Name: isolated hepatic perfusion as a treatment for liver metastases of uveal melanoma
Uploaded: 2015-01-25T14:00:00.000+00:00
Duration: 9 min 52 s
Description: Watch this Scientific Journal Video about Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma at JoVE.com

Lennart Wiman (photographer) is acknowledged for excellent video recording.

Hastalar yazılı bilgilendirilmiş onam ve çalışma Göteborg Üniversitesi&#39;nde Bölgesel Etik İnceleme Kurulu tarafından onaylandı. 1. Anestezi <ol><li> Tüm izleme (EKG, kan basıncı manşet) 17 ayarlayın. </li><li> Orta torasik seviyede 17 alt epidural kateter yerleştirin. </li><li> Propofol 2 mg / kg, Fentanil 150 ug, ve Rokuronyum 0.6 mg ile anestezi øndükle / önceden yerleştirilen periferik venöz kateter yoluyla kg. </li><li> Preoxygenate ve hasta entübe. Sevofluran, oksijen ve hava 17 ile anestezi koruyun. </li><li> Bir çift lümenli santral venöz kateter ve bir arteriyel kateter yerleştirin. CVP ve arteriyel basıncı 17 Monitör. </li></ol> Gemilerinin Karaciğer ve kanülasyondan 2. izolasyonu <ol><li> Heparin 100 IE / kg yönetme ve antibiyotik proflaksisi (örn vermek, Trimethoprim ve 80 160 mgSülfametoksazol 0 mg) eklenmiştir. </li><li> Perkütan Seldinger tekniği kullanılarak femoral ven 17 Fr kateter ve dış juguler ven 18 15 Fr kateter yerleştirin. Floroskopi ile kateter konumlarını doğrulayın. </li><li> Orta hatta aşağı kılıç şeklinde sürecin bir L şeklinde kesi ile laparotomi gerçekleştirin ve sonra sağ subkostal kesi 19 uzatıldı. </li><li> Hiçbir ekstra hepatik metastazlar tam bir denetim ve palpasyonla karın bulunduğunu doğrulayın. <ol><li> Herhangi bir şüpheli lezyonlar bulunursa, frozen ile malignite doğrulayın. </li><li> Ekstrahepatik tezahürü (periaortal lenfadenopati, karın metastaz) kanıt varsa prosedürü sonlandırın. Porta hepatiste lenfadenopati bir kontrendikasyon olarak kabul edilmez. </li></ol></li><li> Falsiform ligament, sol ve sağ üçgen ligament ve koroner ligament 19 bölerek karaciğer Seferber. </li><li> Kaval ayırRetroperitoneal haraç venlerin ligasyonu ile diyaframa kadar böbrek damarları itibaren ven. </li><li> Sağ adrenal ven belirlemek ve çevresinde bir gemi döngü yerleştirin. </li><li> Sağ gonadal ven belirleyin. 5-10 cm için ayır. Kaval ven girişinde etrafında bir çanta-string sütür yerleştirin. <ol><li> Gonadal ven distalde bir bitişik harfleri yerleştirin. Makas kullanarak, kaval ven gonadal ven 3-5 cm açın. </li><li> Sağ gonadal ven yoluyla bir 18 Fr tel takviyeli kateter yerleştirin ve retrohepatically böbrek damarları üzerinde ucu yerleştirin. </li><li> Kateterin konumunu korumak için gonadal ven etrafında bir bitişik harfleri yerleştirin. </li><li> Kateter yoluyla kan dönüşünü doğrulayın. Kateteri 18 Heparinize. </li></ol></li><li> Triadın incelemek ve ortak hepatik arter, gastroduodenal arter ve uygun hepatik arter görselleştirmek. <ol><li> Yer damar ortak hepatik arte etrafında döngülerRy ve gastrodoudenal arter. </li><li> Portal ven inceleyin ve onun etrafında bir gemi döngü yerleştirin. </li><li> Koledok içeren bağın geri kalanından izole bir gemi döngü içinde tüm bu kapsar. </li></ol></li><li> Damar döngü ile gastroduodenal arter kaldırın. Arteriyel girişi kesmeden sonra, makas kullanarak bir kesi yapmak. <ol><li> Uygun hepatik arter içine ucu ile 8-12 Fr kateter yerleştirin. Gastroduodenal arterden etrafında bir dikilen pozisyonu sabitleyin. </li><li> Kateter kan dönüşünü doğrulayın ve ona 18 sonra heparinize. </li></ol></li><li> Prime paketlendi eritrositlerin bir birim, albümin, 100 ml (50 g / L), Tribonat (sodyum bikarbonat) ve bir heparin 2500 birim (5.000 IE / ml), 100 ml ve kristalloidlerle 250 ml perfüzyon sistemi. </li><li> Arteriyel ve silindir pompası ile donatılmış bir kalp akciğer makinesinin oluşan perfüzyon sistemine kaval ven kateterleri ve bir ısıtıcı t bağlayıntek tip bir venöz rezervuar, oksijenatörü ve boru sistemleri ile ogether. </li><li> Bir ısıtıcı ünitesi ile birlikte, bir santrifüj pompanın oluşan venovenöz bypass pompası femoral ve dış juguler kateter bağlayın ve bypass başlar. </li><li> Infrahepatically böbrek damarları üzerinde kaval ven etrafında Rumel turnike sıkma ve bir Klintmalm vasküler kelepçe kullanarak suprahepatically kaval ven sıkma yoluyla karaciğer izolasyonunu tamamlayın. <ol><li> Koledok, portal ven ve sağ adrenal ven etrafında Rumel turnike sıkın ve nihayet bir damar kelepçe kullanarak hepatik arter kelepçe. </li></ol></li></ol> 3. Perfüzyon <ol><li> Perfüzyon başlatın ve elle venöz rezervuar kan seviyesini izlemek. Bir kalıcı-hal seviyesi 500-1,200 ml / dakika arasında, genellikle bir akış hızı elde edilene kadar akış hızını ayarlayın. </li><li> Sağ ve sol lob karaciğer içine termistör probları yerleştirin ve doğrudan bir içinearteriyel kateter. </li><li> 40 o C arasında bir hedef karaciğer sıcaklığında yönelik perfüzat Isı Perfüzyon boyunca bu sıcaklık tutun. </li><li> Venovenöz Bypass pompası başının üzerinde bir parıldama probu yerleştirin. </li><li> Sistemik dolaşıma 10 MBq 99m Tc-albümin (1 ml) küçük bir doz enjekte edilerek, kaçak izleme sistemi kalibre ve bazal aktivite kayıt. <ol><li> Hepatik perfüzyon birimine, bir on-kat daha yüksek bir doz, 100 MBq 99mTc-albümin (1 mi) enjekte edilir. </li><li> Sintilasyon sensörü tarafından ölçülen aktivitesinde bir artış olarak sistemik dolaşıma perfüzyon sistemine herhangi bir sızıntıyı kaydedin. </li><li> Venöz haznesinde hacminde bir artış olarak perfüzyon sistemine sistemik dolaşımdan herhangi bir sızıntıyı kaydedin. </li></ol></li><li> Akış hızı kararlı durum kurulduğunda, bir dozda melfalan enjekte kaçak mevcut olması ve karaciğer sıcaklığı 40 ° C sıcaklığa ulaşmıştırPerfüzyon sistemine, 1 mg / kg vücut ağırlığı dışında 30 dakikada bir, iki doz halinde bölünür. </li></ol> 4. Perfüzyon End ve kateterler kaldır <ol><li> Perfüzyon 60 dakika sonra sistemi için perfüzat boşaltıp kristalloid 1000 ml karaciğer yıkayın. </li><li> Perfüzyon birimine paketlenmiş eritrositlerin bir birim ekle, karaciğere demlemeye ve sonra perfüzyon durdurun. </li><li> Klintmalm kelepçe ve kaval ven Rumel turnike bırakın. </li><li> Hepatoduodenal ligament adlı Rumel turnike bırakın. </li><li> Gastroduodenal arterden bitişik harfleri çıkarın. Kateteri çıkarın ve gemi Arter. </li><li> Hepatik arterden kelepçeyi serbest bırakın. </li><li> Gonadal ven kateteri çıkarın ve gemi Arter. </li><li> Venovenöz bypass pompasını durdurun ve tüpler ayırın. </li><li> Kesintisiz fasiyal dikiş ve daha sonra bir intrakütan cilt sütür ile karın kapatın. </li><li> C kaldırfemoral ve dış boyun damarlarında atheters ve 5 dakika için yerel bir basınç uygulanır. </li></ol> 5. Ameliyat Sonrası Bakım <ol><li> Hastayı ekstübe ve 24 saat sonrası bakım ünitesine transfer. Santral venöz basınç ve arteriyel kan basıncını izleme tutun. </li><li> Post-operatif bakım 3-7 gün tipik bir cerrahi departmanı hastayı aktarın. </li><li> 4 haftalık toplam 5000 IE / gün arasında bir dozda düşük moleküler ağırlıklı heparin (LMWH) ile devam ediniz. </li></ol>

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The authors have nothing to disclose.

Metastatik Uveal melanom olan hastalar birkaç tedavi seçenekleri vardır. Kemoterapi 6, immünoterapi 23 ve hedefli tedavi 24 gelişmiş işletim göstermek mümkün olmamıştır. Birkaç karaciğer metastazı olan hastalar için, karaciğer rezeksiyonu bir seçenek 12&#39;dir. Diğer tedaviler hepatik intra-arteriyel kemoterapi (SED) 9 Transarteriyel kemoembolizasyon (TAKE) 25 ve seçici iç radyasyon tedavisi (SIRT) 26 içerir. <p clas...

Uveal melanom insidansı Kafkas nüfus 1 en yüksek olmak, erişkinlerde en sık görülen primer göziçi kanseridir. Yerel tedavi enükleasyon veya yerel plak radyoterapi 2,3 oluşmaktadır. Bağımsız yerel tedavi, metastatik hastalık sonuçta hastaların yaklaşık 4,5 35-50% gelişecektir. Karaciğer en sık metastaz site ve izole karaciğer metastazı olan mevcut hastaların yaklaşık% 50&#39;dir. karaciğer metastazı olan hastalarda medyan genel sağkalım (OS) 6-12 ay 4. Birçok farklı sistemik ve bölgesel tedavi stratejileri araştırılmıştır, ancak sağkalım oranları 2 geliştirilmiş değil. Sistemik kemoterapi ile tedavi, hem tek madde (Dakarbazin veya Temozolomide 6) ya da kombinasyon tedavileri (BOLD rejimi 7, treosülfan 8 ile gemsitabin), daha az tepki oranlarını gösterir% 10. Karaciğer intra-arteriyel kemoterapi (SED), sistemik kemoterapi ile karşılaştırıldığında biraz daha yüksek bir genel yanıt oranı, ancak genel sağkalım 9 herhangi bir artış göstermiştir. Sisplatin ve karboplatin ile transarteryel kemoembolizasyon (TAKE) 9 ay 10 medyan sağkalım hastaların% 57&#39;sinde kısmi tepki gösterdi. Seçici iç radyasyon tedavisi (SIRT) 7 ay 11 medyan sağkalım hastaların% 62&#39;sinde kısmi yanıt göstermiştir. 255 hastanın dahil karaciğer rezeksiyonu bir çalışmada, 14 aylık bir genel sağkalım bildirilmiştir; Bir mikroskobik tam rezeksiyon mümkün hastaların 76 yılında, sağkalım 27 ay 12 oldu. İzole karaciğer perfüzyon (IHP) başlangıçta Ryan ve Ausman tarafından geliştirilen bir bölgesel tedavi seçeneği vardır. tekniğin arkasındaki mantık sistemik kaçınarak cerrahi izole etmek ve bir kemoterapötik maddenin bir yüksek doz karaciğer serpmek içinxicity 13. Buna ek olarak, aynı anda hipertermi tümör kan akımı ve hücre membran geçirgenliği 14 değişikliklerden kemoterapötik ajanın artmış tutulum aracılık eder. Komple damar izolasyonu Tc-99 insan serum albümin 15 etiketli kullanarak radyoaktif izleyici tekniği ile teyit edilir. Retrospektif faz II çalışmada İsveç 16 Uveal melanom karaciğer metastazı ile en uzun hayatta kalanlara oranla IHP uygulanan hastalarda 14 ay (26 vs 12 ay) bir potansiyel sağkalım yararı göstermiştir. Burada mevcut sonuçları ve gelecek perspektifleri kısa bir inceleme ile IHP&#39;den tekniği sunuyoruz.

<table><tbody><tr><td>Wire re-inforced catethers</td><td>Medtronic Inc, Minnesota, USA</td><td></td><td>12-18Fr</td></tr><tr><td>St&amp;ouml;ckert S5</td><td>Sorin Group, Mirandola, Italy</td><td></td><td>Heart-lung machine</td></tr><tr><td>Rotaflow</td><td>Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany</td><td></td><td>Centrifugal pump</td></tr><tr><td>HU 35</td><td>Maquet cardiopulmonary AG, Hirrlingen, Germany</td><td></td><td>Heater unit</td></tr><tr><td>Flexbumin 200 g/l</td><td>Baxter Medical AB, Kista, Sweden</td><td></td><td></td></tr><tr><td>Tribonat</td><td>Fresenius Kabi AB, Uppsala, Sweden</td><td></td><td></td></tr><tr><td>Heparin LEO, 5000 IE/ml</td><td>LEO Pharma AB, Sweden</td><td></td><td></td></tr><tr><td>Ringer Acetate</td><td>Baxter Medical AB, Kista, Sweden</td><td></td><td></td></tr><tr><td>Vasculosis</td><td>Cis-Bio International, Gif-Sur-Yvette, France</td><td></td><td>99mTc-albumin</td></tr><tr><td>MedicView</td><td>SystemData AB, Gothenburg, Sweden</td><td></td><td>Leakage monitoring system</td></tr><tr><td>Alkeran</td><td>Aspen Europe GmbH, Bad Oldesloe, Germany</td><td></td><td>melphalan</td></tr></tbody></table>

isolated hepatic perfusion as a treatment for liver metastases of uveal melanoma

İzole karaciğer perfüzyon (IHP) karaciğer cerrahi izole ve kemoterapötik ajan melphalan yüksek konsantrasyon ile perfüze bir işlemdir. Kısaca, prosedür eksternal juguler ven femoral ven bir perkütan venovenöz bypass kurulumu ile başlar. Bir laparotomi ile, kateterler sonra uygun hepatik arter ve ven kaval içine yerleştirilir. supra ve infrahepatically, daha sonra kenetlenir hem portal ven ve kaval ven. arteriyel ve venöz kateterleri bir kalp-ciğer makinesi bağlanır ve karaciğer, 60 dakika boyunca melfalan (1 mg / kg vücut ağırlığı) ile perfüze edilmiştir. Bu mümkündür Bu şekilde, yerel olarak sistemik dolaşıma sızıntı olmadan, bir kemoterapötik maddenin bir yüksek doz karaciğer serpmek. Uveal melanom izole karaciğer metastazı olan hastalarda dahil olmak üzere önceki çalışmalarda, 33-100% genel yanıt oranı ve 9 ve 13 ay arasındaki medyan sağkalım,bildirilmiştir. Bu protokolün amacı yordamı gerçekleştirmek için nasıl bir net bir açıklama vermek ve uveal melanom karaciğer metastazları için bir tedavi seçeneği olarak IHP tartışmaktır.

Bir ilk rapor ile veya TNF-alfa olmadan melfalan ile tedavi 22 hasta dahil edildi. Sonuçlar iki CR (% 10) olan hastalarda ve 11 ay 20 medyan genel sağkalım olmak üzere% 62 genel yanıt oranı, gösterdi. Bir sonraki çalışma tek başına melfalan kullanılarak tedavi 29 hastada sonucunu rapor. sonuç% 10 tam yanıt ve 12 ay 21 medyan sağkalım dahil% 62, genel yanıt ile çok benzer oldu. Tarafından Rizell ark. Bir çalışmada, uveal melanom olan 20 ha...

Watch this Scientific Journal Video about Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma at JoVE.com

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

Uveal Melanom Karaciğer Metastazlı için bir tedavi olarak izole Karaciğer Perfüzyon

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

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Research

JoVE Journal

Medicine

13.3K Görüntüleme.  Institute of Clinical Sciences. Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

Video: Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Murine Model of Metastatic Liver Tumors in the Setting of Ischemia Reperfusion Injury

Liver ischemia and reperfusion (I/R) injury, a common clinical challenge, remains an inevitable pathophysiological process that has been shown to induce multiple tissue and organ damage. Despite recent advances and therapeutic approaches, the overall morbidity has remained unsatisfactory especially in patients with underlying parenchymal abnormalities. In the context of aggressive cancer growth and metastasis, surgical I/R is suspected to be the promoter regulating tumor recurrence. This article aims to describe a clinically relevant murine model of liver I/R and colorectal liver metastasis. In doing so, we aim to assist other investigators in establishing and perfecting this model for their routine research practice to better understand the effects of liver I/R on promoting liver metastases.

We describe in detail a clinically relevant colorectal cancer liver metastases (CRLM) tumor model and the influence of liver ischemia reperfusion (I/R) in tumor growth and metastasis. This model can help to better understand the mechanisms underlying surgery-induced promotion of liver metastatic growth.

İskemi Reperfüzyon Hasarı Ayarında Metastatik Karaciğer Tümörlerinin Murine Modeli

Liver ischemia and reperfusion (I/R) injury, a common clinical challenge, remains an inevitable pathophysiological process that has been shown to induce ...

Kanser Araştırmaları

Generation of a Liver Orthotopic Human Uveal Melanoma Xenograft Platform in Immunodeficient Mice

In recent decades, subcutaneously implanted patient-derived xenograft tumors or cultured human cell lines have been increasingly recognized as more representative models to study human cancers in immunodeficient mice than traditional established human cell lines in vitro. Recently, orthotopically implanted patient-derived tumor xenograft (PDX) models in mice have been developed to better replicate features of patient tumors. A liver orthotopic xenograft mouse model is expected to be a useful cancer research platform, providing insights into tumor biology and drug therapy. However, liver orthotopic tumor implantation is generally complicated. Here we describe our protocols for the orthotopic implantation of patient-derived liver-metastatic uveal melanoma tumors. We cultured human liver metastatic uveal melanoma cell lines into immunodeficient mice. The protocols can result in consistently high technical success rates using either a surgical orthotopic implantation technique with chunks of patient-derived uveal melanoma tumor or a needle injection technique with cultured human cell line. We also describe protocols for CT scanning to detect interior liver tumors and for re-implantation techniques using cryopreserved tumors to achieve re-engraftment. Together, these protocols provide a better platform for liver orthotopic tumor mouse models of liver metastatic uveal melanoma in translational research.

Orthotopic human liver metastatic uveal melanoma xenograft mouse models were created using surgical orthotopic implantation techniques with patient-derived tumor chunk and needle injection techniques with cultured human uveal melanoma cell lines.

İmmünficient Farelerde Karaciğer Ortotopik İnsan Uveal Melanom Xenograft Platformu Üretimi

In recent decades, subcutaneously implanted patient-derived xenograft tumors or cultured human cell lines have been increasingly recognized as more ...

Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography

Establishing experimental choroidal melanoma models is challenging in terms of the ability to induce tumors at the correct localization. In addition, difficulties in observing posterior choroidal melanoma in vivo limit tumor location and growth evaluation in real-time. The approach described here optimizes techniques for establishing choroidal melanoma in mice via a multi-step sub-choroidal B16LS9 cell injection procedure. To enable precision in injecting into the small dimensions of the mouse uvea, the complete procedure is performed under a microscope. First, a conjunctival peritomy is formed in the dorsal-temporal area of the eye. Then, a tract into the sub-choroidal space is created by inserting a needle through the exposed sclera. This is followed by the insertion of a blunt needle into the tract and the injection of melanoma cells into the choroid. Immediately after injection, noninvasive optical coherence tomography (OCT) imaging is utilized to determine tumor location and progress. Retinal detachment is evaluated as a predictor of tumor site and size. The presented method enables the reproducible induction of choroid-localized melanoma in mice and the live imaging of tumor growth evaluation. As such, it provides a valuable tool for studying intraocular tumors.

Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography

The present protocol describes the implantation and evaluation of melanoma in the murine choroid utilizing optical coherence tomography.

Murin Koroidinde Melanomun İmplantasyonu ve Optik Koherens Tomografi ile Değerlendirilmesi

Establishing experimental choroidal melanoma models is challenging in terms of the ability to induce tumors at the correct localization. In addition, ...

Normothermic Ex Vivo Liver Machine Perfusion in Mouse

This protocol presents an optimized erythrocytes-free NEVLP system using mouse livers. Ex vivo preservation of mouse livers was achieved by employing modified cannulas and techniques adapted from conventional commercial ex vivo perfusion equipment. The system was utilized to evaluate the preservation outcomes following 12 h of perfusion. C57BL/6J mice served as liver donors, and the livers were explanted by cannulating the portal vein (PV) and bile duct (BD), and subsequently flushing the organ with warm (37 &#176;C) heparinized saline. Then, the explanted livers were transferred to the perfusion chamber and subjected to normothermic oxygenated machine perfusion (NEVLP). Inlet and outlet perfusate samples were collected at 3 h intervals for perfusate analysis. Upon completion of the perfusion, liver samples were obtained for histological analysis, with morphological integrity assessed using modified Suzuki-Score through Hematoxylin-Eosin (HE) staining. The optimization experiments yielded the following findings: (1) mice weighing over 30 g were deemed more suitable for the experiment due to the larger size of their bile duct (BD). (2) a 2 Fr (outer diameter = 0.66 mm) polyurethane cannula was better suited for cannulating the portal vein (PV) when compared to a polypropylene cannula. This was attributed to the polyurethane material&#39;s enhanced grip, resulting in reduced catheter slippage during the transfer from the body to the organ chamber. (3) for cannulation of the bile duct (BD), a 1 Fr (outer diameter = 0.33 mm) polyurethane cannula was found to be more effective compared to the polypropylene UT - 03 (outer diameter = 0.30 mm) cannula. With this optimized protocol, mouse livers were successfully preserved for a duration of 12 h without significant impact on the histological structure. Hematoxylin-Eosin (HE) staining revealed a well-preserved morphological architecture of the liver, characterized by predominantly viable hepatocytes with clearly visible nuclei and mild dilation of hepatic sinusoids.

Normothermic Ex Vivo Liver Machine Perfusion in Mouse

A normothermic ex vivo liver perfusion (NEVLP) system was created for mouse livers. This system requires experience in microsurgery but allows for reproducible perfusion results. The ability to utilize mouse livers facilitates the investigation of molecular pathways to identify novel perfusate additives and enables the execution of experiments focused on organ repair.

Normothermic Ex Vivo Karaciğer Makinesi Farede Perfüzyon

This protocol presents an optimized erythrocytes-free NEVLP system using mouse livers. Ex vivo preservation of mouse livers was achieved by employing ...

Mühendislik

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

In this manuscript, we describe percutaneous isolated hepatic perfusion with simultaneous chemofiltration as treatment for unresectable liver metastases. This procedure is performed under general anaesthesia in the angiosuite by an experienced team, consisting of an interventional radiologist, a clinical perfusionist and anaesthesiologist.

Karaciğer için Kapalı ckiabl Metastazına bir tedavi olarak Melfalan ile Perkütan karaciğer perfüzyon (PHP)

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

Tıp

Visualization of Vascular and Parenchymal Regeneration after 70% Partial Hepatectomy in Normal Mice

A modified silicone injection procedure was used for visualization of the hepatic vascular tree. This procedure consisted of in-vivo injection of the silicone compound, via a 26 G catheter, into the portal or hepatic vein. After silicone injection, organs were explanted and prepared for ex-vivo micro-CT (&#181;CT) scanning. The silicone injection procedure is technically challenging. Achieving a successful outcome requires extensive microsurgical experience from the surgeon. One of the challenges of this procedure involves determining the adequate perfusion rate for the silicone compound. The perfusion rate for the silicone compound needs to be defined based on the hemodynamic of the vascular system of interest. Inappropriate perfusion rate can lead to an incomplete perfusion, artificial dilation and rupturing of vascular trees.
The 3D reconstruction of the vascular system was based on CT scans and was achieved using preclinical software such as HepaVision. The quality of the reconstructed vascular tree was directly related to the quality of silicone perfusion. Subsequently computed vascular parameters indicative of vascular growth, such as total vascular volume, were calculated based on the vascular reconstructions. Contrasting the vascular tree with silicone allowed for subsequent histological work-up of the specimen after &#181;CT scanning. The specimen can be subjected to serial sectioning, histological analysis and whole slide scanning, and thereafter to 3D reconstruction of the vascular trees based on histological images. This is the prerequisite for the detection of molecular events and their distribution with respect to the vascular tree. This modified silicone injection procedure can also be used to visualize and reconstruct the vascular systems of other organs. This technique has the potential to be extensively applied to studies concerning vascular anatomy and growth in various animal and disease models.

Tools used for visualizing vascular regeneration require methods for contrasting the vascular trees. This film demonstrated a delicate injection technique used to achieve optimal contrasting of the vascular trees and illustrate the potential benefits resulting from a detailed analysis of the resulting specimen using &#181;CT and histological serial sections.

Normal Farelerde% 70 hepatektomi sonrası Vasküler ve Parankimal Rejenerasyon görselleştirme

A modified silicone injection procedure was used for visualization of the hepatic vascular tree. This procedure consisted of in-vivo injection of the ...

Isolation of Regenerating Hepatocytes after Partial Hepatectomy in Mice

Partial hepatectomy has been widely used to investigate liver regeneration in mice, but the isolation of high yields of viable hepatocytes for downstream single-cell applications is challenging. A marked accumulation of lipids within regenerating hepatocytes is observed during the first 2 days of normal liver regeneration in mice. This so-called transient regeneration-associated steatosis (TRAS) is temporary but partially overlaps the major proliferative phase. Density-gradient purification is the backbone of most existing protocols for the isolation of primary hepatocytes. As gradient purification relies on the density and size of cells, it separates non-steatotic from steatotic hepatocyte populations. Therefore, fatty hepatocytes often are lost, yielding non-representative hepatocyte fractions. 
The presented protocol describes an easy and reliable method for the in vivo isolation of regenerating hepatocytes regardless of their lipid content. Hepatocytes from male C57BL/6 mice are isolated 24-48 h after hepatectomy by a classic two-step collagenase perfusion approach. A standard peristaltic pump drives the warmed solutions via the catheterized inferior vena cava into the remnant, using a retrograde perfusion technique with outflow through the portal vein. Hepatocytes are dissociated by collagenase for their release from the Glisson's capsule. After washing and careful centrifugation, the hepatocytes can be used for any downstream analyses. In conclusion, this paper describes a straightforward and reproducible technique for the isolation of a representative population of regenerating hepatocytes after partial hepatectomy in mice. The method may also aid the study of fatty liver disease.

Lipid-laden hepatocytes are inherent to liver regeneration but are usually lost upon density-gradient centrifugation. Here, we present an optimized cell isolation protocol that retains steatotic hepatocytes, yielding representative populations of regenerating hepatocytes after partial hepatectomy in mice.

Farelerde Parsiyel Hepatektomi Sonrası Rejenere Hepatositlerin İzolasyonu

Partial hepatectomy has been widely used to investigate liver regeneration in mice, but the isolation of high yields of viable hepatocytes for downstream ...

<meta charset="utf8"></head><body>Domuz Ex Situ İzole Karaciğer Perfüzyon Modelinin Geliştirilmesi ve Validasyonu

Porcine Normothermic Isolated Liver Perfusion

Porcine models of liver ex situ normothermic machine perfusion (NMP) are increasingly being used in transplant research. Contrary to rodents, porcine livers are anatomically and physiologically close to humans, with similar organ size and bile composition. NMP preserves the liver graft at near-to-physiological conditions by recirculating a warm, oxygenated, and nutrient-enriched red blood cell-based perfusate through the liver vasculature. NMP can be used to study ischemia-reperfusion injury, preserve a liver ex situ before transplantation, assess the liver's function prior to implantation, and provide a platform for organ repair and regeneration. Alternatively, NMP with a whole blood-based perfusate can be used to mimic transplantation. Nevertheless, this model is labor-intensive, technically challenging, and carries a high financial cost.
In this porcine NMP model, we use warm ischemic damaged livers (corresponding to donation after circulatory death). First, general anesthesia with mechanical ventilation is initiated, followed by the induction of warm ischemia by clamping the thoracic aorta for 60 min. Cannulas inserted in the abdominal aorta and portal vein allow flush-out of the liver with cold preservation solution. The flushed-out blood is washed with a cell saver to obtain concentrated red blood cells. Following hepatectomy, cannulas are inserted in the portal vein, hepatic artery, and infra-hepatic vena cava and connected to a closed perfusion circuit primed with a plasma expander and red blood cells. A hollow fiber oxygenator is included in the circuit and coupled to a heat exchanger to maintain a pO2 of 70-100 mmHg at 38 &#176;C. NMP is achieved by a continuous flow directly through the artery and via a venous reservoir through the portal vein. Flows, pressures, and blood gas values are continuously monitored. To evaluate the liver injury, perfusate and tissue are sampled at predefined time points; bile is collected via a cannula in the common bile duct.

<meta charset="utf8"></head><body>Domuz Normomik İzole Karaciğer Perfüzyonu

The porcine model of liver normothermic machine perfusion (NMP), described here, can be successfully used to study NMP as a preservation strategy, a tool for viability assessment, and a platform for organ repair. It holds a high translational value, however it is technically challenging and labor-intensive.

Domuz Normomik İzole Karaciğer Perfüzyonu

Porcine models of liver ex situ normothermic machine perfusion (NMP) are increasingly being used in transplant research. Contrary to rodents, porcine ...

Uveal Melanom Karaciğer Metastazlı için bir tedavi olarak izole Karaciğer Perfüzyon

Özet

Daha Fazla Video Keşfet

Bu videodaki bölümler

İskemi Reperfüzyon Hasarı Ayarında Metastatik Karaciğer Tümörlerinin Murine Modeli

İmmünficient Farelerde Karaciğer Ortotopik İnsan Uveal Melanom Xenograft Platformu Üretimi

Murin Koroidinde Melanomun İmplantasyonu ve Optik Koherens Tomografi ile Değerlendirilmesi

Normothermic Ex Vivo Karaciğer Makinesi Farede Perfüzyon

Karaciğer için Kapalı ckiabl Metastazına bir tedavi olarak Melfalan ile Perkütan karaciğer perfüzyon (PHP)

Normal Farelerde% 70 hepatektomi sonrası Vasküler ve Parankimal Rejenerasyon görselleştirme

Farelerde Parsiyel Hepatektomi Sonrası Rejenere Hepatositlerin İzolasyonu

Domuz Normomik İzole Karaciğer Perfüzyonu

Domuz Normomik İzole Karaciğer Perfüzyonu

Domuz Normomik İzole Karaciğer Perfüzyonu