Impaired endothelium-dependent relaxation of human hepatic arteries after preservation with the University of Wisconsin solution

OBJECTIVE

To evaluate the effect of University of Wisconsin solution on endothelium-dependent relaxation and contraction of human hepatic arteries in vitro.

DESIGN

Human hepatic arteries were harvested from 24 patients with hepatocellular carcinoma who had undergone hepatectomy.

SETTING

A tertiary care center.

INTERVENTIONS

Human hepatic arteries (n = 6 in each group) were harvested during resection for hepatocellular carcinoma. The arteries in group 1 (i.e., the control group) were immediately studied without preservation. The arteries in group 2 were preserved in cold (4 degrees C) physiological solution for 1 hour, while the arteries in groups 3 and 4 were preserved in University of Wisconsin solution for 1 and 16 hours, respectively. Segments of control and preserved hepatic arteries with or without endothelium were then suspended in organ chambers to measure the isometric force.

RESULTS

The relaxation of segments of the hepatic arteries with endothelium in response to acetylcholine and adenosine diphosphate was significantly (P < .05) greater than that of segments without endothelium. The maximal relaxation of hepatic arterial segments with endothelium in groups 3 and 4 in response to acetylcholine was notably different from that of segments in groups 1 and 2. The maximal relaxation of hepatic arterial segments with endothelium in groups 3 and 4 in response to adenosine diphosphate was notably different from that of segments in groups 1 and 2. Perfusate hypoxia (mean +/- SD PO2, 30 +/- 5 mm Hg) caused the endothelium-dependent contraction of the arteries (the median initial tension in groups 1, 2, 3, and 4 was 251%, 233%, 276%, and 260%, respectively; P > .05).

CONCLUSIONS

The endothelium-dependent relaxation of human hepatic arteries in response to acetylcholine and adenosine diphosphate was notably attenuated by University of Wisconsin solution. The impaired endothelium-dependent relaxation by University of Wisconsin solution and the prominent endothelium-dependent contraction of human hepatic arteries would favor vasospasm and thrombosis after hepatic transplantation.

New form of bone dysplasia with multiple fractures associated with monosomy X

We report on the clinical, radiologic, and pathologic findings in a 20-week-old fetus with monosomy X and severe hydrops associated with fetal dwarfism. The fetus presented with osteoporosis, bent bones, multiple fractures, and distinctive symmetric submetaphyseal transverse bone interruptions or pseudofractures. We excluded by radiologic and histopathologic examination the diagnoses of osteogenesis imperfecta, hypophosphatasia, campomelic dysplasia, achondrogenesis, hypochondrogenesis, and other types of bone dysplasia. To our knowledge, this is a previously undescribed bone dysplasia associated with monosomy X. This bone dysplasia may be inherited as an X-linked recessive disorder.

Effects of increasing flow rate on aortic stenotic indices: evidence from percutaneous transvenous balloon dilatation of the mitral valve in patients with combined aortic and mitral stenosis

OBJECTIVES

To investigate the effects of transvalvar flow rate on aortic valve resistance and valve area after percutaneous transvenous balloon dilatation of the mitral valve in a homogeneous group of patients with rheumatic heart disease.

DESIGN

Retrospective analysis of 12 patients with combined aortic and mitral stenosis who had undergone balloon dilatation of the mitral valve over a period of 9 years.

SETTING

Tertiary referral centre.

PATIENTS

Twelve (8 women, 4 men; mean (SD) age 37 (9) of 227 consecutive patients with critical mitral stenosis undergoing transvenous balloon dilation of the mitral valve in the centre also had aortic stenosis, defined as a transaortic pressure gradient of more than 25 mm Hg measured at a catheterisation study before valvuloplasty.

INTERVENTIONS

Echocardiographic variables (mitral valve area measured by the pressure half-time method and planimetry, and the aortic valve area derived from the continuity equation) and haemodynamic measurements (cardiac output, left ventricular mean systolic pressure, aortic mean pressure, transaortic valve pressure gradient, mitral valve and aortic valve areas derived from the Gorlin formula, and aortic valve resistance) were assessed before and after transvenous balloon dilatation of the mitral valve. Follow up catheterisation to measure haemodynamic variables was performed one week after mitral valvuloplasty.

RESULTS

Mean transaortic flow rate increased 33% after mitral valvuloplasty (from 198 (68) to 254 (41) ml/s, P = 0.002). Aortic valve areas derived from the Gorlin formula were significantly increased from 0.57 (0.12) to 0.73 (0.14) cm2 (P = 0.006) after mitral valvuloplasty. However, aortic valve area and valve resistance derived from the continuity equation were independent of the increase in flow rate after mitral valvuloplasty (from 1.29 (0.35) to 1.30 (0.29) cm2 and from 317 (65) to 259 (75) dyn.s.cm-5, both P = NS).

CONCLUSION

The Gorlin-derived aortic valve area tends to be flow-dependent, and continuity equation-derived aortic valve area and catheterisation-derived valve resistance seem to be less flow-dependent. In patients with combined mitral and aortic stenosis, these flow-independent indices are important for decision-making.

Left atrial spontaneous echo contrast in asymptomatic patients with a mechanical valve prosthesis

BACKGROUND

Valve thromboembolism may be a fatal complication of mechanical valve prosthesis if detected late. Spontaneous echo contrast (SEC) is a well-documented prothrombotic phenomenon; here we report it in asymptomatic patients with a mechanical valve prosthesis.

METHODS

Ninety-two asymptomatic patients with a mechanical valve prosthesis for underlying rheumatic heart disease underwent transesophageal echocardiography. Appendage area, peak filling and emptying velocities of the left atrial appendage, and the presence or absence of SEC and thrombi were determined. The results of 56 patients without SEC or thrombi (group I) were compared with those of 24 patients with SEC and no thrombi (group II) and 12 patients with thrombi (group III).

RESULTS

Spontaneous echo contrast was present in 39% of the asymptomatic patients with a mechanical valve prosthesis. Although 12 patients had cardiac thrombi, including valve thrombi in 4, no patients presented symptoms. Anticoagulant therapy had no significant association with SEC and atrial thrombi. There was a significantly greater prevalence of atrial fibrillation and mitral prosthesis in groups II and III than in group I. Two patterns of left atrial appendage flow were identified: one was organized biphasic flow with peak filling velocities of 41.2 +/- 17.2 cm/s and emptying velocities of 40.5 +/- 17.5 cm/s. The other showed irregular, very low peak filling velocities (104 +/- 11.5 cm/s) and emptying velocities (12.3 +/- 13.1 cm/s). The former flow pattern was associated with sinus rhythm and the latter form was associated with atrial fibrillation.

CONCLUSIONS

There was a relatively high prevalence of SEC and thrombi in patients with a mechanical valve prosthesis. Patients with a valve prosthesis may not have clinical symptoms. Anticoagulation intensity was not associated with the occurrence of SEC and thrombi. Patients with the mitral valve prosthesis and atrial fibrillation were identified as a high-risk of subgroup for the development of SEC and thrombi.

The effect of gabexate mesilate on pancreatic and hepatic microcirculation in acute experimental pancreatitis in rats

Microcirculatory derangements are important early features in many organs during the process of acute pancreatitis. However, dynamic evaluation of these factors has been difficult. Antiprotease has long been used for the treatment of acute pancreatitis, although its effects and mechanism have not been fully elucidated. The involvement of proteases and microcirculatory derangement early in the course of acute pancreatitis are the main concern of this study. A severe acute pancreatitis model in male Sprague-Dawley rats (225-275 g) was established by adding caerulein (15 microg/kg/ hr) in intravenous infusion fluid and intraductal injection of 0.1 ml glycodeoxycholic acid (5 mM). Gabexate mesilate [GM; ethyl-4-(6-guanidinohexanoyloxy)benzoate methanesulfonate], a synthetic antiprotease, was infused intravenously in doses of 0.01, 0.1, 1, and 10 mg as a therapeutic intervention in this model. Pathology hematocrit, serum amylase level, and glutamic-oxaloacetic transaminase (GOT) levels were used to confirm the severity of disease and effect of therapy. In vivo microscopic technique was used as a investigating tool in this study of microcirculatory derangement in pancreas and liver, 8 hr after induction of acute pancreatitis. GM can significantly improve pathologic criteria and changes of serum amylase levels in the range of 1-10 mg/kg/hr. The severity of changes of hematocrit and GOT was significantly lessened with GM in the range of 0.1-10 mg/kg/hr. This agent also could improve the microcirculatory environment in pancreas and liver after induction of acute pancreatitis according to the parameters, such as flow velocity and rolling leukocyte phenomenon, in the range of 1-10 mg/kg/hr. According to our observation, severity of hyperpermeability had not changed with the treatment of GM. These results indicated the beneficial effects of GM on pancreatic and hepatic microcirculation early in the course of acute pancreatitis. The beneficial effects were noted in serum parameters and hematocrit. The importance of protease activation and remote organ dysfunction is emphasized in the course of acute pancreatitis from this study.

Surgical treatment of choledochal cyst in adults: results and long-term follow-up

BACKGROUND/AIMS

Results of the surgical management of 60 adults with choledochal cysts at Chang Gung Memorial Hospital Taipei are presented.

PATIENTS AND METHODS

All patients were diagnosed and surgically managed during the period between March 1979 and December 1992. There were 47 females and 13 males, with ages ranging from 16 to 81 years (mean age = 31.9 years). Of the total, there were 41 Type I, one Type II, 14 Type IV, and four Type V choledochal cysts classified according to Todani's classification system. The definite surgical procedures were cyst excision and hepatico-jejunostomy in 43 cases in type I and IV diseases, one cyst excision in type II disease, two hepatectomy for type V disease, cyst enterostomy in seven cases, and T-tube choledochocystostomy in seven cases.

RESULTS

The operative mortality rate was 3.3% and the complication rate related to the surgical procedure was 20%. Early postoperative complications include wound infection, leakage of anastomosis, acute pancreatitis, septic shock, left pleural effusion, and intra-abdominal abscessing. Reoperations were needed in the early postoperative days in two cases due to hepatico-jejunostomy leakage and intraabdominal abscess formation. Long-term surgical outcome, concerning recurrence of symptoms, was related to the following factors, excluding the factors of surgery: presence of bile duct lithiasis, common channel less than 22 mm, presence of preoperative pancreatitis and acute angle type pancreaticobiliary unions. Only common channel less than 22 mm is statistically significant. The percentage of recurrence of the symptoms after resectional surgery was 32.5% in the long term follow-up period. Most of the cases responded well to an antibiotics treatment. Three of the cases required a second operation or PTCD as well as dilatation to treat the recurrent cholangitis.

CONCLUSION

Although the recurrence of symptoms is not uncommon and satisfactory explanation of the analysed factors is still the treatment of choice for adult patients with choledochal cysts.

Changes of left ventricular function after percutaneous balloon mitral valvuloplasty in mitral stenosis with impaired left ventricular performance

The pathophysiological role of mechanical and myocardial factors for impairment of left ventricular performance in mitral stenosis is still not clear. To investigate this controversy, 27 patients of mitral stenosis with left ventricular ejection fraction < 50% were studied. Patients were divided into two groups: Group 1: 20 patients, left ventricular ejection fraction improved to > 50% after valvuloplasty, and Group 2: 7 patients, left ventricular ejection fraction still < 50% after valvuloplasty. The clinical and hemodynamic characteristics were comparable for the two groups before valvuloplasty. Follow-up catheterization done one week later showed similar changes in mitral valve area, cardiac index, pulmonary pressure, left ventricular end-diastolic volume index and systemic vascular resistance between the two groups. However, left ventricular end-systolic volume was significantly decreased after valvuloplasty in Group 1 but not in Group 2, resulting in significantly higher ejection fraction in Group 1 than in Group 2. Postoperatively, regional wall motion scores were lower in Group 1 than in Group 2 (2.0 +/- 0.6 vs. 2.7 +/- 0.5 at the anterolateral wall, P = 0.002; 1.9 +/- 0.6 vs. 2.9 +/- 0.4 at the posterobasal wall, P = 0.0003). Most of our mitral stenosis patients with impaired left ventricular ejection fraction showed improvement after mitral valvuloplasty had released the mechanical obstruction. However, in some patients, impaired ejection fraction persisted after valvuloplasty, suggesting the mechanism of myocardial failure. Thus, both myocardial and mechanical factors play important roles in the pathogenesis of left ventricular ejection performance impairment.

Surgical treatment of hepatolithiasis: long-term results

BACKGROUND

Hepatolithiasis is a common disease in East Asia and is prevalent in Taiwan. Surgical and nonsurgical procedures for management of hepatolithiasis have been discussed, but long-term follow-up results of surgical treatment of hepatolithiasis are rarely reported.

METHODS

We conducted a retrospective study of case records of patients with hepatolithiasis who underwent surgical or nonsurgical percutaneous transhepatic cholangioscopy treatment. Of 614 patients with hepatolithiasis seen between January 1984 and December 1988, 427 underwent follow-up after surgical (380) or percutaneous transhepatic cholangioscopy (47) treatment for 4 to 10 years and constituted the basis of this study.

RESULTS

Long-term results of 427 patients with hepatolithiasis after surgical and nonsurgical treatment within 4 to 10 years of follow-up were recurrent stone rate 29.6% (105 of 355), repeated operation 18.7% (80 of 427), secondary biliary cirrhosis 6.8% (29 of 427), late development of cholangiocarcinoma 2.8% (12 of 427), and mortality rate 10.3% (44 of 427). The patients with hepatectomy had a better quality of life (symptom-free) with a lower recurrent stone rate (9.5%), lower mortality rate (2.1%), and lower incidence of secondary biliary cirrhosis (2.1%) and cholangiocarcinoma (0%) than did the nonhepatectomy group (p < 0.01). The patients without residual stones after choledochoscopy had a better quality of life than did the residual stone group (p < 0.01).

CONCLUSIONS

Long-term follow-up study of hepatolithiasis after surgical treatment revealed a high recurrent stone rate (29.6%) that required repeated surgery and a high mortality rate (10.3%) resulting from repeated cholangitis, secondary biliary cirrhosis, and late development of cholangiocarcinoma. Patients who received hepatectomy or without residual stones after choledochoscopy had a good prognosis and quality of life.

Excessive papillary muscle traction and dilated mitral annulus in mitral valve prolapse without mitral regurgitation

This study demonstrated excessive papillary muscle displacement during peak systole but normal mitral annulus function during the cardiac cycle in patients with mitral valve prolapse and no mitral regurgitation. The excessive papillary muscle displacement may play an important role in the pathogenesis of the superior displacement of mitral leaflets in patients with mitral valve prolapse.

Usefulness of transdermal scopolamine for vasovagal syncope

We studied short-term effectiveness of transdermal scopolamine in a group of patients with unexplained syncope provoked during head-up tilt testing. This double-blind randomized trial of transdermal scopolamine demonstrated no significant effect of preventing vasovagal syncope.

Transcatheter embolization of a coronary arteriovenous fistula with a complex, helical-fibered platinum coil

Transcatheter embolization was successfully performed on a 51-year-old man with a coronary arteriovenous fistula arising from the left circumflex coronary artery and draining into the superior vena cava. The patient presented with typical manifestations of angina pectoris that were first noticed during childhood but had worsened over the past 5 years. A 2 x 20 mm complex, helical-fibered platinum coil was placed in the mid-portion of the fistula and successfully occluded the fistula within 30 minutes. The patient has been free from angina pectoris since the procedure.

Successful treatment of acute myocardial infarction by thrombolytic therapy in a patient with primary antiphospholipid antibody syndrome

A dilemma must be faced when deciding whether or not to use thrombolytic therapy in patients with acute myocardial infarction and circulating antiphospholipid antibody. This report is about a patient whose infarct-related coronary artery was successfully revascularized by recombinant tissue plasminogen activator without any major bleeding complications. The nature of the infarct-related artery was described by the use of intravascular ultrasonography.

Propofol anesthesia in a patient with myasthenia gravis--a case report

Experience with the use of propofol for induction and maintenance of anesthesia in patients with myasthenia gravis is limited in the literature. We report, in this case, the well prepared and successful use of continuous propofol infusion without conventional neuromuscular blocking agents in a patient with Ossermann stage IIb of myasthenia gravis undergoing laparoscopic cholecystectomy.

Plasma and erythrocyte thiamin concentrations in geriatric outpatients

OBJECTIVE

The objective of this study was a) to determine the plasma and red cell thiamin levels in geriatric outpatients and b) to evaluate, using the rat model, the sensitivity of plasma thiamin concentration as an indicator of nutritional status for this vitamin.

SUBJECTS

Thirty geriatric outpatients were evaluated for their plasma and erythrocyte thiamin levels.

METHODS

Plasma and red cell thiamin levels were determined by a microbiologic assay using kloeckera apiculata. Sprague-Dawley rats were fed a thiamin deficient diet. Blood samples were obtained on specified days and the plasma and erythrocyte thiamin levels determined.

RESULTS

Forty-three percent of the subjects studied had plasma thiamin levels below 2 SD of the mean of the younger-age group (20-60 yr) while 57% had a plasma thiamin below 10 ng/ml (the lower reference range of the younger age group). Twenty-seven percent were found to have red cell thiamin levels below 2 SD of the mean of the younger-age group, while 33% had red cell thiamin levels below 138 ng/ml (the lower reference range of the younger-age group). The rat study indicated that plasma thiamin concentration is a sensitive indicator of the nutritional status for this vitamin.

CONCLUSION

About 50% of geriatric outpatients in this study had low plasma thiamin levels. The long-term effect of a low plasma thiamin level on cognitive functions remains to be investigated.

Bacteremia following postoperative choledochofiberscopy--a prospective study

BACKGROUND/AIMS

The following investigation was undertaken in order to determine the frequency and clinical consequences of bacteremia after postoperative choledochofiberscopy.

MATERIALS AND METHODS

A total of 100 patients were prospectively studied for the frequencies of bacteremia after postoperative choledochoscopy.

RESULTS

Positive blood cultures were obtained in 15%; at 5-minutes period in seven patients, at 15-minutes in eight patients and at 30-minutes in two patients. There were two patients with positive cultures at 5 minutes and 10 minutes periods. All the bacteria species cultured were aerobes. Enterococcus, E-coli and Klebsilla were the most commonly cultured bacteria. The frequencies of occurrence of bacteremia seemed not be influenced by the existence of residual stones, session of the endoscopy and duration of the procedure. Six of the 15 bacteremic patients developed cholangitis within 24 hours of the procedure. They all recovered with antibiotic treatment. Patients with negative blood cultures were not found with cholangitic symptoms after the postoperative choledochoscopy.

CONCLUSIONS

The results of our study indicated that fifteen percent of patients undergoing postoperative choledochofiberscopy are associated with bacteremia. We believe that with adequate aseptic preparation and meticulous, gentle manipulation, routine prophylactic antibiotics may not be necessary for postoperative choledochoscopy in selected conditions.

Factors influencing survival after hepatectomy for peripheral cholangiocarcinoma

BACKGROUND/AIMS

Radical resection for patients with peripheral cholangiocarcinoma is rare. Prognostic factors related to survival with peripheral cholangiocarcinoma after hepatectomy have not yet been reported.

MATERIALS AND METHODS

Of 41 hepatectomized patients with peripheral cholangiocarcinoma, a computer analysis of 14 clinicopathological factors on patients survival was performed with univariate and multivariate analysis.

RESULTS

Median and mean survival times for patients with peripheral cholangiocarcinoma after hepatectomy were 12.0 and 22.8 months. The 1-, 2-, 3-, 4- and 5-year survival rates were 53.7%, 39.0%, 36.6%, 26.8%, and 26.8% respectively. Univariate analysis of overall survival involving all patients identified 7 factors that were associated with a significantly outcome: mucobilia (p = 0.043), capsular invasion (p = 0.007), tumor spreading type (p = 0.0003), section margin (p = 0.001), histologic type (p = 0.008), macroscopic and microscopic vascular involvement (p = 0.031), and lymphatic invasion (p = 0.004). With multivariate analysis using the COX stepwise proportional hazards model, only mucobilia, tumor spreading type and section margin were significantly related to prognosis.

CONCLUSIONS

Intrahepatic bile duct carcinoma patients with mucobilia, intraductal papillomatosis and a tumor-free margin after hepatectomy had a better prognosis.

Dobutamine stress echocardiography for detecting coronary artery disease

To assess the value of dobutamine stress echocardiography (DSE) to detect coronary artery disease (CAD) and to compare the diagnostic accuracy between DSE and treadmill exercise test (TXT), 104 patients (mean age 58 +/- 12 years) presenting for coronary angiography were prospectively studied. TXT was performed according to the Bruce protocol. Dobutamine (5-40 micrograms/kg/min) was infused in 3-min stages. Digital echocardiograms were recorded on-line at baseline, during low- and peak-dose dobutamine infusion, and at recovery. An echocardiogram positive for CAD was defined as the one showing a new wall motion abnormality (WMA) induced by dobutamine. There were no major complications during the study. Significant CAD (> or = 50% diameter stenosis) was present in 17 of 30 patients who had normal echocardiograms at baseline. The sensitivity for detecting CAD was 76% by TXT and 94% by DSE, and the specificity was only 38% by TXT and 92% by DSE, respectively. Seventy-four patients had localized rest WMAs. Twenty-four had no significant CAD or lesions only confined to regions with abnormal rest wall motion, and 50 had disease remote from these regions. The sensitivity for detection of remote disease was 60% by TXT and 76% by DSE, and the specificity was 75% by TXT and 96% by DSE, respectively. In conclusion, DSE is a safe and accurate diagnostic tool for identifying CAD and for predicting the extent of disease in those who have localized rest WMAs.

Hurthle cell tumor

Hurthle cell tumor is rare type of thyroid tumor. There are few recent reports about the proper management of patients with Hurthle cell tumors. We reviewed our patients from 1988 to 1994 with pathological proof of Hurthle cell tumor. There were 26 patients in total: four cases were Hurthle cell carcinoma and the other twenty-two cases were Hurthle cell adenoma. Only one patient with Hurthle cell carcinoma is male and all the others were female. All of them except one with metastatic bone lesion presented with painless neck mass. The mean size of the tumor in carcinoma patients is 3.7 cm and in adenoma patient 2.3 cm. Five patients had multiple adenoma. The mean age of carcinoma patients is 49.5 years and the adenoma patients 45.1 years. No patient had a history of exposure to low dose radiation. The only carcinoma patient with bone metastases has positive radioactive iodine uptake. Lobectomy is advised for adenoma patients and total thyroidectomy for carcinoma patients. There were no operative complications in these patients. No local recurrence or metastases occurred in those patients with Hurthle cell adenoma. One patient with adenoma died of poorly differentiated thyroid carcinoma. Our conclusion is that most Hurthle cell tumors have a gender preponderance toward female. Carcinoma patients seem to be older than adenoma patients and tumor size is larger, but no discriminative point can be found. Pathological diagnosis with capsular or vascular invasion is accurate for differentiating benign from malignant tumors. No benign adenoma tumor had recurrence or metastases during follow up. Lobectomy is adequate for adenoma patients and total thyroidectomy for carcinoma patients. All of these patients need long term follow-up.

Surgical treatment of gastric outlet obstruction after corrosive injury--can early definitive operation be used instead of staged operation?

For the comparison of advantage and outcome, thirty six patients with corrosive upper GI injury resulting in only distal gastric outlet obstruction and failing to receive endoscopic balloon dilatation underwent prospective randomized different surgical treatments in the past years. Sixteen patients (Group A) received early definitive treatment with antrectomy or pyloroplasty for their gastric outlet obstruction, only 3 (18.8%) of them needed a second operation for the delayed esophageal stricture. The long-term follow-up for these patients revealed the stricture resolved after the antrectomy or pyloroplasty. All of the other 20 patients (Group B) who received gastrostomy plus feeding jejunostomy during their first operation required a second operation. Among the 20 patients receiving a second operation, delayed esophageal stricture was the reason in only 4 patients. It meant that 16 patients (80%) of Group B were able to avoid the second operation if early definitive treatment for their gastric outlet obstruction was performed during the first operation. We concluded that the early definitive treatment of gastric outlet obstruction can give patients a better quality of life, avoid a second operation in about 80% of them and save operative time in those who need a second operation for final esophageal reconstruction.

The endothelium-dependent response of human hepatic artery after preservation with the UW solution

The University of Wisconsin's (UW) solution has been used commonly for current liver transplantation. However, its effect on the vascular endothelium remains unclear. Experiments were designed to study the effects. Human hepatic arteries harvested from patients with hepatocellular carcinoma undergoing liver resection were preserved in 4 degree C physiological solution (group 1, the content showed on the text) and UW solution (group 2) for 1 hr. Segments of preserved and control (group 3) hepatic arteries were suspended in organ chamber to measure the isometric force. The relaxations to acetylcholine (ACH) and adenosine diphosphate in segments of hepatic artery with endothelium were significantly greater than those segments without endothelium. The maximal relaxation to ACH in arterial segments with endothelium of group 2 was significantly different from those of group 1 and 3 (group 1 to group 3, 82 +/- 2%, 57 +/- 6%, and 83 +/- 4% of the initial tension contracted by neoepinephrine (3 X 10-7 mole/l, P < 0.05). The maximal relaxation to adenosine diphosphate was similar to the response to ACH. Perfusate hypoxia (oxygen tension 30 +/- 5 mmHG) caused endothelium-dependent contraction of the arterial segments (group 1 to group 3, 233 +/- 32%, 276 +/- 35%, and 251 +/- 40% of the initial tension, P < 0.05). Endothelium-independent relaxation and contraction of human hepatic artery to sodium nitroprusside and norepinephrine were not altered by UW solution. In summary, the impaired endothelium-dependent relaxation by UW solution and prominent endothelium-dependent contraction to hypoxia of human hepatic artery would favor vasospasm and thrombus formation after liver transplantation.