32.2%, 60.4% to 69.7%. The 5-year survival in triple treatment group was 24.9%, double treatment 15.2%, and single treatment only 10.9%, which was also correlated with the downstaging-resection rate of 34.6%, 16.2% and 1.8% respectively.
CONCLUSIONS: Downstaging-resection plays a role in improving prognosis of unresectable HCC. Triple and double treatments provide a higher downstaging-resection rate and may result in better prognosis.

BACKGROUND: Failed surgical treatment and multiple operations often lead to liver failure and make it difficult to be treated by traditional methods. Liver transplantation may be the ideal and the last choice. In this study we tried to explore the indication of liver transplantation for hepatic alveolar echinococcosis(HAE) and the improvement of intraoperative treatment.
METHODS: Five patients who had received liver transplantation of hepatic alveolar echinococcosis in our hospital from 1999 through 2003 were analyzed retrospectively.
RESULTS: All the patients (3 were male and 2 female) were in late stage of hepatic alveolar echinococcosis. During orthotopic liver transplantation (OLT), 4 patients underwent veno-venous bypass, 3 were subjected to veno-venous bypass prior to the mobilization of the liver, and 2 received placement of T tube in the bile duct. In all the patients treated successfully by OLT, 4 recovered, and 1 died of severe infection and acute rejection after operation. T tube fell off in one patient. Postoperatively, pathological diagnosis verified hepatic alveolar echinococcosis. Four patients were followed up to the present, showing a good life quality and work capacity.
CONCLUSIONS: Hepatic alveolar echinococcosis in late stage can be considered as one of the indications of liver transplantation. Technique of veno-venous bypass prior to the mobilization of the liver could decrease operative time and bleeding. Early diagnosis and treatment of the disease ensures a better prognosis.

BACKGROUND: Chronic hepatitis B virus infection is one of the major causes of liver cirrhosis worldwide, especially in Asia. Liver transplantation for the end-stage liver disease with hepatitis B virus(HBV) is commonly complicated by the recurrence of HBV. The present study was designed to evaluate lamivudine in the prevention and treatment of recurrent HBV after liver transplantation.
METHODS: Seventeen patients with HBV-related liver disease in a total of 41 patients have received liver transplantation at our hospital since 2001. All the patients were HBV positive before transplantation, 5 of them had acute liver failure. Artificial liver was used in 4 patients with acute liver failure. All of the patients received lamivudine at a dose of 100 mg/d after liver transplantation. Lamivudine and HBIg therapy were given to 3 patients.
RESULTS:  Liver transplantation was successfully performed in all 17 patients. Three patients died of complications 3-6 months after the transplantation. One patient withdraw from lamivudine therapy and died of liver failure at 14 months after the transplantation. Thirteen patients were  followed up from 6 to 18 months. Two viremic patients had HBV recurrence shortly after the transplantation. Two viremic patients who had received HBIg and lamivudine after the transplantation had no evidence of HBV recurrence.
CONCLUSIONS: Lamivudine therapy is effective in preventing HBV recurrence after liver transplantation. The recurrence of HBV is closely related to HBV DNA status before liver transplantation.

BACKGROUND: Acute liver failure is still a life-threatening disease although it can be treated by liver transplantation. This study was conducted to assess the molecular adsorbent recycling system (MARS), which may bridge acute liver failure patients to liver transplantation.
METHODS: Biochemical indexes and other clinical data were analyzed of 8 patients with acute liver failure, who had been treated by MARS for 34 times and subsequent Piggyback liver transplantation.
RESULTS: After treatment with MARS, the levels of transaminase and total bilirubin decreased markedly, but coagulation function remained unimproved. All patients survived and discharged from the hospital.
CONCLUSION: MARS is effective in bridging patients with acute liver failure to liver transplantation.

BACKGROUND: Tissue-type plasminogen activator (tPA), which is highly efficient and specific in resolution of thrombus, could significantly improve the survival rate and life-quality of the patients with thrombosis. This study was designed to clone human tPA gene, construct eukaryotic expression plasmid pcDNA3.1(+)/tPA, and evaluate their biological activities.
METHODS: The tPA gene was obtained from dead human heart tissue with reverse transcriptase-polymerase chain reaction (RT-PCR). It was cloned to eukaryotic expression plasmid pcDNA3.1(+) by recombination strategy. The eukaryotic expression plasmid pcDNA3.1(+)/tPA was identified by restriction enzyme digestion and sequenced. The pcDNA3.1(+)/tPA was transfected into vascular smooth muscle cell (VSMC) by using lipofection. The tPA expression level was detected by Northern blot and dot blot, and the protein biological activities of tPA were detected by the fibrin plate technique.
RESULTS: The tPA gene was cloned and pcDNA3.1(+)/tPA was constructed. The tPA expression levels of mRNA and protein were highly increased after pcDNA3.1(+)/tPA transfected into VSMC, and the expression of tPA protein showed evident biological activities.
CONCLUSIONS: The present study has laid a foundation for further animal experiment in treating thrombus in transplanted organ by tPA gene transfection.

BACKGROUND: Partial porto-systemic shunts have been popularized because of reported low rate of mortality and morbidity (especially encephalopathy, liver failure and occlusion). To further investigate these assumptions, we retrospectively reviewed the results of partial porta-caval shunts performed at different stages of liver disease.
METHODS: Twenty-nine cirrhotic patients underwent a partial porta-caval shunt with a ringed polytetrafluoroethylene interposition prosthesis of 8-mm (20 patients) or 10-mm (9 patients) in diameter. Pre- and post-shunt porta-caval pressure was measured in all patients. Twelve patients (41.4%) belonged to Child A, 11 Child B (37.9%), and 6 Child C (20.7%). Eleven patients (37.9%) suffered from hepatic encephalopathy preoperatively. Twelve patients (41%) were operated on in emergency/urgency.
RESULTS: Porta-caval pressure gradient, reduced significantly using either 8-  or 10-mm prosthesis. The overall early mortality and morbidity were 13.8% and 48% respectively. The early mortality and morbidity were different between patients of Child A and B when compared to those of Child C (0 vs 66.6% and 34.8% vs 66.6% respectively). No patient re-bled early from varices. The overall late mortality and morbidity were 40% and 64% respectively. Shunt thrombosis and stenosis took place in 16% and 8% of the two groups of patients respectively; variceal re-bleeding occurred in 4 patients (16%). Encephalopathy occurred postoperatively in 5 patients (20%), acute in 3 patients (12%), and chronic in 2 (8%). The actuarial survival rate at 3 and 5 years was 92% and 75% for patients of Child A, 70% and 60% for patients of Child B, and 0% for patients of Child C.
CONCLUSIONS: Our results indicate that partial porta-caval shunt with a small diameter interposition H-graft is an effective procedure for the treatment of variceal bleeding, as well as for the prevention of re-bleeding in patients of Child A and those of Child B, as an elective or emergency/urgency procedure, with a low rate of complications and encephalopathy. This technique could be used safely in patients with good liver function but they should be monitored closely because of the risk of shunt occlusion.

BACKGROUND: Budd-Chiari syndrome (BCS) is an uncommon disorder caused by the obstruction of hepatic venous outflow and/or the inferior vena cava. Major therapeutic approaches include operation and radiological intervention. This study was conducted to investigate the treatment of severe BCS.
METHODS: The clinical data of 147 patients with severe BCS who had been treated at our hospital from November 1994 to December 2003 were retrospectively analyzed.
RESULTS:  One hundred twenty-one patients with BCS underwent surgery, including mesocaval C type shunt with artificial graft (82 patients), splenojugular shunt (37), mesojugular shunt (2), percutaneous transhepatic recanalization and dilatation and/or stent placement of the main hepatic vein (MHV) (12), and combined percutaneous transhepatic angioplasty (PTA) and stent placement of the inferior vena cava and mesocaval shunt (14). Follow-up for 6-108 months showed excellent results in 102 patients (69.4%), good results in 40 (27.2%), and 5 deaths.
CONCLUSION: Good results could be obtained in most of patients with BCS after different surgical treatments according to the pathological changes of the IVC and MHV.

BACKGROUND:  Giant splenic artery aneurysm (GSAA) is a rare but clinically relevant disease. Its importance lies in potential rupture and hemorrhage. Early diagnosis and treatment before rupture of GSAA are crucial to GSAA patients especially to GSAA patients with portal hypertension(PHT).
METHODS:  Four patients of GSAA with PHT treated at our hospital from December 1999 to September 2001 were retrospectively reviewed.
RESULTS: GSAA was found in all patients with digital substracted angiography (DSA) and/or magnetic resonance angiography (MRA) before operation. Resection of GSAA and treatment of PHT were carried out successfully with no perioperative mortality.
CONCLUSIONS: Patients with GSAA are apt to have PHT or segmental PHT because of suppression of the splenic vein or formation of aneurysm-portal vein fistula. Operation should be focused on  GSAA, and PHT complications.

BACKGROUND: Quality of life (QL) is a concept which reflects the physical, social, and emotional attitudes and behaviours of an individual. QL assessment is becoming increasingly recognised as an outcome and predictor for cancer patients. Although hepatectomy has been widely accepted as treatment of choice to offer a chance of cure for patients with liver cancer, little is known about the subjective clinical results after this operation. This prospective study was designed to evaluate the Pre- and postoperative quality of life in patients with liver cancer.
METHODS: The quality of life of 36 consecutive patients was measured using gastrointestinal quality of life index (GQLI) regularly 2 years after the operation, starting with a preoperative measurement.
RESULTS: The score of mean preoperative GQLI was 106±13 points, and it was reduced significantly 2-10 weeks after the operation (86-98) (P<0.05-0.001). The quality of life recovered gradually. The GQLI score was 101±21 points 4 months after operation and increased to the preoperative level (P>0.05). In the patients who survived more than 9 months，the GQLI score was higher than that before the operation. Major hepatectomy (lobectomy and combined segmentectomy) reduced the GQLI score more evidently than did minor hepatectomy (simple segmentectomy) in 2-5 weeks after the operation (P<0.05). The age and preoperative liver function of the patients played an important role in the recovery of the quality of life in the early postoperative stage (P<0.05). The patients with tumor recurrence showed a continuous decrease of the quality of life (P<0.05-0.001).
CONCLUSIONS: The assessment of the quality of life is meaningful for patients with liver cancer. Tumor recurrence, poor liver function and major operation are the most important factors for reducing the quality of life. Hepatic resection is justified by its effects on the survival and the quality of life of the patients.

BACKGROUND: Portal hypertension is a common disease. The surgical therapy of this disease focuses on the resultant upper digestive tract bleeding, which can imperil patients’ life directly. This study was to evaluate the effect of triplex operation (mesocaval C shunt with artificial graft, ligation of the coronary vein and splenic artery) on portal hypertension and its associated upper digestive tract bleeding.
METHODS:  A retrospective study was made on clinical data of 140 patients undergoing triplex operation, who had suffered from portal hypertension and upper digestive tract bleeding.
RESULTS: Postoperative portal pressure was 25-43 cmH2O (preoperative portal pressure 27-45 cmH2O) with the average reduction of 10 cmH2O. One patient (0.7%) died of cerebrovascular disease. Five patients (3.5%) suffered from mild hepatic encephalopathy, which was ameliorated through conservative treatment. Lymphatic fistula occurred in 3 patients (2.1%) who recovered without treatment 5, 10 days and 3 months after operation respectively. One hundred patients were followed up for 1 month to 6 years without recurrent hemorrhage or hepatic encephalopathy. Hypersplenism and ascites disappeared in 70 patients (70%) and  80 patients (80%) respectively. A significant reduction of ascites was seen in 12 patients(12%). The artificial vessels remained unblocking detected by B type ultrasonography and Doppler sonography in 95 patients(95%).
CONCLUSION: Triplex operation is suitable for patients with the following portal hypertensions: portal hypertension caused by simple occlusion of the hepatic vein (a pathological type of Budd-Chiari syndrome); thrombosis of the portal vein or prehepatic portal hypertension because of cavernous transformation; intrahepatic portal hypertension with rebleeding after splenectomy or non-operation, and those patients with liver function in grade A or B according to the Child-Pugh classification.

BACKGROUND: Co-infection of hepatitis C virus (HCV) and human immunodeficiency virus type 1 (HIV-1) is common in hemophiliacs and drug abusers. To assess the interaction between HIV and HCV disease progression, we examined 82 HIV/HCV co-infection patients and 62 HCV infection patints.
METHODS: Liver function, pathological changes, infection duration, immune function and qualitative HCV-RNA and HCV antibody were compared retrospectively between the two groups of patients.
RESULTS: Fourty-eight patients (58.5%) in the HIV/HCV co-infection group and 53 patients (85.5%) in the HCV infection group showed abnormal liver function. No significant difference was observed in inflammation and  fibrosis in the two groups P=0.187, 0.954). However, liver abnormality in the patients with HIV/HCV co-infection appeared 8 years earlier than in those with HCV infection alone  (P<0.001). As to immune function, the counts of CD+4 T and CD+8 T in the HIV/HCV group were (226.35±173.49)×106/L and (914.40±448.28)×106/L, whereas in the HCV group they were (752.31±251.69)×106/L and (529.01±170.67)×106/L respectively. The difference in the two groups was highly significant (P<0.001; P<0.001). The ratio of the number of people with both HCV-RNA and HCV antibody positive to the number of HCV-RNA positive and HCV antibody negative in the HIV/HCV group was 52∶9, whereas in  the HCV group it was 44∶1 (P=0.043).
CONCLUSION: HIV/HCV co-infection can accelerate deterioration of hepatitis C, which may be due to the effect of HIV on cellular immunity and humoral immunity of the body.

BACKGROUND: It has been shown that telomerase activity and hepatitis B virus (HBV) replication are closely associated with cell cycle. This study aimed to further investigate the effects of cell cycle on telomerase activity and on HBV replication.
METHODS:  Human hepatoma cells transfected with HBV DNA (HepG2 2.2.15 cell line) were treated respectively with serum deprivation, all-trans retinoic acid (RA), dimethyl sulfoxide (DMSO), or sodium butyrate. The cell cycle of HepG2 2.2.15 cells was analyzed by flow cytometry. The telomerase activities of the cells were detected by TRAP-PCR-ELISA. HBV DNA in culture medium was assayed by a fluorescent quantitative PCR assay and a semiquantitative dot blot hybridization technique. HBsAg and HBeAg in culture media were quantitatively examined by an ELISA assay.
RESULTS: Treatments with serum deprivation, RA, DMSO, or sodium butyrate inhibited the proliferation of HepG2 2.2.15 cells and led to cell arrest in the G0/G1 phase of cell cycle. The percentage of the G0/G1 phase in the groups of sodium butyrate, DMSO, RA and serum-free was 85.2%, 71.9%, 68.3% and 65.2%, respectively, but in the control group, 43.1% (P<0.01). The activities of telomerase of the cells were also significantly inhibited by 82.8%, 74.6%, 76.1% and 69.4% respectively. In addition, HBV replication of the HepG2 2.2.15 cells remarkably increased as shown by the contents of HBV DNA, HBsAg and HBeAg in the culture media of the cells treated with sodium butyrate, DMSO, RA or serum deprivation (P<0.01). The amounts of HBV DNA in the groups of sodium butyrate, DMSO, RA, serum deprivation and control were 6.7×106, 4.8×106, 4.4×106, 5.1×106 and 1.2×106 copies/ml, respectively (P<0.01). Telomerase was expressed mainly in the cells in S phase. HBV replication increased in quiescent cells (G0/G1 phase), and decreased in proliferating phase (S phase).
CONCLUSION: The current data approve that HBV replication is associated with the cellular proliferative activity.

BACKGROUND: Chemotaxis is an important step during the invasion of carcinoma cells. And integrins are most important receptors mediating interaction between cells and extracellular matrix (ECM). This study was designed to study integrin beta1 mediating chemotaxis of hepatocellular carcinoma (HCC) cells to laminin(LN).
METHODS: A micropipette technique was adopted to investigate the effect of blockade of integrin beta1 on pseudopod protrusion of HCC cells in response to LN stimulation. Chemotactic pseudopod protrusion of a HCC cell was evaluated using a dual-pipette set-up, in which two pipettes filled with LN solution were positioned in close contact with the same cell, and pseudopod protrusion into each pipette was viewed dynamically and recorded with a tape recorder. The lengths of pseudopods were measured and plotted against time to obtain a pseudopod growth curve. The integrin beta1 subunit on the surfaces of HCC cells were analyzed by flow cytometry.
RESULTS: In dual pipette chemotaxis experiment, when the two pipettes were filled with LN（50 μg/ml, 200 μg/ml), pseudopods extended from the HCC cell into each of the pipettes nearly symmetrically, ie, with nearly identical maximum pseudopod length and similar pseudopod growth curves. Upon addition of anti-CD29 （20 μg/ml） to one of the pipettes, pseudopod protrusion was blocked nearly completely while protrusion into the opposite pipette became more evidently, with a larger maximum length.  Expression of integrin beta1 was up to 95.78% to cells chosen in the experiment.
CONCLUSION: Integrin beta1 subunit was an important constituent receptor subunit for mediating chemotactic pseudopod protrusion of HCC cell to LN.

BACKGROUND: It is widely recognized that the growth of solid tumor depends on angiogenesis. Vascular endothelia growth factor (VEGF) is an endothelial cell-specific mitogen that promotes angiogenesis in solid tumor. Inhibition of angiogenesis is considered a promising approach for cancer therapy, and treatments including administration of antisense drugs and RNA interference for the VEGF gene are geared to the suppression of  tumor angiogenesis.
METHODS: As a new approach for gene therapy of hepatocellular carcinoma (HCC）, four groups of antisense oligodeoxynucleotide (ASODN) (A-Cap, A-AUG, A-UGA and A-Exon-3) were used to block the expression of VEGF, then VEGF mRNA and protein were detected by RT-PCR and Western blot.
RESULTS:
After treatment with ASODN, the relative VEGF mRNA levels of  A-Cap, A-AUG, A-UGA, and A-Exon-3 were decreased significantly to (32±9)%, (63±1)%, (86±3)%, and (70±5)%, respectively（F=64.18, P<0.001）. The relative VEGF protein levels of A-Cap, A-AUG, A-UGA and A-Exon-3 were decreased significantly to (41±5)%, (59±3)%, (88±7)%, and (79±9)% respectively (F=60.64, P<0.001）.
CONCLUSIONS: Among the four ASODNs, the ASODN for Cap structure showed the strongest inhibitory effect and that for A-UGA, the least (P<0.05 ）. The inhibitory effect of ASODN on the expression of VEGF proteins was similar to that of  VEGF mRNA expression.

BACKGROUND: Hepatic fibrosis is the common pathological change in various chronic liver diseases，and its major cause is the imbalance between the production and degradation of  the extracellular matrix, which is mainly composed of collagens. Dan-Shao-Hua-Xian (DSHX) capsule, a traditional Chinese herbal compound, has shown marked preventive effects on hepatic fibrosis in rats in our previous studies. The present study was designed to further investigate its therapeutic actions on hepatic fibrosis in rats and its possible mechanisms.
METHODS: Eighty male Wistar rats were randomly divided into normal control group, hepatic fibrosis group, non-DSHX-treated group, low-dose-treated group, and high-dose-treated group. The rat models of hepatic fibrosis were established by subcutaneous injecton of CCl4, drinking alcohol, giving diet of hyperliprosis and hypoprotein for 8 weeks. The two DSHX-treated groups were treated respectively with low dose (0.5 g/kg) and high dose (1.0 g/kg) of DSHX capsule p.o. everyday for 8 weeks. At the end of the experiment, liver indexes were calculated in each group in addition to the levels of the serum hyaluronic acid and alanine aminotransferase. Their degree of hepatic fibrosis and urinary excretion of hydroxyproline and expression of collagen I, III were detected.
RESULTS: Comparison of the indexes of the hepatic fibrosis group and non-DSHX-treated group  revealed that the liver indexes, levels of serum hyaluronic acid and alanine aminotransferase,  and stage of hepatic fibrosis were all significantly reduced in the two DSHX treated groups. The urinary excretion of hydroxyproline was increased and the expression of collagen I and III in liver tissue was lessened. These alterations were more obviously observed in the high-dose-treated group.
CONCLUSION: DSHX capsule has certain therapeutic effect on hepatic fibrosis in rats.

BACKGROUND: Although the hepatoma-specific band of gamma-glutamyltransferase (GGT) is a highly sensitive marker in diagnosis of hepatocellular carcinoma, the kinetic expression and the early alterations of GGT in the development of hepatoma remain unclear. In this study, we investigated the expression and the alterations of GGT multiple molecular forms in hepatotumorigenesis.
METHODS: The expression of GGT in a chemically induced hepatocarcinogenesis model was examined by giving 0.05% of 2-fluoenylacetamide in diet for 12 weeks. The expression levels of total RNA and GGT, and the changes of liver pathology, GGT multiple molecular forms and sugar-chain heterogeneity were investigated at the different stages of rat hepatoma development.
RESULTS: Pathological examination and biochemical analysis found that liver GGT was over-expressed and secreted into blood during canceration. Serum total GGT and liver GGT specific activities (IU/g) including soluble and membrane-combined GGT were significantly higher (P<0.05) in experimental groups than those in control group, respectively. A highly positive correlation was found between total GGT activities and total RNA levels (r=0.90, P<0.05) of the liver. Both were higher six weeks later than before. Con A-non-reactive-GGT was increased consistantly during the development of rat hepatoma. GGT multiple molecular forms in the liver and sera of experimental rats showed that fetal liver-type GGT bands were associated with the development of hepatoma.
CONCLUSIONS: Fetal liver-type GGT in sera and the liver of rats is closely related to hepatotumorigenesis. It can be used as a sensitive enzymatic marker for the early diagnosis of liver cancer.

BACKGROUND: Portal hypertension (PHT) with upper gastrointestinal hemorrhage as its chief complication is a very common disease with great harm to humans. The effects of infusion volume, speed, and type on hemodynamics in case of cirrhosis, PHT esophageal variceal bleeding, and their mechanism should be clarified. This study was designed to assess the effects of different infusion volumes on hemodynamics of PHT canines after hemorrhagic shock (HS).
METHODS: PHT canine models were made by chronic embolization via coarctating half of the main portal vein with silk suture. Two weeks later, the models were subjected to hemorrhagic shock by quick femoral artery venesection. The canines were divided into two groups to resuscitate: one to receive a large volume of infusion (n=6) (large volume infusion group) and the other to receive a small volume of infusion (n=6) (small volume infusion group). Hemodynamic indexes of PHT canines after HS and infusion were observed closely.
RESULTS: The PHT canines showed a series of hemodynamical changes in hemorrhagic shock stage, which aggravated hemodynamical disorder in PHT.  After quick infusion, mean arterial pressure (MAP), inferior vena cava pressure (IVCP), portal venous pressure (PVP), portal vein pressure gradient (PVPG), portal vein blood flow (PVBF), hepatic artery blood flow (HABF) and hepatic blood flow (HBF) increased significantly. These indexes in the large volume infusion group were higher than those in the small volume infusion group. Portal vascular resistance (PVR), splanchnic vascular resistance (SVR), hepatic arterial resistance (HAR) decreased significantly, but PVP, PVPG, PVBF, HABF and HBF showed a rebounding increase above the baseline values in the large volume infusion group. The changes of PVP, PVPG, PVBF, HABF and HBF were in parallel with those of MAP and inferior vena cava pressure (IVCP), without a rebounding increase in the small volume infusion group. In the large volume infusion group PVPG increased earlier and more significantly than did PVP; moreover PVPG exceeded the baseline by 13%, making the possibility of rebleeding great. In the small volume infusion group, PVPG was lower than the baseline by more than 22%, indicating a small possibility of rebleeding. SVR and HAR were lower in the large volume infusion group. PVP, PVPG, PVBF, HABF and HBF were positively correlated with accumulated volume of vein infusion. PVR showed a positive correlation with accumulated volume of vein infusion in the small volume infusion group. HAR was negatively correlated with accumulated volume of vein infusion in the large volume infusion group.
CONCLUSIONS: PHT canines after HS, resuscitated by vein infusion, may show a rebounding increase of PVP, PVPG, PVBF, HABF and HBF above the baseline values in the large volume infusion group but not in the small volume infusion group. A large volume infusion causes PVP, PVPG, PVBF, HABF and HBF to increase higher than does a small volume infusion.

BACKGROUND: As an anti-oxidation agent, tea polyphenols may have the effect of anti-fibrosis. This study was designed to observe the effect of tea polyphenols on hepatic fibrosis in rats with alcoholic liver disease and to explore the related mechanisms.
METHODS: Sixty healthy Sprague-Dawley rats were divided randomly into normal control group, single alcohol group, and three alcohol groups given different doses of tea polyphenols. Alcohol or isovolumic normal saline and corresponding doses of tea polyphenols were given daily to the rats separately. The rats were sacrificed at the end of the 24th week. Masson staining was performed to observe liver fibrosis, serum endotoxin, and oxidant and anti-oxidant activity.
RESULTS: Hepatic fibrosis was less severe in the rats of the alcohol groups given tea polyphenols than in the single alcohol group. Tea polyphenols increased the serum anti-oxidant capacity and decreased the endotoxin level.
CONCLUSION: Tea polyphenols show anti-fibrosis effect in rats with alcoholic liver disease, and the mechanism may be related to the clearance of overall oxidant and decrease of the endotoxin level.

BACKGROUND: Non-operative therapy takes an important position in comprehensive therapy of liver cancer. Despite some effects by using ethanol, acetic acid and heat saline for  intra-tumor injection in the treatment of liver cancer, it is difficult to attain a complete cure but bring about injury to the liver to some extent. Hence, searching for other drugs for the local treatment of liver tumor is an important option. This study was designed to set up rat models of transplanted liver cancer, intra-tumor injection of Kang-Lai-Te (KLT), and negative control  (saline) and positive control (ethanol). The effect of intra-tumor injection of KLT in treating transplanted hepatoma in rats and its advantages and disadvantages were assessed and the possibility of its use in treating patients with liver cancer was evaluated.
METHODS: Forty rats were divided into 4 groups (G1, G2, G3 and G4, 10 rats in each group). Different drugs were injected into their implanted hepatoma (G1 with 0.2 ml saline as control, G2 with 10 mg KLT, G3 with 20 mg KLT, G4 with 0.2 ml ethanol). After 3  and 8 days, the hepatoma volume (HV), the serum levels of albumin, alanine aminotransferase(ALT), aspartate aminotransferase alkaline phosphatase(ALP) and creatinine, as well as the expression of proliferation cell nuclear antigen(PCNA) in hepatoma were detected.
RESULTS: After 3 days, the HVs were smaller in G3 and G4 than in G1 (P<0.05), the serum levels of albumin were higher in G2 and G3 than in G1 and G4 (P<0.05), the serum levels of ALT and AST were lower in G2 and G3 than in G4 (P<0.05), the serum levels of ALP was lower in G2 and G3 than in G1 and G4 (P<0.05),the PCNA labeling indexes (PCNA LI) were lower in G2 and G3 than in G1 and G4 (P<0.05). After 8 days, the HVs were smaller in G2, G3 and G4 than in G1 (P<0.05), and the differences of HVs among G2, G3 and G4 were not significant. The serum levels of ALP were lower in G1, G2 and G3 than in G4 (P<0.05), and the PCNA LI were lower in G3 than in G1 and G4 (P<0.05).
CONCLUSION: Intra-tumor injection of KLT into implanted hepatoma is evidently effective, but it is less effective than ethanol. The effect of KLT on liver function is markedly lower than that of ethanol.

BACKGROUND: Rat hepatocellular carcinoma (HCC) model which has a high analogy to clinical liver cancer is of great value in understanding the pathogenesis and evolution of liver cancer, in searching effective anti-cancer treatments (drug, hepatectomy and liver transplantation), and designing cancer prevention strategies. In this study we established a modified rat model of hepatocellular carcinoma to enhance rats’ physique and surgical endurance.
METHODS: Wistar rats were fed with diethylnitrosamine (DENA) by three methods for evaluation of general conditions for 130 days: Doppler ultrasonographic measurement, laparotomy and histopathological examination.
RESULTS: No rat died in control group (group A) and modified DENA-induction-HCC group(group C), but 6 deaths in classical DENA-induction-HCC group (group B) (survival rate 80%). All survived rats in groups B and C developed diffusive hepatocellular carcinoma and liver cirrhosis. General appearance of rats in the group C was better than that in the group B.
CONCLUSION: With good general conditions for surgery, the modified rat model for hepatocellular carcinoma has a high carcinogenic rate and a high survival rate.

BACKGROUND: Invasion and metastasis cause death of patients with liver cancer. Increased expression of matrix metalloproteinases (MMPs) is closely associated with tumor progression. Type Ⅳ collagen is the main structure protein of basilar membrane which is a natural barrier for inhibiting the metastasis of liver cancer cells. In this experiment, we used all trans-retinoic acid (ATRA) to inhibit collagenase type Ⅳ in order to protect the type Ⅳ collagen and basilar membrane, further to suppress the metastasis of hepatocellular carcinomas.
METHODS: By the use of cell culture and experimental animal models, the influence of all trans-retinoic acid (ATRA) on the invasion of Hca-F liver cancer cells was studied in terms of adhesion capacity to artificial basilar membrane and production of collagenase type IV.
RESULT: ATRA could inhibit the adhesion capacity and collagenase IV secretion of Hca-F cells in a dose-dependent manner.
CONCLUSION: ATRA can exert multiple effects on the invasion of Hca-F cells.

BACKGROUND: With the wide use of B-ultrasonography in recent years, the polypoid lesion of the gallbladder (PLG) has been one of the most common diseases detected in biliary surgery. This study was to investigate the diagnostic method and operative indications of PLG.
METHODS: The clinical and pathological data of 194 patients with PLG who had received operation at our hospital from January 1994 to September 2002 were analyzed retrospectively. Categorized data were analyzed by the chi-square test.
RESULTS: All the patients received preoperative B-ultrasonography. 185 of the 194 PLG patients were diagnosed as having cholecystic polyp, and 9  adenomas. Among the 42 patients who received CT, 6 showed early gallbladder cancer. Pathologically, cholesterol polyps were mostly multiple lesions (64.7%) with a mean diameter of 3.86±2.2 mm in 136 patients. Of 16 patients with adenomas, 10 had a tumor diameter of more than 10 mm (62.5%). In 11 patients with gallbladder carcinoma, 7 were accompanied with gallbladder stone (63.6%). In addition, inflammatory polyps and adenomyomas were found in 25 and 6 patients respectively.
CONCLUSIONS: B-ultrasonography is the most effective diagnostic method for detecting PLG. When large or irregular lesions are found, CT should be performed in order to avoid missing of gallbladder carcinoma. Operative indications for PLG include: a maximal tumor diameter of more than 10 mm; an over 50-year-old patient with a widebase and a single polyp lesion; a wide-base lesion or a lesion showing a tendency to enlargement; co-existing gallbladder stone or cholecystitis; a patient without other diseases but obvious clinical features and failure of general management; big or long pedicels or polyps at the neck of the gallbladder for preventing the empty of the gallbladder and a history of biliary colic; and PLG with irregularly thickened local gallbladder wall.

BACKGROUND: Spinal cord injury (SCI) is found to be related to increased prevalence of gallstones and acute acalculous cholecystitis. In this study we assessed the prevalence of cholelithiasis in male patients with SCI and the correlation of cholelithiasis with age and weight of patients, level of injury, as well as severity and duration of SCI.
METHODS: One hundred male SCI patients (58 patients rated ASIA A or B and 42 rated ASIA C or D) aged more than 20 years (average 46.5 years) suffered from a spinal cord injury for more than one year. One hundred male volunteers served as controls without SCI and biliary diseases(age range 20-68 years; average 42.6 years). The two groups were subjected to ultrasonography of the gallbladder and biliary tract.
RESULTS: The prevalence of cholelithiasis in the group of SCI patients and the control group was 26% and 10% respectively. Significant differences in the prevalence of cholelithiasis were found between the normal controls and SCI patients and between highand low-level injury (P<0.01). But the differences were not statistically significant when correlating the presence of cholelithiasis with the age and weight of the patients, the duration of SCI, and the severity of spinal lesion（P>0.05).
CONCLUSIONS: SCI represents a major risk factor for the development of cholelithiasis,especially in patients with high-level injury. Cholelithiasis in SCI patients is not related to their age and weight, the severity of spinal lesion, and the duration of spinal cord injury.

BACKGROUND: Hilar cholangiocarcinoma is associated with low resectability and poor survival. The aim of this study was to evaluate the roles of matrix metalloproteinases-2 (MMP-2) and its tissue inhibitor of metalloproteinase-2(TIMP-2) in tumor invasion or as a prognostic factor in patients with human hilar cholangiocarcinoma. 
METHODS: The expressions of MMP-2 and TIMP-2 were investigated in patients. Paraffinized tissue sections obtained from 50 patients with human hilar cholangiocarcinoma were analysed. The expressions of MMP-2 and TIMP-2 were examined immunohistochemically. Image analysis with image-pro plus analysis software was used to semiquantitatively determine the ratio of MMP-2 to TIMP-2.
RESULTS: The expression levels of MMP-2 and TIMP-2 were strongly associated with tumor hepatic invasion in patients with hilar cholangiocarcinoma. Significant differences in the ratio of MMP-2 to TIMP-2 between some pathologic factors were observed in patients with hilar cholangiocarcinoma.
CONCLUSIONS: MMP-2 plays an essential role in tumor invasion and metastasis，while TIMP-2 is shown to strongly inhibit cancer invasion and metastasis. The ratio of MMP-2 to TIMP-2 may be a prognostic indicator for patients with hilar cholangiocarcinoma.

BACKGROUND: Gallbladder carcinoma is a highly lethal and aggressive disease with early metastasis, strong invasion and poor prognosis. Most patients with this disease are at the advanced and un-resectable stage and should be considered for palliative treatment such as chemotherapy and radiotherapy. Unfortunately, reports of chemotherapy and radiotherapy for gallbladder carcinoma are disappointing. We investigated the influence of norcantharidin (NCTD) on proliferation, proliferation-related gene proteins PCNA and Ki-67 of human gallbladder carcinoma GBC-SD cells in vitro.
METHODS: GBC-SD cell lines of human gallbladder carcinoma were cultured by the cell culture technique. The experiment was divided into NCTD group and control group. The tetrazolium-based colorimetric assay was used to evaluate cell growth. The streptavidin-biotin complex method was used to determine the expressions of proliferation-related gene proteins PCNA and Ki-67 of human gallbladder carcinoma GBC-SD cells.
RESULTS: NCTD inhibited the growth and proliferation of GBC-SD cells from 10 mg/L or after 6 hours in a dose-and time-dependent manner, with the IC50 value of 56.18 μg/ml at 48 hours. After treatment with NCTD, the expression of PCNA (0.932±0.031 vs. 0.318±0.023, P<0.001) and Ki-67 (0.964±0.092 vs. 0.297±0.018, P<0.001) proteins were decreased significantly.
CONCLUSION: NCTD inhibits the proliferation of human gallbladder carcinoma GBC-SD cells in vitro and the expression of their proliferation-related gene proteins PCNA and Ki-67.

BACKGROUND: Pancreatic encephalopathy (PE), an unfamiliar complication of severe acute pancreatitis (SAP), is difficult to diagnose and treat, and it has a high mortality. The aim of this study was to investigate the manifestation, classification, mechanism and therapy of PE.
METHODS: Of 132 patients with SAP treated at our hospital from March 1994 to March 2004, 24 patients complicated by PE were analyzed retrospectively.
RESULTS: The causes of SAP were mostly biliary and alcoholic. Twenty-four patients (18.2%) were complicated by PE within 3 hours-38 days（average 6.6 days）\[21(87.5%) within 2 weeks, and 3(12.5%) after 2 weeks] . Eleven patients were male and 13 female, with an average of 47 years (range 25-72 years). Excitement or restrain was the main manifestation. Nine patients (37.5%) received surgery and 15(62.5%) conservative treatment, with a mortality of 11.1%(1/9) and 66.7%(10/15), respectively.
CONCLUSIONS: PE occurs 2 weeks after SAP and is part of multiple organ failure (MOF). Some patients have PE in the late stage of SAP because of lack of VitB1 and nutrition. But PE can be prevented by prescribing adequate nutrition and VitB1 in the early stage of SAP.

BACKGROUND: The incidence of carcinoma of the pancreas is increasing in the world. Pancreatic carcinoma is characterized by early local extension to contiguous structures and metastases to regional lymph nodes and the liver. This study was conducted to increase the rate of pancreatoduodenectomy combined with vascular reconstruction.
METHODS: Pancreatoduodenectomy with vascular reconstruction was performed for 79 patients at a number of hospitals in Fujian Province, Zhejiang Province, Shanghai and Xinjiang Uyghur Autonomous Region from April 1994 to December 2003. One of these patients also underwent right hemicolectomy; but all received through superior mesenteric vein (SMV)-portal vein (PV) reconstruction. The reconstructions of the superior mesenteric artery (SMA) and hepatic artery (HA) were performed in 4 patients, and reconstructions of the SMA or HA were carried out in 7 and 4 patients respectively. Partial reconstruction of the inferior vena cava (ICV) was done in 2 patients when the tumor was adhering to the wall of the inferior caval vein.
RESULTS: Four patients died during the peri-operative period, with a mortality rate of 5%. No complications such as biliary or pancreatic fistulae or artificial blood vessel infection were noted. Histological examination showed one patient with neuroendocrine cancer and the other 78 patients with adenocarcinoma of the pancreatic head. Resected endothelia and vascular margins proved to be microscopically tumor-free. Follow-up for 3 months to 10 years for all except two patients showed 7 of the 9 patients who had undergone resection and reconstruction of the SMA and HA died 7 months or 4 years after operation and 37 survived for over 3 years and 12 for more than 5 years. The rest are still under follow-up.
CONCLUSION: Pancreatoduodenectomy with vascular reconstruction for carefully selected patients with carcinoma of the pancreatic head has proved to be a safe and reliable treatment, capable of raising the rates of tumor resection and survival.

BACKGROUND: Surgeons are always concerned about the localization of pancreatic functioning islet cell tumor. If the tumor is accurately localized before operation, resection of the pancreatic body and tail without intention can be avoided. The purpose of this study was to evaluate spiral CT localization of pancreatic functioning islet cell tumors and CT techniques.
METHODS: CT manifestations in 6 patients with clinically and pathologically proved pancreatic functioning islet cell tumors were analyzed retrospectively.
RESULTS: In 4 patients with insulinomas and 2 patients with glucagonomas, 5 were localized accurately by CT before surgery and 1 was detected retrospectively. The enhancement of tumors was greater than that of normal pancreas in arterial phase and pancreatic parenchymal phase. Four patients showed mild high-density and 2, iso-density in the portal venous phase.
CONCLUSION: Spiral CT multi-phase enhanced scan with 1.5 ml/kg contrast agent and 2-5 mm slice width can localize functioning islet cell tumors accurately.

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK) with portal-enteric drainage is physiological effective in treatment of patients with diabetes mellitus complicated by end-stage renal disease. A case is reported with a review of our clinical experience.
METHODS: A patient with type 2 diabetes complicated by renal failure was subjected to SPK transplantation with portal-enteric drainage. Pancreaticoduodenal allograft procured from corpse was transplanted to recipient’s right abdomen with donor’s portal vein anastomosed to recipient’s superior mesenteric vein. Donor’s plastic pancreas artery was anastomosed to recipient’s right common iliac artery and donor’s duodenum anastomosed to recipient’s jejunum. The kidney allograft was transplanted ectopically to the contralateral iliac fossa. Postoperative immunosuppression includes tacrolimus (TAC)/mycophenolate mofetil (MMF)-based regimen and methylprednisolone or prednisone.
RESULTS: On the 5th postoperative day, the level of blood creatinine decreased from 590 μmol/L to normal. Daily urine volume was about 2500 ml. On the 18th postoperative day, insulin was given up, and the levels of fasting blood-glucose and after meal blood-glucose were kept normal. No acute rejection symptoms or other complications were observed except infection of Pseudomonas aeruginosa.
CONCLUSION: Combined pancreas and kidney transplantation with portal-enteric drainage is a physiological effective treatment for diabetic patients with end-stage renal disease.

BACKGROUND: Chronic liver fluke disease with dyspepsia is rarely seen clinically. In this study, we assessed the etiological factors, symptoms, physical signs and diadynamic methods in a case of chronic liver fluke disease with dyspepsia.
METHODS: Physical examination, laboratory studies, ultrasonography and CT scan were performed before pathogen examination. The eggs of fluke found with the inverted sedimentation method were also observed under a microscopy. They were diagnosed as the eggs of Clonorchis sinensis.
RESULTS: The patient was diagnosed as having chronic liver fluke disease, and his appetite recovered after three courses of treatment with praziquantel.
CONCLUSION:  Eating fresh fish and shrimp might cause liver fluke disease. The symptoms of this disease with dyspepsia can be anorexia, abdominal distention, bellyache, and loose stools.