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1.  Portal vein thrombosis in liver cirrhosis 
World Journal of Hepatology  2014;6(2):64-71.
Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.
doi:10.4254/wjh.v6.i2.64
PMCID: PMC3934638  PMID: 24575165
Portal vein thrombosis; Liver cirrhosis; Thrombophilic factors; Anticoagulation; Splenectomy
2.  Non-cirrhotic portal-systemic encephalopathy caused by enlargement of a splenorenal shunt after pancreaticoduodenectomy for locally advanced duodenal cancer: report of a case 
Surgery Today  2013;44(8):1573-1576.
We report a case of portal-systemic encephalopathy occurring secondary to a splenorenal shunt, 2 years after a pancreaticoduodenectomy for locally advanced duodenal carcinoma. A 55-year-old woman was brought to our hospital with a decreased level of consciousness. Laboratory testing revealed an elevated serum ammonia level (221 μg/dl) and normal liver function. Retrospective review of a series of contrast-enhanced computed tomography scans of the abdomen identified a splenorenal shunt, which had gradually enlarged over the past 2 years (Fig. 1). The decreased level of consciousness was thought to be due to portal-systemic encephalopathy secondary to the splenorenal shunt. We performed balloon-occluded retrograde transvenous obliteration to occlude the splenorenal shunt, following which her serum ammonia level returned to normal (28 μg/dl) and an alert level of consciousness was maintained.Fig. 1Review of abdominal computed tomography scans. a Preoperatively, b 6 months postoperatively, c 1 year postoperatively, d 2 years and 2 months postoperatively. The shunt vessel gradually enlarged after pancreaticoduodenectomy (circle)
doi:10.1007/s00595-013-0679-1
PMCID: PMC4097198  PMID: 23982193
Encephalopathy; Splenorenal shunt; Duodenal cancer; Pancreaticoduodenectomy; Balloon-occluded retrograde transvenous obliteration
3.  Effect of laparoscopic splenectomy in patients with Hepatitis C and cirrhosis carrying IL28B minor genotype 
BMC Gastroenterology  2012;12:158.
Background
IL28B and ITPA genetic variants are associated with the outcome of pegylated-interferon and ribavirin (PEG-IFN/RBV) therapy. However, the significance of these genetic variants in cirrhotic patients following splenectomy has not been determined.
Methods
Thirty-seven patients with HCV-induced cirrhosis who underwent laparoscopic splenectomy (Spx group) and 90 who did not (non-Spx group) were genotyped for IL28B and ITPA. The outcome or adverse effects were compared in each group. Interferon-stimulated gene 15 (ISG15) and protein kinase R expression in the spleen was measured using total RNA extracted from exenterate spleen.
Results
Sustained virological response (SVR) rate was higher in patients carrying IL28B major genotype following splenectomy (50% vs 27.3%) and in patients carrying minor genotype in the Spx group compared to non-Spx group (27.3% vs 3.6%, P < 0.05). Pretreatment splenic ISG expression was higher in patients carrying IL28B major. There was no difference in progression of anemia or thrombocytopenia between patients carrying each ITPA genotype in the Spx group. Although splenectomy did not increase hemoglobin (Hb) level, Hb decline tended to be greater in the non-Spx group. In contrast, splenectomy significantly increased platelet count (61.1 × 103/μl vs 168.7 × 103/μl, P < 0.01), which was maintained during the course of PEG-IFN/RBV therapy.
Conclusions
IL28B genetic variants correlated with response to PEG-IFN/RBV following splenectomy. Splenectomy improved SVR rate among patients carrying IL28B minor genotype and protected against anemia and thrombocytopenia during the course of PEG-IFN/RBV therapy regardless of ITPA genotype.
doi:10.1186/1471-230X-12-158
PMCID: PMC3503804  PMID: 23145809
IL28B; ITPA; Splenectomy; Liver cirrhosis
4.  Successful Treatment for Hepatic Encephalopathy Aggravated by Portal Vein Thrombosis with Balloon-Occluded Retrograde Transvenous Obliteration 
Case Reports in Gastroenterology  2011;5(2):366-371.
This report presents the case of a 78-year-old female with hepatic encephalopathy due to an inferior mesenteric venous-inferior vena cava shunt. She developed hepatocellular carcinoma affected by hepatitis C virus-related cirrhosis and underwent posterior sectionectomy. Portal vein thrombosis developed and the portal trunk was narrowed after hepatectomy. Portal vein thrombosis resulted in high portal pressure and increased blood flow in an inferior mesenteric venous-inferior vena cava shunt, and hepatic encephalopathy with hyperammonemia was aggravated. The hepatic encephalopathy aggravated by portal vein thrombosis was successfully treated by balloon-occluded retrograde transvenous obliteration via a right transjugular venous approach without the development of other collateral vessels.
doi:10.1159/000330287
PMCID: PMC3134060  PMID: 21769289
Hepatic encephalopathy; Portal vein thrombosis; Balloon-occluded retrograde transvenous obliteration
5.  Protein-bound polysaccharide-K reduces colitic tumors and improves survival of inflammatory bowel disease in vivo 
Oncology Letters  2011;2(5):791-796.
Protein-bound polysaccharide-K (PSK) is a biological response modifier that possesses antitumor effects against various tumors. Although an inflammatory response has been considered to play an important role in the development of colorectal cancer, the anti-inflammatory effect of PSK has yet to be elucidated. An inflammatory bowel disease (IBD)-induced colorectal tumor model with 1.2-dimethyl hydrazine (DMH) and dextran sodium sulfate (DSS) was used to examine the effects of PSK on tumor suppression and survival. Although 90% of the mice that were not treated with PSK developed colitic tumors, oral administration of PSK suppressed tumor formation by less than 30%. Although deaths associated with DSS-induced melena were observed, PSK significantly reduced mortality. In conclusion, the present study showed that PSK not only suppressed colorectal tumor formation in the DMH+DSS-induced IBD model, but also improved the survival rate, indicating that anti-inflammatory activity is one of the mechanisms for the antitumor effects of PSK.
doi:10.3892/ol.2011.336
PMCID: PMC3408101  PMID: 22866128
6.  Extended Hemi-Hepatectomy with Portal Vein Reconstruction in a Patient with Situs Ambiguous 
We report a case of far-advanced hepatocellular carcinoma (HCC) with situs ambiguous, complex visceral and vascular anomalies, who was successfully managed by extended hemi-hepatectomy. A 67-year-old man was referred to our hospital with a large liver mass. Abdominal ultrasonography, computed tomography and angiography revealed HCC with a diameter of 10 cm, with tumor thrombus in the main and first branch of the portal vein. Multiple complex anomalies in the abdomen were determined preoperatively. He had right-sided spleens-stomach-duodenum, liver at midline, inferior vena cava interruption with azygous continuation, and hepatic arterial anomaly. Extended left lobectomy of the liver with reconstruction of the portal vein was performed. Postoperatively, the patient recovered without major complications, and he was discharged on postoperative day 21. We report the first successful extended hepatectomy with portal vein reconstruction for HCC in a patient with rare situs anomalies.
doi:10.1159/000118830
PMCID: PMC3075171  PMID: 21490843
Situs ambiguous; Hepatocellular carcinoma; Hepatectomy

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