AIM： TO study if T-cell activation related to portasystemic shunting causes osteoclast-mediated bone loss through RANKL-dependent pathways. We also investigated if T-cell inhibition using rapamycin would protect agai...AIM： TO study if T-cell activation related to portasystemic shunting causes osteoclast-mediated bone loss through RANKL-dependent pathways. We also investigated if T-cell inhibition using rapamycin would protect against bone loss in rats. METHODS： Portasystemic shunting was performed in male Sprague-Dawley rats and rapamycin 0.1 mg/kg was administered for 15 wk by gavage. Rats received powderized chow and supplemental feeds to prevent the effects of malnutrition on bone composition. Weight gain and growth was restored after surgery in shunted animals. At termination, biochemical parameters of bone turnover and quantitative bone histology were assessed. Markers of T-cell activation, inflammatory cytokine production, and RANKL-dependent pathways were measured. In addition, the roles of IGF-1 and hypogonadism were investigated. RESULTS： Portasystemic shunting caused low turnover osteoporosis that was RANKL independent. Bone resorbing cytokine levels, including IL-1, IL-6 and TNFα, were not increased in serum and TNFα and RANKL expression were not upregulated in PBMC. Portasystemic shunting increased the circulating CD8＋ T-cell population. Rapamycin decreased the circulating CD8＋ T-cell population, increased CD8＋ CD25＋ T-regulatory cell population and improved all parameters of bone turnover. CONCLUSION： Osteoporosis caused by portasystemic shunting may be partially ameliorated by rapamycin in the rat model of hepatic osteodystrophy.展开更多
BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively ...BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.展开更多
BACKGROUND Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is ...BACKGROUND Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is located distal to the second part od duodenum. The pre- transjugular intrahepatic portosystemic shunt (TIPS) presence of spontaneous portosystemic shunt (SPSS) was found to be associated with an increased risk of early morbidity and mortality after TIPS placement. CASE SUMMARY A 43-year-old cirrhotic male presented with melena for three days. Upper endoscopy was performed and showed active blood oozing from the distal duodenum concerning for ectopic duodenal varix. A computed tomography (CT) angiogram was performed and showed an enlarged cluster of venous collaterals around the distal duodenum. He underwent TIPS placement. He had another episode of melena three days later. Push enteroscopy with injection sclerotherapy into the duodenal varices was performed with no success. A repeat CT angiogram showed occluded TIPS shunt. Therefore, a TIPS revision was performed and there was an extensive portal venous thrombosis with a large shunt between the inferior mesenteric vein and left renal vein via the left gonadal vein. Thrombectomy and TIPS shunt balloon angioplasty was performed, followed by embolization of the portosystemic. The melena was resolved, and patient was discharged with arranged hepatology follow up. CONCLUSION It importance to look and embolize the SPSS shunts in patients with early TIPS dysfunction and recurrent duodenal variceal bleeding.展开更多
INTRODUCTIONMore than 10 years ago ,an interventional technique for the creation of an intrahepatic decompressive shunt between a branch of the portal vein and a main hepatic vein using expandable metallic stents has ...INTRODUCTIONMore than 10 years ago ,an interventional technique for the creation of an intrahepatic decompressive shunt between a branch of the portal vein and a main hepatic vein using expandable metallic stents has been intriduced for the treatmint of portal hypertension[1,2],This transjugular portosystemic intrahepatic stent shunt (TIPS) functions as a side to side shunt ,similarly to surgical shunts .展开更多
INTRODUCTIONFrom the technical aspect of liver surgery ,control of bleeding during hepatic parenchymal resection is one of the most important procedures in hepatectomy .Pringle,s maneuver ,a temporary cross-clamping ...INTRODUCTIONFrom the technical aspect of liver surgery ,control of bleeding during hepatic parenchymal resection is one of the most important procedures in hepatectomy .Pringle,s maneuver ,a temporary cross-clamping of the hepatoduodnal ligament ,has often been used for this purpose[1],This is the simplest and userul technique to reduce intraoperative blood loss .展开更多
AIM: To evaluate a new balloon-expandable stainless steel stent (Cordis stent) in a transjugular intrahepatic portosystemic shunt (TIPS) porcine model and compared with Wallstent. METHODS: TIPS was performed in 26 nor...AIM: To evaluate a new balloon-expandable stainless steel stent (Cordis stent) in a transjugular intrahepatic portosystemic shunt (TIPS) porcine model and compared with Wallstent. METHODS: TIPS was performed in 26 normal domestic pigs weighing 20 kg-30 kg using a Cordis stent or Wallstent (13 pigs in each stent). All pigs were sacrificed at the 14th day after TIPS. The stent deployment delivery system, stent patency, and stent recoil after placement were evaluated.Proliferative response in representative histological sections from the center,hepatic and portal regions of the two stent designs were quantified. RESULTS: The shunt was widely patent in 4 pigs in the Cordis stent group (4/12, premature dead in 1 pig), and in 5 pigs in the Wallstent group (5/13). All remaining stents of both designs were occluded or stenotic. The mean quantified proliferation including thickness of the proliferation and the ratio of proliferation: total area in three assayed regions in Cordis stent and Wallstent was 2.18 mm:2.00 mm, and 59.18 mm2:51.66 mm2, respectively (P 】 0.05). The delivery system and mechanical properties of the Cordis stent functioned well. CONCLUSION: The new Cordis stent is appropriate for TIPS procedure.展开更多
AIM:To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma,who developed serious side effects. METHODS:Serum l...AIM:To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma,who developed serious side effects. METHODS:Serum levels of budesonide,6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC/MS/MS; portosystemic shunt-index (SI) was determined by 99mTc nuclear imaging.All values were compared with a matched control patient without side effects. RESULTS:Serum levels of budesonide were 13-fold increased in the index patient.The ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH- prednisolone,respectively,and serum levels of budesonide was diminished (1.0 vs.4.0 for 6β-OH-budesonide,4.2 vs. 10.7 for 16α-OH-prednisolone).Both patients had portosystemic SI (5.7 % and 3.1%) within the range of healthy subjects.CONCLUSION:Serum levels of budesonide Vary uP to 13-fold in AIH Patients with Child A eirrhosis in the absenee ofrelevant Portosystemic shunting.Redueed hePatiemetabolism,as indicated by redueed metabolite-to-drugratio,rather than Portosystemie shunting may explainsystemic side effects of this drug in cirrhosis展开更多
Purpose:We aimed to compare treatment efficacy,safety and material cost between tissue gel and coil regarding variceal embolization during transjugular intrahepatic portosystemic shunt(TIPS).Materials&Methods:This...Purpose:We aimed to compare treatment efficacy,safety and material cost between tissue gel and coil regarding variceal embolization during transjugular intrahepatic portosystemic shunt(TIPS).Materials&Methods:This retrospective study including cirrhotic patients with variceal bleeding treated with TIPS combined with variceal embolization between January 2016 and August 2017.Patients were divided into three groups according to embolic agents used in variceal embolization:tissue gel group(Group A),combination group(Group B),and coil group(Group C).The primary endpoint was 1-year rebleeding rate after TIPS creation.The secondary endpoints included shunt dysfunction,overt hepatic encephalopathy,liver function,and embolic agents-related expense.Results:A total of 60 patients(30,10,and 20 in Group A,B,and C)were included.Variceal rebleeding occurred in3(10%),0(0%),and 4(20%)patients within one year after TIPS creation in Group A,B,and C,respectively.Stent dysfunction occurred in 2(3.3%)patients and 9(15.0%)patients experienced overt hepatic encephalopathy.No significant differences were observed between three groups regarding primary and secondary endpoints except embolic agents-related expense,with a significantly lower cost in Group A when compared to the other two groups.Stent dysfunction occurred in two patients,with one patient in Group A developed acute occlusion caused by thrombus and another patient in Group C underwent stent stenosis during follow-up.Conclusions:Compares to coil alone or combines with coil,tissue gel has similar treatment efficacy and safety,but with significantly lower cost for variceal bleeding during TIPS.展开更多
Objective: To investigate intestinal permeability in patients with portal hypertension and its relationship with portal pressure. Methods: Twenty patients with portal hypertension were divided into two groups (A, B), ...Objective: To investigate intestinal permeability in patients with portal hypertension and its relationship with portal pressure. Methods: Twenty patients with portal hypertension were divided into two groups (A, B), 10 patients per group. In group A, patients were treated with com- bined transjugular intrahepatic portosystemic shunt (TIPS) and modified Sugiura. In group B, patients were treated with modified Sugiura only. Intestinal permeability was assessed before operation, two weeks after TIPS. and two weeks after modified Sug- iura; 20 healthy control subjects were also assessed. Results: Intestinal permeability was significantly higher in the patients than in the control group (P< 0. 01). In group A, portal pressure, intestinal per- meability decreased two weeks after TIPS (P< 0. 05), and no obvious change was noted two weeks after modified Sugiura; but they were significantly lower than those before TIPS (P<0. 05). In group B, intestinal permeability was not different before and after operation. Intestinal permeability in group A was not different from that in group B before treatment, but significantly lower after modified Su- giura (P<0. 05). Portal pressure was significantly correlated with intestinal permeability (r=0. 627, P <0. 01). Conclusions: This study shows that combined TIPS and modified Sugiura can lower portal pressure and intestinal permeability, and enhance the therapeutic efficacy on portal hypertension.展开更多
Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications ...Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome.</span><b> </b><span style="font-family:Verdana;">Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.展开更多
Life-threatening hemorrhage rarely occurs from the portal vein following blunt hepatic trauma.Traditionally,severe portal bleeding in this setting has been controlled by surgical techniques such as packing,ligation,an...Life-threatening hemorrhage rarely occurs from the portal vein following blunt hepatic trauma.Traditionally,severe portal bleeding in this setting has been controlled by surgical techniques such as packing,ligation,and venorrhaphy.The presence of portal hypertension could potentially increase the amount of hemorrhage in the setting of blunt portal vein trauma making it more difficult to control.This case series describes the use of indirect carbon dioxide portography to identify portal hemorrhage.Furthermore,these cases illustrate attempted endovascular treatment utilizing a transjugular intrahepatic portosystemic shunt in one scenario and transmesocaval shunt coiling of a jejunal varix in the other.展开更多
Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options....Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general anesthesia and morbidity associated with surgical shunt placement and has been successful in several case reports. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement.展开更多
文摘AIM： TO study if T-cell activation related to portasystemic shunting causes osteoclast-mediated bone loss through RANKL-dependent pathways. We also investigated if T-cell inhibition using rapamycin would protect against bone loss in rats. METHODS： Portasystemic shunting was performed in male Sprague-Dawley rats and rapamycin 0.1 mg/kg was administered for 15 wk by gavage. Rats received powderized chow and supplemental feeds to prevent the effects of malnutrition on bone composition. Weight gain and growth was restored after surgery in shunted animals. At termination, biochemical parameters of bone turnover and quantitative bone histology were assessed. Markers of T-cell activation, inflammatory cytokine production, and RANKL-dependent pathways were measured. In addition, the roles of IGF-1 and hypogonadism were investigated. RESULTS： Portasystemic shunting caused low turnover osteoporosis that was RANKL independent. Bone resorbing cytokine levels, including IL-1, IL-6 and TNFα, were not increased in serum and TNFα and RANKL expression were not upregulated in PBMC. Portasystemic shunting increased the circulating CD8＋ T-cell population. Rapamycin decreased the circulating CD8＋ T-cell population, increased CD8＋ CD25＋ T-regulatory cell population and improved all parameters of bone turnover. CONCLUSION： Osteoporosis caused by portasystemic shunting may be partially ameliorated by rapamycin in the rat model of hepatic osteodystrophy.
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.
文摘BACKGROUND Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is located distal to the second part od duodenum. The pre- transjugular intrahepatic portosystemic shunt (TIPS) presence of spontaneous portosystemic shunt (SPSS) was found to be associated with an increased risk of early morbidity and mortality after TIPS placement. CASE SUMMARY A 43-year-old cirrhotic male presented with melena for three days. Upper endoscopy was performed and showed active blood oozing from the distal duodenum concerning for ectopic duodenal varix. A computed tomography (CT) angiogram was performed and showed an enlarged cluster of venous collaterals around the distal duodenum. He underwent TIPS placement. He had another episode of melena three days later. Push enteroscopy with injection sclerotherapy into the duodenal varices was performed with no success. A repeat CT angiogram showed occluded TIPS shunt. Therefore, a TIPS revision was performed and there was an extensive portal venous thrombosis with a large shunt between the inferior mesenteric vein and left renal vein via the left gonadal vein. Thrombectomy and TIPS shunt balloon angioplasty was performed, followed by embolization of the portosystemic. The melena was resolved, and patient was discharged with arranged hepatology follow up. CONCLUSION It importance to look and embolize the SPSS shunts in patients with early TIPS dysfunction and recurrent duodenal variceal bleeding.
文摘INTRODUCTIONMore than 10 years ago ,an interventional technique for the creation of an intrahepatic decompressive shunt between a branch of the portal vein and a main hepatic vein using expandable metallic stents has been intriduced for the treatmint of portal hypertension[1,2],This transjugular portosystemic intrahepatic stent shunt (TIPS) functions as a side to side shunt ,similarly to surgical shunts .
基金This work was supported partly by Grant 90089102 from the Scientific Research Fund of the Ministry of Education,Japan
文摘INTRODUCTIONFrom the technical aspect of liver surgery ,control of bleeding during hepatic parenchymal resection is one of the most important procedures in hepatectomy .Pringle,s maneuver ,a temporary cross-clamping of the hepatoduodnal ligament ,has often been used for this purpose[1],This is the simplest and userul technique to reduce intraoperative blood loss .
文摘AIM: To evaluate a new balloon-expandable stainless steel stent (Cordis stent) in a transjugular intrahepatic portosystemic shunt (TIPS) porcine model and compared with Wallstent. METHODS: TIPS was performed in 26 normal domestic pigs weighing 20 kg-30 kg using a Cordis stent or Wallstent (13 pigs in each stent). All pigs were sacrificed at the 14th day after TIPS. The stent deployment delivery system, stent patency, and stent recoil after placement were evaluated.Proliferative response in representative histological sections from the center,hepatic and portal regions of the two stent designs were quantified. RESULTS: The shunt was widely patent in 4 pigs in the Cordis stent group (4/12, premature dead in 1 pig), and in 5 pigs in the Wallstent group (5/13). All remaining stents of both designs were occluded or stenotic. The mean quantified proliferation including thickness of the proliferation and the ratio of proliferation: total area in three assayed regions in Cordis stent and Wallstent was 2.18 mm:2.00 mm, and 59.18 mm2:51.66 mm2, respectively (P 】 0.05). The delivery system and mechanical properties of the Cordis stent functioned well. CONCLUSION: The new Cordis stent is appropriate for TIPS procedure.
文摘AIM:To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma,who developed serious side effects. METHODS:Serum levels of budesonide,6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC/MS/MS; portosystemic shunt-index (SI) was determined by 99mTc nuclear imaging.All values were compared with a matched control patient without side effects. RESULTS:Serum levels of budesonide were 13-fold increased in the index patient.The ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH- prednisolone,respectively,and serum levels of budesonide was diminished (1.0 vs.4.0 for 6β-OH-budesonide,4.2 vs. 10.7 for 16α-OH-prednisolone).Both patients had portosystemic SI (5.7 % and 3.1%) within the range of healthy subjects.CONCLUSION:Serum levels of budesonide Vary uP to 13-fold in AIH Patients with Child A eirrhosis in the absenee ofrelevant Portosystemic shunting.Redueed hePatiemetabolism,as indicated by redueed metabolite-to-drugratio,rather than Portosystemie shunting may explainsystemic side effects of this drug in cirrhosis
基金funded by the Jiangsu Provincial Medical Talent Funding(ZDRCA2016038)the Suzhou Special Diagnosis and Treatment Technology of Clinical Key Diseases(LCZX201704)+2 种基金the National Natural Science Foundation of China(81771945,81901847)the Natural Science Foundation of Jiangsu Province(BK20190177)the Suzhou Science and Technology Youth Plan(KJXW2018003).
文摘Purpose:We aimed to compare treatment efficacy,safety and material cost between tissue gel and coil regarding variceal embolization during transjugular intrahepatic portosystemic shunt(TIPS).Materials&Methods:This retrospective study including cirrhotic patients with variceal bleeding treated with TIPS combined with variceal embolization between January 2016 and August 2017.Patients were divided into three groups according to embolic agents used in variceal embolization:tissue gel group(Group A),combination group(Group B),and coil group(Group C).The primary endpoint was 1-year rebleeding rate after TIPS creation.The secondary endpoints included shunt dysfunction,overt hepatic encephalopathy,liver function,and embolic agents-related expense.Results:A total of 60 patients(30,10,and 20 in Group A,B,and C)were included.Variceal rebleeding occurred in3(10%),0(0%),and 4(20%)patients within one year after TIPS creation in Group A,B,and C,respectively.Stent dysfunction occurred in 2(3.3%)patients and 9(15.0%)patients experienced overt hepatic encephalopathy.No significant differences were observed between three groups regarding primary and secondary endpoints except embolic agents-related expense,with a significantly lower cost in Group A when compared to the other two groups.Stent dysfunction occurred in two patients,with one patient in Group A developed acute occlusion caused by thrombus and another patient in Group C underwent stent stenosis during follow-up.Conclusions:Compares to coil alone or combines with coil,tissue gel has similar treatment efficacy and safety,but with significantly lower cost for variceal bleeding during TIPS.
文摘Objective: To investigate intestinal permeability in patients with portal hypertension and its relationship with portal pressure. Methods: Twenty patients with portal hypertension were divided into two groups (A, B), 10 patients per group. In group A, patients were treated with com- bined transjugular intrahepatic portosystemic shunt (TIPS) and modified Sugiura. In group B, patients were treated with modified Sugiura only. Intestinal permeability was assessed before operation, two weeks after TIPS. and two weeks after modified Sug- iura; 20 healthy control subjects were also assessed. Results: Intestinal permeability was significantly higher in the patients than in the control group (P< 0. 01). In group A, portal pressure, intestinal per- meability decreased two weeks after TIPS (P< 0. 05), and no obvious change was noted two weeks after modified Sugiura; but they were significantly lower than those before TIPS (P<0. 05). In group B, intestinal permeability was not different before and after operation. Intestinal permeability in group A was not different from that in group B before treatment, but significantly lower after modified Su- giura (P<0. 05). Portal pressure was significantly correlated with intestinal permeability (r=0. 627, P <0. 01). Conclusions: This study shows that combined TIPS and modified Sugiura can lower portal pressure and intestinal permeability, and enhance the therapeutic efficacy on portal hypertension.
文摘Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome.</span><b> </b><span style="font-family:Verdana;">Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.
文摘Life-threatening hemorrhage rarely occurs from the portal vein following blunt hepatic trauma.Traditionally,severe portal bleeding in this setting has been controlled by surgical techniques such as packing,ligation,and venorrhaphy.The presence of portal hypertension could potentially increase the amount of hemorrhage in the setting of blunt portal vein trauma making it more difficult to control.This case series describes the use of indirect carbon dioxide portography to identify portal hemorrhage.Furthermore,these cases illustrate attempted endovascular treatment utilizing a transjugular intrahepatic portosystemic shunt in one scenario and transmesocaval shunt coiling of a jejunal varix in the other.
文摘Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general anesthesia and morbidity associated with surgical shunt placement and has been successful in several case reports. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement.
