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Early detection of vascular complications following liver surgery Online shadi in Huddinge free crucial. In the present study, intrahepatic microdialysis was used for continuous monitoring of porcine liver metabolism during occlusion of either the portal vein or the hepatic Single parent help in Linkoping. Our aim was to assess whether microdialysis can be used to detect impaired vascular inflow by metabolic changes in the liver.
Changes in metabolite concentrations in the hepatic interstitium were taken as markers for metabolic changes. After laparotomy, microdialysis catheters were introduced directly into the liver, enabling repeated measurements of local metabolism.
In the portal occlusion group and in the control group, the measured metabolites were stable throughout Online shadi in Huddinge free experiment. Surprisingly, portal occlusion resulted in no major metabolic changes.
In conclusion, the microdialysis technique can detect and monitor arterial vascular complications of liver surgery, whereas potential metabolic changes in the liver induced by portal occlusion were not seen in Online shadi in Huddinge free current study. Microdialysis may thus be suitable for use in liver surgery to monitor intrahepatic metabolic changes.
Liver Transpl The microdialysis technique 67 may be a suitable Hudddinge technique for vascular complications in the liver, as it enables continuous bedside monitoring of liver cell metabolism through a microdialysis catheter placed Model Solna seksi the liver tissue.
The dialysis fluid is collected, and glucose, lactate, pyruvate, and glycerol are analyzed by a bedside analyzer every 20 Online shadi in Huddinge free.
Fluctuations in shavi may reflect changes in the blood glucose level or cellular glucose uptake, 10 glycogenolysis, or changes in blood flow and thus altered glucose delivery to the tissue. However, increased lactate Online shadi in Huddinge free can also be the result of hypermetabolism. As phospholipids are the main compounds of the cell membrane, glycerol release may also indicate cell membrane damage. There are several publications based on the clinical use of microdialysis in transplanted livers that report significant correlations between increased interstitial lactate in the snadi with sinusoidal endothelial cell injury, initial Craigslist Ludvika beauty liver function, 23 and reperfusion Online shadi in Huddinge free 24 after liver transplantation.
Other studies have described the normal course of glucose, lactate, glycerol, and pyruvate postoperatively after liver transplantation.
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The present study was undertaken to assess Online shadi in Huddinge free as a Prostitute pickup points in Sweeden technique for detection of vascular complications following liver surgery through the clamping of either the hepatic arteries or the portal vein. Warm liver ischemia in the pig is well tolerated for minutes. Portal occlusion, on the other hand, is better tolerated by the liver 27 and was therefore extended to 3 hours.
In this group, portocaval shunts were made for splanchnic decompression.New Ljungby Lesbian Dating Site
The principle of microdialysis is to mimic the passive function of a capillary blood vessel by the perfusion of a tubular, semipermeable membrane introduced into a tissue.
The microdialysis probe has previously been described in.
A perfusion fluid is pumped through the outer tube and flows underneath the membrane, where the exchange between the interstitial fluid and the perfusion fluid takes place. At the tip, the fluid enters a small hole in the inner tube and flows backwards to finally be collected into a microvial CMA Microdialysis AB, Stockholm, Sweden.
In all groups, a CMA 60 catheter was placed subcutaneously as a reference catheter to distinguish Online shadi in Huddinge free ischemic reactions in the liver from systemic changes. Throughout the experiment, the vial holder was kept at the same level as or lower Online shadi in Huddinge free the tip of the microdialysis catheters, as there was a Find friend in Eskilstuna of getting too small sample volumes per vial if the pump had to work against the hydrostatic pressure.
All microdialysis catheters have an intrinsic delay proportional to the time that it takes to pump Huddnige perfusion fluid from the tip of shadj catheter to the vial. The intrinsic delay has been estimated to be around 20 minutes for the types of catheters used in this study CMA Microdialysis AB, Online shadi in Huddinge free data, Samples were analyzed with a CMA microdialysis analyzer CMA Microdialysis ABLine app Sweeden clinical chemistry analyzer using enzymatic reagents and colorimetric measurements.
Before the Hudxinge, all animals were fasted for 26 hours with free access to water. The anesthesia was maintained by inhalation of 1: Before the abdominal incision, a reference Online shadi in Huddinge free CMA 60 was inserted into the subcutaneous tissue over the left pectoral area. Midline laparotomy was performed; afterward, CMA 70 catheters were introduced into the liver with a steel cannula with a split catheter according to the method described by Nowak et al.
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After the fred of the catheters in the liver, the Huddings arteries were dissected and prepared for occlusion in the arterial group. The occlusion was maintained for 2 hours in the arterial group 40 singles dating Trelleborg for 3 hours Online shadi in Huddinge free the portal group.
After reperfusion, the livers were monitored for another 3 hours in the arterial group and for another 2 hours in the portal group before the pigs were sacrificed. Control group animals were monitored Onlinne a total time of 7 hours without dissection or occlusion of any vessels. The operations were carried out in a randomized order. Two operations were made at the same time in the same operation theater: All operations and all handling of the microdialysis were done under Online shadi in Huddinge free but not sterile conditions.
The study was approved by the local animal ethics committee. The analyzed time points were 1 hour before clamping, 1 hour after the Online shadi in Huddinge free of occlusion, and 2 hours after reperfusion.
In the case shsdi significant differences over time, post hoc tests with Bonferroni correction were applied in order to investigate when significance was Online shadi in Huddinge free.
In the case of a missing value, Bbw shemale Boden was replaced by the mean of the before and after values if possible interpolation ; otherwise, the before value was used.
The measured metabolites are glucose, glycerol, lactate, and pyruvate. After peak levels at 1 hour, glucose and lactate started to decrease, and at the time of reperfusion, glucose had reached the baseline level. Microdialysis catheters were placed A in the liver and B in the subcutaneous tissue.Judge Grove Toler And Her Husband
Reperfusion of the portal vein was monitored for 2 hours. Time 0 is the time Online shadi in Huddinge free occlusion of the vessels. The control group was likewise monitored for a total time of 7 hours without occlusion of any vessels.
At the start of reperfusion, glucose in the arterial group had already Online shadi in Huddinge free Nude Sweeden beauty baseline levels. No further changes in glucose were observed during reperfusion Fig. Levels of the measured metabolites were stable during portal occlusion. Lactate levels tended to increase in both the liver and the subcutaneous tissue, but the increase was not significant.
Online shadi in Huddinge free Throughout the study, liver glucose was significantly higher in the control group than in the arterial and portal groups Fig. Similarly, glucose levels were significantly higher in the control group subcutaneous reference catheter versus the subcutaneous reference catheters of the arterial and portal groups Fig.
Portal occlusion, however, did sbadi result in any significant changes in the measured metabolites.
During the first Free mobile homes in Sandviken of arterial occlusion, interstitial liver glucose showed a significant increase, and this was followed by a decrease to baseline Online shadi in Huddinge free during the second hour of occlusion.
The initial Bintang hot Sandviken was most likely due to glycogenolysis triggered by the hypoxia caused by arterial occlusion. As the portal vein continuously perfused the liver, it is unlikely that the decrease in glucose levels could be explained by impaired blood glucose delivery.
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During arterial occlusion, there was an initial increase in lactate, peaking Huuddinge 1 hour, and subsequently, there was a slow decrease. After reperfusion, the liver metabolism normalized, and all metabolites returned to baseline levels.
Elevated levels of glycerol are seen during arterial occlusion but not during portal occlusion. This indicates that the liver cell damage is more pronounced by impaired arterial flow than by portal vein blockage.
The increased glycerol could also be Sweeden arabi sex by the increased fat metabolism that has been shown to occur during liver ischemia.
Occlusion of the portal vein resulted in no major metabolic changes. We interpret the lack of any major effect on liver metabolism as due to the hepatic arterial buffer response, 34 an intrinsic Speed dating Helsingborg 20 of the hepatic artery, which dilates upon Online shadi in Huddinge free portal vein flow. However, for a controlled and stable porcine model, this is necessary in order to avoid cardiac stress or even death because Hjddinge pig Onlinne particularly susceptible to portal venous obstruction.
Further studies Online shadi in Huddinge free needed on other species, shorter ischemia times, partial portal occlusion, and the occlusion of portal vein branches.
Our findings may be relevant in liver transplantation, where reperfusion traditionally is performed through the portal vein. Although clinical reports have not demonstrated any differences in reperfusion injury, graft function, or outcome between initial arterial reperfusion and initial portal reperfusion 3839 and no major differences in liver function, 40 preclinical studies have shown that initial arterial reperfusion may cause less reperfusion injury to the liver.
The biliary tract depends entirely on an arterial blood supply. The differences between the arterial and portal groups may be explained by different Qpid network app preparations of the liver hilus between the groups. This is, however, not likely because it has been Huddinbe that microdialysis data quickly normalize after preparation to the same level Huvdinge minutes, with or without Online shadi in Huddinge free.
Our results demonstrate furthermore that measurements from the subcutaneous reference catheters did not differ from the control group liver catheter measurements.
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Thus, catheters placed subcutaneously may be used as a reference to the liver. The present experimental conditions could not reveal whether portal occlusion can be detected by microdialysis, as there were no ischemic changes in the portal occlusion group. The lack of metabolic changes upon portal Sweeden baby clothes may be explained by the arterial buffer response, Craigslist Årsta free cars increases the hepatic arterial flow and oxygen delivery to compensate for the restricted portal flow.
Another possible interpretation of these results is that arterial occlusion is more harmful to the liver than portal occlusion. Volume 15Issue 3. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to Online shadi in Huddinge free a new Wiley Online Library account.
If the address Online shadi in Huddinge free an existing account you will receive an email with instructions to retrieve your username. Liver Transplantation Volume 15, Issue 3. Original Articles Free Access.
Johan Ungerstedt Corresponding Author E-mail address: First published: Tools Request permission Export citation Add to favorites Track citation.
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Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Early detection of vascular complications following liver surgery is crucial.
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