Úvod: Správné zhodnocení jaterních pseudolézí pomocí multidetektorového CT či MR je velmi důležité z důvodu odlišení těchto benigních změn od primárních či sekundárních malignit v jaterním parenchymu. Metoda: Autoři provedli systémový přehled literatury v databázi PubMed s vyhledáváním slov játra, pseudoléze v angličtině a češtině od roku 2000 do roku 2014. Výsledky: Autoři předkládají přehled literatury. Dále autoři retrospektivně zhodnotili soubor pacientů léčených pro jaterní onemocnění ve FN Ostrava, kdy se setkali s touto abnormalitou celkem v 7 případech. U 3 pacientů byla provedena diagnostická laparoskopie s vizuální kontrolou léze, s upřesněním diagnostiky pomocí peroperační ultrasonografie (IOUS) a s excizí části ložiska pro následné histologické vyšetření. Histologický nález u všech 3 pacientů odpovídal steatotickému postižení jater. Další 2 pacienti byli operováni pro jiná ložiska metastazujícího kolorektálního karcinomu a revize suspektní léze byla provedena během operačního výkonu otevřenou cestou. Kromě vizuální kontroly a peroperačního IOUS byla provedena excize k histologickému vyšetření, které prokázalo známky velkokapénkové i malokapénkové steatózy a nepřítomnost maligních změn. Poslední dva pacienti jsou dále sledováni v hepatologické poradně a jsou v rámci dispenzarizace kontrolováni v 6měsíčních intervalech. Závěr: Autoři prezentují vlastní zkušenosti získané v rámci mezioborové spolupráce na multidisciplinárních konferencích a připojují literární údaje o této neobvyklé problematice. Správným vyhodnocením nálezů této variety zejména u onkologických pacientů je možno zabránit zbytečným biopsiím, duplicitním vyšetřením a diagnostickým laparoskopiím či explorativním laparotomiím., Introduction: Accurate detection of hepatic pseudolesions using multi-detector CT and MRI examinations is crucial for the differentiation of benign alterations from primary and secondary malignant lesions in hepatic parenchyma. Method: The authors conducted a systematic literature review in PubMed. “Liver“ and “pseudolesion“ were used as keywords in English and Czech, and papers/articles published from 2000 to 2014 were retrieved. Results: The authors presented a literature review. In addition, the authors performed a retrospective evaluation of a group of patients treated for liver disease at University Hospital Ostrava where this anomaly was encountered in 7 cases. In 3 of the patients, diagnostic laparoscopy was done, with visual examination of the lesion accompanied by intraoperative ultrasound exam (IOUS) and partial excision, to establish the diagnosis. Subsequent histological assessment of the specimens confirmed the diagnosis of a steatotic lesion in each of these 3 patients. Additional 2 of the 7 patients underwent liver surgery for concurrent metastatic lesions of colorectal cancer and an open-access revision of the suspected lesions was performed. Visual inspection and intraoperative ultrasound (IOUS) was followed by excisional biopsy. The histology revealed macro- and micro-vesicular steatosis and excluded malignant changes. The last 2 patients still continue to be followed–up regularly on a 6-month routine check-up basis at our hepatology unit. Conclusion: The authors presented their own experience gained through inter-disciplinary cooperation at Multidisciplinary conferences. A literature overview of this unusual subject is also included. Particularly in oncologic patients, correct interpretation of these pseudolesions may help to avoid unnecessary biopsies, further imaging examinations and diagnostic laparoscopies and/or explorative laparotomies., and P. Vávra, M. Vávrová, P. Delongová, T. Jonszta, J. Dvořáčková, A. Pelikán, M. Penhaker, J. Nowaková, M. Peteja, P. Zonča
Acute liver failure (ALF) is a clinical syndrome resulting from widespread damage of hepatocytes, with extremely high mortality rate. Urgent orthotopic liver transplantation was shown to be the most effective therapy for ALF but this treatment option is limited by sca rcity of donor organs. Therefore, hepatocyte transplantation (Tx) has emerged as a new therapeutical measure for ALF, however, the first clinical applications proved unsatisfactory. Apparently, extensive preclinical studies are needed. Our aim was to exami ne if hepatocytes isolated from transgenic “firefly luciferase” Lewis rats into the recipient liver would attenuate the course of thioacetamide (TAA) -induced ALF in Lewis rats. Untreated Lewis rats after TAA administration showed a profound decrease in sur vival rate; no animal survived 54 h. The rats showed marked increases in plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, in plasma level of bilirubin and ammonia (NH 3 ), and in a significant decrease in plasma albumin. Hepatocyte Tx attenuated the course of TAA -induced ALF Lewis rats which was reflected by improved survival rate and reduced degree of liver injury showing as lowering of elevated plasma ALT, AST, NH 3 and bilirubin levels and increasing plasma albumin. In addition, bioluminescence imaging analyses have shown that in the TAA- damaged livers the transplanted hepatocyte were fully viable throughout the experiment. In conclusion, the results show that hepatocyte Tx into the liver can attenuate the course of TAA- induced ALF in Lewis rats. This information should be considered in attempts to develop new therapeutic approaches to the treatment of ALF., E. Koblihová, O. Lukšan, I. Mrázová, M. Ryska, L. Červenka., and Obsahuje bibliografii
Hepatoprotective properties of rooibos tea (Aspalathus linearis) were investigated in a rat model of liver injury induced by carbon tetrachloride (CCl4). Rooibos tea, like N-acetyl-L-cysteine which was used for the comparison, showed histological regression of steatosis and cirrhosis in the liver tissue with a significant inhibition of the increase of liver tissue concentrations of malondialdehyde, triacylglycerols and cholesterol. Simultaneously, rooibos tea significantly suppressed mainly the increase in plasma activities of aminotransferases (ALT, AST), alkaline phosphatase and billirubin concentrations, which are considered as markers of liver functional state. The antifibrotic effect in the experimental model of hepatic cirrhosis of rats suggests the use of rooibos tea as a plant hepatoprotector in the diet of patients with hepatopathies., O. Uličná, M. Greksák, O. Vančová, L. Zlatoš, Š. Galbavý, P. Božek, M. Nakano., and Obsahuje bibliografii
Hepatorenální syndrom je život ohrožující komplikace jaterních chorob. Jedná se o funkční postižení ledvin, které se vyskytuje jak u akutních (typ I), tak i chronických (typ II) onemocnění jater a je spojeno s vysokou mortalitou. Léčba má omezené možnosti, ale podávání vazopresorů (terlipresin), albuminu a portosystémový shunt dokážou prognózu zlepšit. Transplantace jater je léčbou nejefektivnější. Autoři prezentují aktuální data o této problematice včetně doporučení pro léčebnou praxi., Hepatorenal syndrome (HRS) is a life-treating complication of liver diseases. This functional kidney impairment is classified into acute (type I) and chronic (type II) types and is connected with high mortality. Treatment options are limited, but administration of vasoconstrictors (terlipressin), albumin and portosystemic shunt may improve their prognosis. Liver transplantation is the most effective method for these patients. Authors want to present recent data relating to HRS, including therapeutic recommendations., and Vladimír Hrabovský, Alice Mendlová, Terezie Vavříčková
D-galactosamine is a hepatotoxic agent, which induces diffuse injury of liver tissue followed by the regeneration process. Our data showed a high increase of serum aminotransferases after D-galactosamine administration, which indicates a high extent of liver injury. When lipid emulsion was applied immediately after D-galactosamine, the increase of serum aminotransferases was greatly reduced. In addition, the decrease of the cytochrome c oxidase activity induced by D-galactosamine was not observed after lipid emulsion administration and the increase of total liver oxidative capacity in the regeneration period due to activated mitochondrial biogenesis was accelerated. All these findings indicate a protective effect of lipid emulsion administration against D-galactosamine toxicity., R. Ferenčíková, Z. Červinková, Z. Drahota., and Obsahuje bibliografii
Hepcidin is a key regulator of iron homeostasis, while hemojuvelin is an important component of the hepcidin regulation pathway. It has been recently proposed that soluble hemojuvelin, produced from hemojuvelin by the protease furin, decreases hepcidin expression. The aim of the presented study was to examine the downregulation of hepcidin by chronic bleeding in hemojuvelin-mutant mice. Male mice with targeted disruption of the hemojuvelin gene (Hjv-/- mice) and wild-type littermates were maintained on an iron-deficient diet and subjected to weekly phlebotomies for 7 weeks. Gene expression was examined by real-time PCR. In wild type mice, repeated bleeding decreased hepcidin mRNA by two orders of magnitude. In Hjv-/- mice, basal hepcidin expression was low; however, repeated bleeding also decreased hepcidin mRNA content by an order of magnitude. Phlebotomies reduced hepatic iron overload in Hjv-/- mice by 80 %. Liver and muscle furin mRNA content was not significantly changed. No effect on hepatic Tmprss6 mRNA content was observed. Results from the study indicate that soluble hemojuvelin is not the sole factor responsible for hepcidin downregulation. In addition, the presented data suggest that, under in vivo conditions, tissue hypoxia does not transcriptionally regulate the activity of furin or TMPRSS6 proteases., J. Krijt ... [et al.]., and Obsahuje bibliografii a bibliografické odkazy
Hepcidin, a key regulator of iron metabolism, plays a crucial role in the pathogenesis of anemia of chronic disease. Although it is produced mainly in the liver, its recently described expression in adipose tissue has been shown to be enhanced in massive obesity due to chronic low-grade inflammation. Our objective was to study the changes in hepcidin expression in adipose tissue during acute-phase reaction. We measured hepcidin mRNA expression from isolated subcutaneous and epicardial adipose tissue at the beginning and at the end of the surgery. The expression of mRNAs for hepcidin and other iron-related genes (transferrin receptor 1, divalent metal transporter 1, ferritin, ferroportin) were measured by real-time RT-PCR. Hepcidin expression significantly increased at the end of the surgery in subcutaneous but not in epicardial adipose tissue. Apart from the increased levels of cytokines, the parameters of iron metabolism showed typical inflammation-induced changes. We suggest that acute inflammatory changes could affect the regulation of hepcidin expression in subcutaneous adipose tissue and thus possibly contribute to inflammation-induced systemic changes of iron metabolism., M. Vokurka ... [et al.]., and Obsahuje bibliografii a bibliografické odkazy