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Tranchart H, Koffi GM, Gaillard M, Lainas P, Poüs C, Gonin P, Nguyen TH, Dubart-Kupperschmitt A, Dagher I. Liver regeneration following repeated reversible portal vein embolization in an experimental model. Br J Surg 2016; 103:1209-19. [PMID: 27256140 DOI: 10.1002/bjs.10153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 01/26/2016] [Accepted: 02/10/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Portal vein embolization (PVE) is used routinely to prevent postoperative liver failure as a result of anticipated insufficient future liver remnant volume following resection. The authors have recently developed a technique for temporary PVE. The aim of this study was to assess the effect of repeated reversible PVE on hepatocyte proliferation and subsequent liver hypertrophy in rodents. METHODS Four treatments were compared (n = 21 rats per group): single reversible PVE, two PVEs separated by 14 days, partial portal vein ligation or sham procedure. The feasibility and tolerance of the procedure were assessed. Volumetric imaging by CT was used to estimate the evolution of liver volumes. After death, the weight of liver lobes was measured and hepatocyte proliferation evaluated by immunostaining. RESULTS Embolization of portal branches corresponding to 70 per cent of total portal flow was performed successfully in all animals. Repeated PVE induced additional hepatocyte proliferation. Repeated embolization resulted in superior hepatocyte proliferation in the non-occluded segments compared with portal vein ligation (31·1 versus 22·2 per cent; P = 0·003). The non-occluded to total liver volume ratio was higher in the repeated PVE group than in the single PVE and sham groups (P = 0·050 and P = 0·001 respectively). CONCLUSION Repeated reversible PVE successfully induced additional hepatocyte proliferation and subsequent liver hypertrophy. Surgical relevance Portal vein embolization (PVE) is used routinely to prevent postoperative liver failure as a result of anticipated insufficient future liver remnant volume following resection. In the present study, a technique of repeated temporary PVE was developed in a rat model; this induced additional hepatocyte proliferation and an increase in liver volume compared with single embolization. This novel approach might help induce major hypertrophy of the future remnant liver, which could increase the rate of patients amenable to major liver resections.
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Affiliation(s)
- H Tranchart
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Villejuif, France.,Departement Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Unité Mixte de Recherche, Paris-Sud University, Villejuif, France.,Departments of Minimally Invasive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Sud University, Clamart, France
| | - G M Koffi
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Villejuif, France.,Departement Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Unité Mixte de Recherche, Paris-Sud University, Villejuif, France
| | - M Gaillard
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Villejuif, France.,Departement Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Unité Mixte de Recherche, Paris-Sud University, Villejuif, France.,Departments of Minimally Invasive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Sud University, Clamart, France
| | - P Lainas
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Villejuif, France.,Departement Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Unité Mixte de Recherche, Paris-Sud University, Villejuif, France.,Departments of Minimally Invasive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Sud University, Clamart, France
| | - C Poüs
- Departments of Biochemistry, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Sud University, Clamart, France
| | - P Gonin
- Service Commun d'Expérimentation Animale, Gustave Roussy Institut, Villejuif, France
| | - T H Nguyen
- INSERM U1064, Hôtel Dieu Hospital, Nantes, France
| | - A Dubart-Kupperschmitt
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Villejuif, France.,Departement Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Unité Mixte de Recherche, Paris-Sud University, Villejuif, France
| | - I Dagher
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Villejuif, France.,Departement Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Unité Mixte de Recherche, Paris-Sud University, Villejuif, France.,Departments of Minimally Invasive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Sud University, Clamart, France
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Soro KG, Attia KA, Coulibaly A, Koffi GM, Yapo P, Ehua SF, Miessan JBK. [Digestive burns by simultaneous oral and rectal self-administration of ingestion sulphuric acid: an unusual mode of suicide]. Sante 2008; 18:205-208. [PMID: 19810615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The authors report an unusual mode of suicide in two patients admitted to the Teaching Hospital of Yopougon. One 26-year-old woman swallowed sulphuric acid and then self-administered more of the same product rectally. She presented with abdominal pain, vomiting, bloody diarrhoea, without fever (T=37,9 degrees C). The abdomen did not appear to require surgery. Endoscopy showed erosive cesophagitis on day 5 (D5) and ulcerated bleeding inflammation of the entire colon and rectum on D26. She died on D30, during generalized convulsions. The second patient, a 31-year-old women, ingested sulphuric acid in the same way. She presented initially with diffuse abdominopelvic pains; clinical examination showed neither guarding nor contraction. Her temperature was 37,8 degrees C. Oesogastric endoscopy observed cesophagitis stage II B and III A and gastritis III A and III B. On D9, acute and generalized peritonitis was discovered, leading to surgical exploration. The patient died at the end of the operation. This unusual mode of suicide induces grave clinical presentations despite their apparent calm. The prognosis is worse because of the double localization of the lesions, the toxicity of the product, and the underestimation of its gravity.
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Affiliation(s)
- Kountélé Gona Soro
- Service de Chirurgie Générale et Digestive du CHU de Yopougon, 21 BP 632 Abidjan 21, Côte d'Ivoire.
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