title: The effects of hemorrhagic shock secondary to hepatectomy in a swine model.
abstract: BACKGROUND
  Ischemia-reperfusion injury caused by severe hemorrhagic shock and subsequent resuscitation leads to deterioration of hepatic homeostasis and possibly to liver failure. The present study focuses on determining whether there is a different biological response to hemorrhagic shock by different sources of hemorrhage, hepatic hemorrhage (HH) versus peripheral hemorrhage.
  
  
  METHODS
  Twenty-one male swine (Sus scrofa domesticus) were randomly allocated in three groups as follows: sham group (S, n = 5), central venous hemorrhage group, (CVH) (n = 8), and HH group (n = 8). Hepatectomy of the left liver lobe was carried out in groups CVH and HH, and the animals were subjected to controlled bleeding from the internal jugular vein and the traumatic liver surface, respectively. After 10 min of hemorrhage, shock was maintained for 30 min at mean arterial pressure levels of 30 mm Hg-40 mm Hg and resuscitation was initiated with crystalloids and colloids. Hemodynamic parameters and fluid balance were monitored throughout the 6 h of total duration of the experiment. Blood samples were collected at 0-, 40-, and 360-min time points for transaminases, albumin, and interleukin-6 measurement. Hepatic tissue was harvested at the end of the experiment for oxidative marker and proliferation analysis.
  
  
  RESULTS
  Although blood loss was comparable between the two groups, the amount of fluids needed for resuscitation was higher for the HH group. Inflammatory response, measured by interleukin-6, was found higher in HH group. Oxidative stress markers did not reveal statistically significant difference between the two groups. Liver hemorrhage decreased hepatocellular proliferation measured by proliferating cell nuclear antigen.
  
  
  CONCLUSIONS
  Our study provides evidence that HH entails worse consequences for the hepatocytes than systemic hemorrhage. Higher needs for resuscitation fluids, decreased proliferation, and augmented inflammatory response when HH takes place are findings with possible clinical importance in liver surgery and trauma.
authors: 4th Department of Surgery, Attikon Hospital, Medical School, University of Athens, Haidari, Athens, Greece.
authors: Anastasios I
authors: AI
authors: Mylonas
authors: 4th Department of Surgery, Attikon Hospital, Medical School, University of Athens, Haidari, Athens, Greece. Electronic address: norfanos@gmail.com.
authors: Nikolaos F
authors: NF
authors: Orfanos
authors: Department of Anesthesia, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom.
authors: Iosifina I
authors: II
authors: Karmaniolou
authors: 4th Department of Surgery, Attikon Hospital, Medical School, University of Athens, Haidari, Athens, Greece.
authors: Evangelos D
authors: ED
authors: Lolis
authors: Department of Clinical Biochemistry, Attikon Hospital, Medical School, University of Athens, Haidari, Athens, Greece.
authors: Eirini P
authors: EP
authors: Stergiou
authors: Experimental-Research Center ELPEN Pharmaceuticals, Pikermi, Attiki, Hellas.
authors: Apostolos E
authors: AE
authors: Papalois
authors: Department of Science of Nutrition-Dietetics, Harokopio University of Athens, Kalithea, Athens, Greece.
authors: Tzortzis N
authors: TN
authors: Nomikos
authors: Department of Pathology, Aretaeio Hospital, Medical School, University of Athens, Athens, Greece.
authors: Agathi I
authors: AI
authors: Kondi-Pafiti
authors: 4th Department of Surgery, Attikon Hospital, Medical School, University of Athens, Haidari, Athens, Greece.
authors: Vasileios E
authors: VE
authors: Smyrniotis
authors: 4th Department of Surgery, Attikon Hospital, Medical School, University of Athens, Haidari, Athens, Greece.
authors: Nikolaos F
authors: NF
authors: Arkadopoulos
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical; D004195:Disease Models, Animal; D006439:Hemodynamics; D006498:Hepatectomy / Q000009:adverse effects*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D011897:Random Allocation; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000209:etiology* / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D013552:Swine
keywords: Central venous hemorrhage; Hepatic hemorrhage; Hepatocyte proliferation; Interleukin 6; Ischemia–reperfusion; Swine