scholarly journals The effects of terlipressin and direct portacaval shunting on liver hemodynamics following 80% hepatectomy in the pig

2019 ◽  
Vol 133 (1) ◽  
pp. 153-166 ◽  
Author(s):  
John S. Hammond ◽  
Fred Godtliebsen ◽  
Sonja Steigen ◽  
I. Neil Guha ◽  
Judy Wyatt ◽  
...  
Keyword(s):  
Liver Failure ◽  
Primary Outcome ◽  
Venous Pressure ◽  
Portacaval Shunt ◽  
Control Treatment ◽  
Hepatic Arterial Flow ◽  
Venous Flow ◽  
Histological Changes ◽  
Portacaval Shunting ◽  
Liver Hemodynamics

Abstract Liver failure is the major cause of death following liver resection. Post-resection portal venous pressure (PVP) predicts liver failure, is implicated in its pathogenesis, and when PVP is reduced, rates of liver dysfunction decrease. The aim of the present study was to characterize the hemodynamic, biochemical, and histological changes induced by 80% hepatectomy in non-cirrhotic pigs and determine if terlipressin or direct portacaval shunting can modulate these effects. Pigs were randomized (n=8/group) to undergo 80% hepatectomy alone (control); terlipressin (2 mg bolus + 0.5–1 mg/h) + 80% hepatectomy; or portacaval shunt (PCS) + 80% hepatectomy, and were maintained under terminal anesthesia for 8 h. The primary outcome was changed in PVP. Secondary outcomes included portal venous flow (PVF), hepatic arterial flow (HAF), and biochemical and histological markers of liver injury. Hepatectomy increased PVP (9.3 ± 0.4 mmHg pre-hepatectomy compared with 13.0 ± 0.8 mmHg post-hepatectomy, P<0.0001) and PVF/g liver (1.2 ± 0.2 compared with 6.0 ± 0.6 ml/min/g, P<0.0001) and decreased HAF (70.8 ± 5.0 compared with 41.8 ± 5.7 ml/min, P=0.002). Terlipressin and PCS reduced PVP (terlipressin = 10.4 ± 0.8 mmHg, P=0.046 and PCS = 8.3 ± 1.2 mmHg, P=0.025) and PVF (control = 869.0 ± 36.1 ml/min compared with terlipressin = 565.6 ± 25.7 ml/min, P<0.0001 and PCS = 488.4 ± 106.4 ml/min, P=0.002) compared with control. Treatment with terlipressin increased HAF (73.2 ± 11.3 ml/min) compared with control (40.3 ± 6.3 ml/min, P=0.026). The results of the present study suggest that terlipressin and PCS may have a role in the prevention and treatment of post-resection liver failure.

A multicentre randomized controlled trial on trans-generational attention deficit/hyperactivity disorder (ADHD) in mothers and children (AIMAC): an exploratory analysis of predictors and moderators of treatment outcome

2019 ◽  
Vol 47 (1) ◽  
pp. 49-65 ◽  
Author(s):  
Charlotte Jaite ◽  
Betteke Maria van Noort ◽  
Timo D. Vloet ◽  
Erika Graf ◽  
Viola Kappel ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Specific Treatment ◽  
Externalizing Symptoms ◽  
Control Treatment ◽  
Comorbid Depression ◽  
Adhd Treatment ◽  
Mothers And Children ◽  
Maternal Adhd

Abstract. Objective: We examined predictors and moderators of treatment outcome in mothers and children diagnosed with ADHD in a large multicentre RCT. Method: In total, 144 mother-child dyads with ADHD were randomly assigned to either a maternal ADHD treatment (group psychotherapy and open methylphenidate medication, TG) or to a control treatment (individual counselling without psycho- or pharmacotherapy, CG). After maternal ADHD treatment, parent-child training (PCT) for all mother-child dyads was added. The final analysis set was based on 123 dyads with completed primary outcome assessments (TG: n = 67, CG: n = 56). The primary outcome was the change in each child’s externalizing symptoms. Multiple linear regression analyses were performed. Results: The severity of the child’s externalizing problem behaviour in the family at baseline predicted more externalizing symptoms in the child after PCT, independent of maternal treatment. When mothers had a comorbid depression, TG children showed more externalizing symptoms after PCT than CG children of depressive mothers. No differences between the treatment arms were seen in the mothers without comorbid depression. Conclusions: Severely impaired mothers with ADHD and depressive disorder are likely to need additional disorder-specific treatment for their comorbid psychiatric disorders to effectively transfer the contents of the PCT to the home situation (CCTISRCTN73911400).

Changes in the dimensions of the venae cavae

1959 ◽  
Vol 196 (4) ◽  
pp. 741-744 ◽  
Author(s):  
Hiroshi Irisawa ◽  
Alexander P. Greer ◽  
Robert F. Rushmer
Keyword(s):  
Venous Pressure ◽  
Dimensional Change ◽  
Venous Flow ◽  
Dimensional Changes ◽  
Cyclic Patterns ◽  
Venae Cavae ◽  
Surgical Conditions ◽  
Two Phases ◽  
Pressure Changes ◽  
Clockwise Hysteresis

In 11 dogs a variable resistance gauge, a bonded strain gauge, or mutual inductance coils were installed on the venae cavae under aseptic surgical conditions so that dimensional changes in unexposed veins could be measured directly. The cyclic patterns of dimensional change resembled inverted images of venous flow records obtained by others. Since some changes in the venous dimensions apparently were not related to pressure, active contraction of the walls may have been responsible. Studies involving infusion and hemorrhage confirmed the existence of two phases in the pressure-diameter relationship correlated with the level of venous pressure. The pattern of diameter and venous pressure changes during transfusion and withdrawal of blood tended to be a clockwise hysteresis loop.

Active hepatic capacitance responses to neural and humoral stimuli in dogs

1982 ◽  
Vol 242 (6) ◽  
pp. H1000-H1009 ◽  
Author(s):  
T. D. Bennett ◽  
C. L. MacAnespie ◽  
C. F. Rothe
Keyword(s):  
Blood Volume ◽  
Nerve Stimulation ◽  
Venous Pressure ◽  
Constant Flow ◽  
Arterial Infusion ◽  
Hepatic Arterial Flow ◽  
Fluid Filtration ◽  
Control Value ◽  
Flow Perfusion ◽  
Hepatic Vasculature

Active changes in hepatic capacitance were studied in pump-perfused dog livers during hepatic nerve stimulation or during intrahepatic arterial infusion of histamine (0.01-1 mg/l) or epinephrine (0.05 mg/l). Hepatic nerve stimulation at 5 pulses/s (pps) reduced hepatic blood volume by 76 +/- 39 (SD) ml/kg tissue and decreased the apparent hepatic compliance 36% from a control value of 25.6 +/- 9.3 ml.kg-1.mmHg-1, with constant flow perfusion. With a constant hepatic arterial pressure, 5 pps stimulation decreased hepatic arterial flow to 16% of control; the volume expelled was 91 +/- 33 ml/kg. Epinephrine caused hepatic artery constriction, the active expulsion of 71 ml/kg of blood, and a decrease of about 30% in hepatic compliance. Histamine dramatically reduced the hepatic vascular compliance, decreased the portal venous conductance, increased hepatic arterial conductance, and caused the apparent hepatic blood volume to double. Increased hepatic venous pressure, hepatic nerve stimulation, epinephrine, and, especially, histamine caused a significant filtration of fluid from the hepatic vasculature. We conclude that significant active capacitance changes and transsinusoidal fluid filtration can be induced in the canine liver by neural and hormonal stimuli.

Comparison of the metabolic disturbances caused by end-to-side and side-to-side portacaval shunts

1996 ◽  
Vol 80 (3) ◽  
pp. 885-891 ◽  
Author(s):  
P. A. Hawkins ◽  
M. R. DeJoseph ◽  
J. R. Vina ◽  
R. A. Hawkins
Keyword(s):  
Amino Acid Content ◽  
Portacaval Shunt ◽  
Glucose Consumption ◽  
Fundamental Question ◽  
Sham Operation ◽  
Metabolic Disturbances ◽  
Normal Pattern ◽  
Liver Atrophy ◽  
Portacaval Shunting ◽  
At Will

Portacaval shunting causes liver atrophy, hyperammonemia, and hepatic encephalopathy. A fundamental question is whether the changes, especially those to brain, are permanent. To answer this, it is necessary to have a model whereby a portacaval shunt can be created for a period of time and then the normal pattern of circulation to the liver restored at will. An end-to-side shunt, the most extensively studied model of liver dysfunction, is permanent. However, a side-to-side shunt can be constructed that results in a somewhat different pattern of circulation but with the potential to be reversed. The purpose of the present study was to compare the severity of the metabolic disturbances caused by the two models. Rats with an end-to-side shunt, a side-to-side shunt, or sham operation were prepared and studied after 14-19 days. Both models of shunting caused the same degree of liver atrophy, hyperammonemia, and indistinguishable disturbances in the amino acid content of plasma and brain. Furthermore, both models produced the same degree of cerebral depression as measured by glucose consumption.

Intraoperative Increase of Portal Venous Pressure is an Immediate Predictor of Posthepatectomy Liver Failure After Major Hepatectomy

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Andreas Bogner ◽  
Christoph Reissfelder ◽  
Fabian Striebel ◽  
Arianeb Mehrabi ◽  
Omid Ghamarnejad ◽  
...  
Keyword(s):  
Liver Failure ◽  
Major Hepatectomy ◽  
Venous Pressure ◽  
Portal Venous Pressure ◽  
Posthepatectomy Liver Failure

Spinal Arteriovenous Fistula: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (6) ◽  
pp. E226-E226
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Venous Pressure ◽  
Video Recording ◽  
Mass Effect ◽  
Type I ◽  
Venous Flow ◽  
Arteriovenous Fistulas ◽  
Root Entry Zone ◽  
Spinal Arteriovenous Fistula ◽  
Institutional Review ◽  
Icg Angiography

Abstract Spinal dural arteriovenous fistulas (AVFs) have been categorized on the basis of the Anson and Spetzler classification into 4 types. Type I is the most common type and describes an abnormal connection between a radicular artery at the nerve root sleeve and an intradural draining vein. This communication results in progressive dilatation and mass effect from the draining vein experiencing arterial pressures without intervening arterioles. In this patient, preoperative angiography showed a type I dural AVF. A laminoplasty was performed to provide dural exposure, and a midline durotomy was performed. Indocyanine green (ICG) angiography was used to visualize flow within the fistula. This dorsal dural AVF demonstrated the characteristic slow venous flow. Pressure recordings were obtained and confirmed the elevated venous pressure observed in these lesions. Bipolar coagulation of the fistulous point was performed, and the vessel was removed at the site of the root entry zone to permit pathologic confirmation of the arteriovenous interface. Intraoperative ICG angiography findings confirmed disconnection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Virtual Extracorporeal Circulation Process

1997 ◽  
Vol 20 (6) ◽  
pp. 341-351 ◽  
Author(s):  
F. Boschetti ◽  
F.M. Montevecchi ◽  
R. Fumero
Keyword(s):  
Flow Rate ◽  
Extracorporeal Circulation ◽  
Gas Flow ◽  
Venous Pressure ◽  
Venous Blood ◽  
Venous Flow ◽  
Pump Flow Rate ◽  
Urine Production ◽  
Diuretic Drugs ◽  
Temperature Levels

Virtual instruments for an extracorporeal circulation (ECC) process were developed to simulate the reactions of a patient to different artificial perfusion conditions. The computer simulation of the patient takes into account the hydraulic, volume, thermal and biochemical phenomena and their interaction with the devices involved in ECC (cannulae dimensions, oxygenator and filter types, pulsatile or continuous pump and thermal exchangers). On the basis of the patient's initialisation data (height, weight, Ht) and perfusion variables (pump flow rate, water temperature, gas flow rate and composition) imposed by the operator, the virtual ECC monitors simulated arterial and venous pressure tracings in real time, along with arterial and venous flow rate tracings, urine production tracing and temperature levels. Oxyhemoglobin arterial and venous blood saturation together with other related variables (pO2, pCO2, pH, HCO3) are also monitored. A drug model which allows the simulation of the effect of vasodilator and diuretic drugs is also implemented. Alarms are provided in order to check which variables (pressure, saturation, pH, urine flow) are out of the expected ranges during the ECC simulation. Consequently the possibility of modifying the control parameters of the virtual devices of the ECC in run-time mode offers an interaction mode between the operator and the virtual environment.

Hepatic venular pressures of rats, dogs, and rabbits

1991 ◽  
Vol 261 (3) ◽  
pp. G539-G547 ◽  
Author(s):  
H. G. Bohlen ◽  
R. Maass-Moreno ◽  
C. F. Rothe
Keyword(s):  
Inferior Vena Cava ◽  
Portal Vein ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Portal Venous Flow ◽  
Venous Flow ◽  
Norepinephrine Infusion ◽  
Venous Resistance ◽  
Venous Vasculature

We tested the hypotheses that the hepatic venule pressures (Phv), just downstream from the hepatic sinusoids, are closely similar (less than 2 mmHg) either to the portal venous pressure (Ppv), indicating a high hepatic venous resistance, or to the inferior vena cava (Pivc) pressure, indicating a high portal-sinusoidal venous resistance, as reported by previous investigators. A micropipette servo-null pressure measurement technique was used with rats, dogs, and rabbits. Phv, referred to the anatomic level of the vena cava, averaged 5.1 +/- 1.0, 6.4 +/- 1.1, and 5.4 +/- 1.0 (SD) mmHg in the rats, puppies, and rabbits, respectively. Ppv averaged 8.0 +/- 1.4, 10.8 +/- 2.2, and 7.4 +/- 1.5 mmHg, respectively. Norepinephrine infusion into the portal vein (1-5 micrograms.min-1.kg-1) caused Ppv to increase and the portal venous flow to decrease but did not significantly affect Phv. The hepatic venous circuit contributed 44 +/- 17% (rats) and 31 +/- 26% (dogs) of the total liver venous vascular resistance under control conditions. We conclude that the portal and sinusoidal vasculatures are the dominant, but not exclusive, resistance sites of the liver venous vasculature both at rest and during norepinephrine-induced vasoconstriction.

scholarly journals Utilising Benefit-Risk Assessments within Clinical Trials – A Protocol for the BRAINS project

2021 ◽  
Author(s):  
Nikki Totton ◽  
Steven Julious ◽  
Dyfrig Hughes ◽  
Jonathan Cook ◽  
Katie Biggs ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Trial Design ◽  
Primary Outcome ◽  
Risk Assessments ◽  
Control Treatment ◽  
Guidance Document ◽  
Publicly Funded ◽  
Treatment Benefit ◽  
Web Based ◽  
The Uk

Abstract Background: Depending on the treatment to be investigated, a clinical trial could be designed to assess objectives of: superiority; equivalence or non-inferiority. The design of the study is affected by many different elements including: the control treatment, the primary outcome and associated relationships. In some studies, there could be more than one outcome of interest. In these situations, benefit-risk methodologies could be used to assess the outcomes simultaneously and consider the trade-off between the benefits against the risks of a treatment. Benefit-risk is used within the regulatory industry but seldom included within publicly funded clinical trials within the UK. This project aims to gain an expert consensus on how to select the appropriate trial design (e.g. superiority) and when to consider including benefit-risk methods.Methods: The project will consist of four work packages:1. A web-based survey to elicit current experiences and opinions,2. A rapid literature review to assess any current recommendations,3. A two-day consensus workshop to gain agreement on the recommendations,4. Production of a guidance document.Discussion: The aim of the project is to provide a guideline for clinical researchers, grant funding bodies and reviewers for grant bodies for how to select the most appropriate trial design and when it is appropriate to consider using benefit-risk methods. The focus of the guideline will be on publicly funded trials, however, the vision is that the work will be applicable across research settings and we will connect with other organisations and committees as appropriate.

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