Ronald H. Wachsberg

The Ischemic Preconditioning Paradox in Deceased Donor Liver Transplantation—Evidence from a Prospective Randomized Single Blind Clinical Trial

While animal studies show that ischemic preconditioning (IPC) is beneficial in liver transplantation (LT), evidence from few smaller clinical trials is conflicting. From October 2003 to July 2006, 101 deceased donors (DD) were randomized to 10 min IPC (n = 50) or No IPC (n = 51). Primary objective was efficacy of IPC to decrease reperfusion (RP) injury. Both groups had similar donor risk index (DRI) (1.54 vs. 1.57). Aminotransferases on days 1 and 2 were significantly greater (p < 0.05) in IPC recipients. In multivariate analyses, IPC had an independent effect only on day 2 aspartate transferase. Prothrombin time, bilirubin and histological injury were similar in both groups. IPC had no significant effect on plasma TNF‐α, IL‐6 and IL‐10 in the donor and TNF‐α and IL‐6 in the recipient. In contrast, IPC recipients had a significant rise in systemic IL‐10 levels after RP (p < 0.05) and had fewer moderate/severe rejections within 30 days (p = 0.09). Hospital stay was similar in both groups. One‐year patient and graft survival in IPC versus No IPC were 88% versus 78% (p = 0.1) and 86 versus 76% (p = 0.25), respectively. IPC increases RP injury after DDLT, an ‘IPC paradox’. Other potential benefits of IPC are limited. IPC may be more effective in combination with other preconditioning regimens.

CT findings of bowel and mesenteric injury.

Bowel and mesenteric injuries are common sequelae of blunt abdominal trauma. CT represents a valuable modality in the diagnosis of bowel and mesenteric injuries. While certain findings on CT are highly specific, such as free air and extravasation of oral contrast agent, they are insensitive and seen only in the minority of patients. Therefore, radiologists must focus their attention on the bowel wall and mesentery to improve their diagnostic accuracy in these injuries. Bowel wall thickening and/or abnormal bowel wall enhancement must be noted. Mesenteric abnormalities, which can consist of mesenteric infiltration, interloop fluid, or fluid trapped in the leaves of the small bowel mesentery, may be crucial yet subtle clues. Knowledge of their typical appearance may aid in their diagnosis. This pictorial essay illustrates the range of findings in bowel and mesenteric injuries as well as possible pitfalls to help in their prompt recognition and diagnosis.

B-flow, a non-Doppler technology for flow mapping : early experience in the abdomen

B-flow imaging is a non-Doppler technology for blood flow imaging that was introduced on high-frequency transducers at the end of the last decade. It has only recently become available on convex array and sector transducers suitable for abdominal examination. B-flow technology is not plagued by some of the troublesome pitfalls often encountered during color and power Doppler flow imaging, and appears promising as an adjunct to Doppler evaluation of blood flow in the abdomen. This article introduces the authors early experience using B-flow in the abdomen, and illustrates the potential advantages this technique offers relative to Doppler flow mapping.

Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure

AbstractBackground: Previous investigators have suggested that narrowing of the suprahepatic inferior vena cava (IVC) occurs in patients with increased intraabdominal pressure (IAP). Subjects and methods: We retrospectively reviewed 59 contrast-enhanced computed tomographic (CT) scans performed over a 2-year period in patients with evidence of increased IAP. We also reviewed CT scans performed in a control group of 30 normal patients. The intrahepatic and suprahepatic IVC segments were assessed for narrowing. Results: Narrowing of the suprahepatic IVC was never observed in the patients with elevated IAP. Slit-like narrowing of the upper intrahepatic IVC was noted in 11 (44%) of 25 patients; the intrahepatic IVC was not evaluated in 34 other patients with liver abnormalities or unsatisfactory opacification of the intrahepatic IVC. In control subjects, narrowing was not observed in either the intrahepatic or suprahepatic IVC. Conclusion: Narrowing of the upper intrahepatic IVC can be seen in some patients with increased IAP. The cause and significance of this phenomenon remain to be determined.

B-Flow Imaging of the Hepatic Vasculature: Correlation with Color Doppler Sonography

OBJECTIVE B-flow imaging is a non-Doppler technology that provides real-time imaging of blood flow during gray-scale sonography. The utility of B-flow imaging is reflected in numerous publications that describe normal and pathologic findings in the carotid arteries and hemodialysis fistulas. However, there is a paucity of articles describing B-flow imaging of the abdominopelvic viscera. The purpose of this article is to illustrate a spectrum of findings encountered during noninvasive flow evaluation of the hepatic vasculature, correlating the Doppler sonography and B-flow imaging findings. CONCLUSION Color and spectral Doppler sonography are invaluable for noninvasive evaluation of the hepatic vasculature. However, a number of pitfalls and artifacts have been described that can cause important pathologic findings to be overlooked or can suggest incorrect diagnoses. In our experience, B-flow imaging often correctly displays normal and pathological vascular structures for which Doppler sonographic findings have been misleading or erroneous.

Doppler ultrasound evaluation of transjugular intrahepatic portosystemic shunt function: pitfalls and artifacts.

Abstract:The current literature reflects controversy regarding the accuracy of Doppler ultrasound for the detection of transjugular intrahepatic portosystemic shunt (TIPS) malfunction. Experience has revealed many pitfalls and artifacts that can potentially interfere with the proper performance and

Liver infarction following unrecognized right hepatic artery ligation at laparoscopic cholecystectomy

Parenchymal liver complications thus far reported following laparoscopic cholecystectomy include abscess, biloma, contusion/laceration, and hematoma. We report a case of liver infarction following unrecognized ligation of the right hepatic artery (HA) during laparoscopic cholecystectomy.

Cholangiographic demonstration of the cholecystohepatic duct of Luschka

Abstract. The cholecystohepatic duct of Luschka is demonstrated. This anomaly directly connects the gallbladder to the bile ducts, draining a portion of the right lobe of the liver. The pertinent embryology is reviewed. When accidentally severed, it may cause a bile leak leading to biloma formation. It should be recognized before surgery to alert the surgeon.

Sonographic endometrial three‐layer pattern in symptomatic first‐trimester pregnancy: Not diagnostic of ectopic pregnancy

We evaluated a recent report that suggested that a “3‐layer” appearance of the endometrium on sonography is diagnostic of ectopic pregnancy in symptomatic pregnant patients.

Echogenic peritoneal fluid as an isolated sonographic finding: Significance in patients at risk of ectopic pregnancy

Echogenic intraperitoneal fluid in any quantity noted on sonography is thought to indicate a very high likelihood of ectopic pregnancy (EP) in patients at risk. We retrospectively reviewed 12 consecutive symptomatic patients with a positive pregnancy test in whom sonography revealed echogenic fluid as an isolated finding without evidence of intrauterine pregnancy and in whom follow-up was available. Final diagnoses were EP in seven patients (58%) and spontaneous abortion in five (42%). EP was diagnosed in all four patients with a large amount of echogenic fluid, but in only three (38%) of eight patients with a small-to-moderate amount of echogenic fluid. We conclude that a small-to-moderate amount of echogenic fluid noted as an isolated finding may not be highly predictive of EP.