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Long-Term Follow-Up After Successful Transjugular Intrahepatic Portosystemic Shunt Placement in a Pediatric Patient with Budd-Chiari Syndrome

CARNEVALE, Francisco Cesar; SZEJNFELD, Denis; MOREIRA, Airton Mota; GIBELLI, Nelson; GREGORIO, Miguel Angel De; TANNURI, Uenis; CERRI, Giovanni Guido
Fonte: SPRINGER Publicador: SPRINGER
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.73%
Orthotopic liver transplantation is the standard of care in patients with Budd-Chiari syndrome (BCS), and transjugular intrahepatic portosystemic shunt (TIPS) has become an important adjunct procedure while the patient is waiting for a liver. No long-term follow up of TIPS in BCS patients has been published in children. We report successful 10-year follow-up of a child with BCS and iatrogenic TIPS dysfunction caused by oral contraceptive use.

TIPS - anastomose portossistêmica intra-hepática transjugular. Revisão

CARREIRO,Gerson; MOREIRA,André da Luz; MURAD,Felipe Francescutti; AZEVEDO,Feliciano; COELHO,Henrique Sérgio Moraes
Fonte: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED Publicador: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2001 PT
Relevância na Pesquisa
26.73%
Diversas alternativas terapêuticas têm sido usadas, atualmente, na tentativa de reduzir a mortalidade de pacientes com hipertensão portal que desenvolvem varizes esofagianas. Abordagem de uma dessas alternativas que ainda é de exceção e pouco utilizada em nosso meio - o "shunt" (desvio) portossistêmico intra-hepático transjugular - TIPS ("transjugular intrahepatic portasystemic shunt"). O TIPS possibilita redução significativa do gradiente de pressão portohepático, uma vez que funciona como um "shunt" portocava látero-lateral, promovendo, dessa forma, descompressão eficiente do sistema portal, reduzindo significativamente o risco de sangramentos. A técnica consiste na inserção percutânea, através da veia jugular interna, de malha metálica através do parênquima hepático, sob controle angiográfico, criando verdadeira comunicação portocava. Bons resultados na utilização do TIPS têm sido atestados em diversos estudos, muito embora bem poucos deles tenham sido controlados e randomizados de modo a concluir que esse procedimento é seguro, eficaz e com boa relação custo-benefício. Dessa forma, buscou-se, nesta revisão, uma análise do estado atual da utilização do TIPS, sua técnica, principais indicações e complicações. O TIPS vem sendo utilizado nos casos de hemorragia digestiva refratária ao tratamento farmacológico e/ou endoscópico...

Hepatic and renal metabolism before and after portasystemic shunts in patients with cirrhosis.

Owen, O E; Mozzoli, M A; Reichle, F A; Kreulen, T H; Owen, R S; Boden, G; Polansky, M
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1985 EN
Relevância na Pesquisa
26.75%
Hepatic cirrhosis with portal hypertension and gastroesophageal hemorrhage is a disease complex that continues to be treated by surgical portasystemic shunts. Whether or not a reduction or diversion of portal blood flow to the liver adversely affects the ability of the liver to maintain fuel homeostasis via gluconeogenesis, glycogenolysis, and ketogenesis is unknown. 11 patients with biopsy-proven severe hepatic cirrhosis were studied before and after distal splenorenal or mesocaval shunts. Hepatic, portal, and renal blood flow rates and glucose, lactate, pyruvate, glycerol, amino acids, ketone bodies, free fatty acids, and triglyceride arteriovenous concentration differences were determined to calculate net precursor-product exchange rates across the liver, gut, and kidney. The study showed that hepatic contribution of glucose and ketone bodies and the caloric equivalents of these fuels delivered to the blood was not adversely affected by either a distal splenorenal or mesocaval shunt. In addition to these general observations, isolated findings emerged. Mesocaval shunts reversed portal venous blood and functionally converted this venous avenue into hepatic venous blood. The ability of the kidney to make a substantial net contribution of ketone bodies to the blood was also observed.

Prognostic factors in survival after portasystemic shunts. Multivariate analysis.

Lacaine, F; LaMuraglia, G M; Malt, R A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /12/1985 EN
Relevância na Pesquisa
26.92%
Multivariate analyses correlated short-term survival and long-term survival with clinical data from 141 patients with portasystemic shunts for bleeding esophageal varices over the 8 years from 1974 through 1981. By logistic regression analysis, the elements with independent prognostic significance for operative death were an emergency operation, serum albumin and bilirubin levels, age, and sex. A cutpoint probability value of 0.75 marked the single level above which 84% of patients could be expected to survive, but below which 77% are likely to die. By a Cox regression model, elements with independent prognostic significance were identical. Male sex (p = 0.02) and prolonged partial thromboplastin time (p = 0.04) indicated a poor prognosis after an emergency operation; after an elective operation only the serum albumin level was prognostic (p = 0.02). Normal blood clotting is the major determinant of survival after an emergency shunt, and the serum albumin level chiefly determines survival after elective portasystemic decompression.

The Metabolic Basis of Portasystemic Encephalopathy and the Effect of Selective vs Nonselective Shunts

Warren, W. Dean; Rudman, Daniel; Millikan, William; Galambos, John T.; Salam, Atef A.; Smith, Robert B.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1974 EN
Relevância na Pesquisa
27.17%
Portasystemic encephalopathy has been a major deterent to the utilization of total or non-selective shunts. A procedure to determine the maximum rate of urea synthesis (MRUS) has been developed and a depression in the ability to synthesize urea has been shown to correlate closely with the development of encephalopathy. Utilizing this procedure and a modified ammonium tolerance curve, a controlled comparison was instituted between selective and non-selective shunts. Following a non-selective or total shunt, there was a definite deterioration in both the MRUS and the ammonium chloride tolerance curve which was accompanied by a high rate of clinical encephalopathy. In marked contrast, the selective shunt, which maintains portal venous perfusion of the liver, showed little or no change in the MRUS and the ammonium chloride tolerance curve following the selective shunt and there was a very low incidence of encephalopathy. The difference between the non-selective and selective shunt in maintenance of urea synthesis, metabolism of ammonium chloride, and the development of clinical encephalopathy show the selective shunt procedure to be definitively superior in this regard.

Hemodynamic Patterns in Human Hepatic Cirrhosis: A Prospective Randomized Study of the Hemodynamic Sequelae of Distal Splenorenal (Warren) and Mesocaval Shunts

Reichle, Frederick A.; Owen, Oliver E.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1979 EN
Relevância na Pesquisa
26.88%
Increasingly successful operative management of gastroesophageal variceal hemorrhage has been achieved by newer techniques of portal venous reconstruction. Although it is postulated that the clinical success may be due to more selectivity in portal venous shunting, direct determination of the effect of portasystemic shunt on portal vein blood flow has not been possible. Direct determinations of portal vein blood flow were performed preoperative on unanesthetized, hemodynamically stable cirrhotic patients by observation of radiopaque water-insoluble droplets. Patients were then randomized into elective distal splenorenal (Warren) or mesocaval shunt and determinations were performed postoperatively under similar conditions when clinically possible. Although portal vein blood flow was not significantly different before (929 ± 147 ml/min) or after 899 ± 271 ml/min) distal splenorenal shunt, there was a large change in portal vein blood flow after mesocaval shunt, decreasing from 772 ± 177 ml/min (hepatopetal) to -1021 ± 310 ml/min (hepatofugal) p < 0.01). After either procedure total hepatic blood flow (as determined by cardiac green clearance) was not significantly changed, nor was renal blood flow; however, cardiac output was significantly increased after mesocaval shunt. Thus the theoretical hemodynamic goals of the selective distal splenorenal shunt...

Hepatic Blood Flow after Canine Portasystemic Shunting

Shatney, Clayton H.; Harmon, John W.; Rich, Norman M.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/1982 EN
Relevância na Pesquisa
27.23%
Effects of portasystemic shunting on total hepatic blood flow (THBF) were evaluated in mongrel dogs with 35 and 50µ radioactive microspheres. THBF was measured prior to shunting and 1 hour and 3 weeks after surgery. Using systemic and pulmonary artery catheters, pertinent hemodynamic variables were also measured. In sham-operated dogs (n = 5), there were no significant changes in the hemodynamic parameters or the components of THBF during the experiment. After end-to-side shunting (n = 7), animals experienced a significant, permanent fall in hepatopetal portal blood flow (HABF). In contrast, dogs with side-to-side shunts (n = 7) exhibited a transient, significant increase in HABF 1 hour after surgery. Although the shunt eliminated HPBF, the rise in HABF prevented a significant, immediate fall in THBF. Three weeks after surgery, however, HABF had returned to the baseline range, and THBF was significantly lower than the preshunt value. Dogs with H-graft mesocaval shunts (n = 5) also exhibited a transient, significant rise in HABF 1 hour after surgery. Since HPBF did not fall substantially, THBF at this time was significantly higher than the baseline value. Three weeks after surgery, HABF had fallen to the baseline range, but THBF was not significantly different from the preshunt level. In animals with distal splenorenal shunts (n = 11)...

Transjugular intrahepatic portasystemic stent shunting for control of acute and recurrent upper gastrointestinal haemorrhage related to portal hypertension.

Simpson, K J; Chalmers, N; Redhead, D N; Finlayson, N D; Bouchier, I A; Hayes, P C
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /07/1993 EN
Relevância na Pesquisa
27.17%
The insertion of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was evaluated in 22 patients with recurrent upper gastrointestinal haemorrhage related to portal hypertension (bleeding from oesophageal varices 10, gastric varices six, portal hypertensive gastropathy six). TIPSS was successfully performed electively in 15 patients and as an emergency in three patients. Twelve patients have had no further admissions with bleeding after TIPSS. Single episodes of bleeding were noted in six patients after TIPSS associated with shunt thrombosis (two), intimal hyperplasia within the shunt (two), and shunt migration (one). Another patient presented with reaccumulated ascites suggesting poor shunt function but died from massive variceal haemorrhage before further assessment could be performed. There was one death related to the procedure. Two patients developed encephalopathy after TIPSS, in one patient this was controlled by the insertion of a smaller diameter stent within the existing TIPSS. Several complications arose in earlier patients that have not recurred after modification of the initial technique. TIPSS can be life saving and is effective in controlling variceal haemorrhage and rebleeding from oesophageal or gastric varices and portal hypertensive gastropathy. Larger and longer term studies are required...

Renal failure following portasystemic shunt in patients with cirrhosis of the liver.

Garrett, J C; Voorhees, A B; Sommers, S C
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/1970 EN
Relevância na Pesquisa
26.42%

Effect of portasystemic venous shunt surgery on hyperglucagonaemia in cirrhosis: paired studies of pre- and post-shunted subjects

Dudley, F. J.; Alford, F. P.; Chisholm, D. J.; Findlay, D. M.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1979 EN
Relevância na Pesquisa
37.55%
The effect of liver disease on glucagon metabolism was examined in nine patients with chronic liver disease who were studied both before and after the creation of a surgical portasystemic shunt. Hepatocellular function did not deteriorate after shunt surgery. However, hepatic perfusion with splanchnic venous blood, as determined by scintisplenoportography, decreased after shunt surgery in six subjects but appeared unaltered in three. Basal plasma immunoreactive glucagon (IRG) levels in the pre-shunt cirrhotic group were significantly greater (p <0·005) than in control subjects and further increased (p <0·05) after shunt surgery. Moreover, the increase in basal IRG after shunt was evident only in patients in whom portasystemic shunting was demonstrably increased by surgery. Despite the higher basal IRG levels postoperatively, shunt surgery in the cirrhotics did not alter basal glucose and insulin levels or the glucose and insulin response to a glucose or protein load. Circulating IRG was heterogeneous in the pre-shunt cirrhotic patients: the 9000 molecular weight fraction comprised 27±4%, the 3500 mol. wt. fraction 71±4%, and the > 40 000 mol. wt. fraction was minimal. After shunt surgery, the relative proportion of the 9000 mol. wt. fraction of IRG (13±3%) decreased significantly (p <0·05) and this fall was associated with a corresponding increase in the 3...

Effects of wide variations in portal pressure on mesenteric blood flow and absorption from the canine colon.

Grandison, A S; Harrison, I D; Shields, R
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1980 EN
Relevância na Pesquisa
26.75%
Splanchnic blood flow was studied over a wide range of portal pressures in five dogs. An inverse linear relationship between flow and pressure was found in the range from 6 to 42 mmHg. The colonic absorption of ammonia, water, sodium, potassium, bicarbonate, and chloride was measured in four dogs over a similar range of portal pressures. Absorption of ammonia, water, sodium, and chloride was significantly reduced by increasing portal pressure, and this reduction was abolished when portal pressure was allowed to return to the basal level. It is suggested that splanchnic decompression by portasystemic shunt gives rise to increased mesenteric flow and increased colonic ammonia absorption, which may contribute to portasystemic encephalopathy.

Effect of a prior portasystemic shunt on subsequent liver transplantation.

Brems, J J; Hiatt, J R; Klein, A S; Millis, J M; Colonna, J O; Quinones-Baldrich, W J; Ramming, K P; Busuttil, R W
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /01/1989 EN
Relevância na Pesquisa
47.38%
Fifteen patients who had a prior portasystemic shunt underwent orthotopic liver transplantation. Shunt types were portacaval in six patients, H-graft mesocaval in six, distal splenorenal in two, and proximal splenorenal in one. Mean blood loss and hospital stay were highest in the portacaval group. Retransplants (two patients) and deaths (two patients) also were limited to this group. In this report, technical considerations, advantages, and disadvantages of the various shunt types are described. Management of patients with late stages of portal hypertension must include estimation of the effects of a portasystemic shunt on subsequent liver transplantation. It is concluded that portacaval shunts should be avoided in patients who may be considered for transplantation. Distal splenorenal shunts are best performed in younger patients with intractable variceal bleeding who are not expected to require transplantation in the near future. A mesocaval H-graft is the shunt of choice in patients who are current liver transplant candidates.

Liver Transplantation in Patients with Previous Portasystemic Shunt

Mazzaferro, Vincenzo; Todo, Satoru; Tzakis, Andreas G.; Stieber, Andrei C.; Makowka, Leonard; Starzl, Thomas E.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /07/1990 EN
Relevância na Pesquisa
47.17%
Over a 9-year period, 58 patients who had previous portasystemic shunt procedures underwent orthotopic liver transplantation (OLTx) under a cyclosporine-steroid immunosuppressive regimen. The types of shunt used were distal splenorenal (18 patients), mesocaval (17 patients), end-to-side portacaval (11 patients), side-to-side portacaval (5 patients) and proximal splenorenal (7 patients). The mean interval between shunt and transplantation was 6 years. There was no statistical difference in survival between patients with previous shunts and the entire population of patients with primary liver transplantation performed during the same period of time. Age, sex, shunt patency, status of portal vein, and use of vein or artery graft did not affect survival. Child’s classification had a significant influence on graft survival, even though no difference was subsequently observed in patient survival. A progressively improved intraoperative strategy and the rwe of veno-venous bypass and University of Wisconsin preservation solution had a significant impact on blood loss, length of operation, length of stay in intensive care unit, and ultimately, on survival. Distal splenorenal and mesocaval shunts with no or minimal hilum dissection are safer shunts if subsequent transplantation is planned; in fact...

Venous allografts: a useful alternative to venous autografts in digestive surgery

Launois, B.; Jamieson, G.; Landen, S.; Maddern, G.; Campion, J.; Coeurdacier, P.; Bardaxoglou, E.
Fonte: College of Surgeons of Australasia Publicador: College of Surgeons of Australasia
Tipo: Artigo de Revista Científica
Publicado em //1995 EN
Relevância na Pesquisa
36.63%
Over a 16 month period seven patients underwent surgery using venous allografts either to reconstruct the portal vein, or to construct a mesocaval 'H' graft or a shunt between the coronary vein and the subhepatic inferior vena cava. The allografts were harvested during multiorgan procurement from the bifurcation of the inferior vena cava, the common iliac vein and the external iliac vein and kept in a preservation solution at 4 degrees C for a mean time of 6 days (range 1-29) before use. Subsequent thrombosis was clinically evident in only two patients. The use of venous allografts appears to be a useful alternative to other venous replacements.

Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience

Funes,Fernanda Ribeiro; Silva,Rita de C. M. A. da; Arroyo Jr.,Paulo César; Duca,William José; Silva,Adinaldo Adhemar Menezes da; Silva,Renato Ferreira da
Fonte: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED Publicador: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2012 EN
Relevância na Pesquisa
46.73%
CONTEXT: Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. OBJECTIVE: Outline the profile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. METHOD: Retrospective study based on the data bank of cirrhotic patients' medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. RESULTS: The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age 47.7 years (age range from 16 to 85 years and SD = 13), 21 (29.2%) patients presented liver disease as cause excessive intake of alcoholic drinks; 21 (29.2%) contamination by hepatitis virus, 16 (22.2%) excessive alcohol intake associated with virus and 14 (19.4%) patients presented other causes. As for initial classification...

Portasystemic shunting versus liver transplantation for the Budd-Chiari syndrome.

Bismuth, H; Sherlock, D J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /11/1991 EN
Relevância na Pesquisa
37.34%
Over 12 years, 22 patients with the Budd-Chiari syndrome were treated surgically. Eighteen underwent a mesenterico-caval shunt (MCS); two, a side-to-side portacaval shunt; one, a mesenterico-atrial shunt (MAS); and one, a liver transplantation (OLT). One patient died after operation from the precipitating condition, and two MCS grafts that thrombosed were restored. All 21 surviving patients remain well, free from ascites, and all shunts are patent after a mean follow-up of 5.6 +/- 1 years, five patients with more than 10 years' follow-up. This long-term survival achieved by portasystemic shunts suggests that they have a major role in the treatment of the Budd-Chiari syndrome. The authors prefer the mesenterico-caval shunt using a jugular graft. This ensures a total portasystemic shunt, avoids subhepatic surgery, and reduces the long-term risk of prosthetic graft thrombosis. The MAS was reserved for cases with complete caval thrombosis. Patients with significant degrees of caval compression were satisfactorily decompressed by MCS. In patients not promptly treated, the disease progresses to cirrhosis, and such patients must be evaluated for transplantation similarly to those with other hepatopathies.

Differential effects on portal and effective hepatic blood flow. A comparison between transjugular intrahepatic portasystemic shunt and small-diameter H-graft portacaval shunt.

Rosemurgy, A S; Zervos, E E; Goode, S E; Black, T J; Zwiebel, B R
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/1997 EN
Relevância na Pesquisa
47.34%
OBJECTIVE: This study was undertaken to determine the effects of transjugular intrahepatic portasystemic shunt (TIPS) and small-diameter prosthetic H-graft portacaval shunt (HGPCS) on portal and effective hepatic blood flow. SUMMARY BACKGROUND DATA: Mortality after TIPS is higher than after HGPCS for bleeding varices. This higher mortality is because of hepatic failure, possibly a result of excessive diminution of hepatic blood flow. METHODS: Forty patients randomized prospectively to undergo TIPS or HGPCS had effective hepatic blood flow determined 1 day preshunt and 5 days postshunt using low-dose galactose clearance. Portal blood flow was determined using color-flow Doppler ultrasound. RESULTS: Treatment groups were similar in age, gender, and Child's class. Each procedure significantly reduced portal pressures and portasystemic pressure gradients. Portal flow after TIPS increased (21 mL/second +/- 11.9 to 31 mL/second +/- 16.9, p < 0.05), whereas it remained unchanged after HGPCS (26 mL/second +/- 27.7 to 14 mL/second +/- 41.1, p = n.s.). Effective hepatic blood flow was diminished significantly after TIPS (1684 mL/minute +/- 2161 to 676 mL/minute +/- 451, p < 0.05) and was unaffected by HGPCS (1901 mL/ minute +/- 1818 to 1662 mL/minute +/- 1035...

A prospective trial of transjugular intrahepatic portasystemic stent shunts versus small-diameter prosthetic H-graft portacaval shunts in the treatment of bleeding varices.

Rosemurgy, A S; Goode, S E; Zwiebel, B R; Black, T J; Brady, P G
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1996 EN
Relevância na Pesquisa
27.02%
OBJECTIVE: The authors compare transjugular intrahepatic portasystemic stent shunts (TIPS) to small-diameter prosthetic H-graft portacaval shunts (HGPCS). SUMMARY BACKGROUND DATA: Transjugular intrahepatic portasystemic stent shunts have been embraced as a first-line therapy in the treatment of bleeding varices due to portal hypertension, although they have not been compared to operatively placed shunts in a prospective trial. METHODS: In 1993, the authors began a prospective, randomized trial to compare TIPS with HGPCSs. All patients had bleeding varices and had failed nonoperative management. Shunting was undertaken as definitive therapy in all. Failure of shunting was defined as an inability to accomplish shunting despite repeated attempts, unexpected liver failure leading to transplantation, irreversible shunt occlusion, major variceal rehemorrhage, or death. Mortality and failure rates were analyzed at 30 days (early) and after 30 days (late) using Fischer's exact test. RESULTS: There were 35 patients in each group, with no difference in age, gender, Child's class, etiology of cirrhosis, urgency of shunting, or incidence of ascites or encephalopathy between groups. In two patients, TIPS could not be placed despite repeated attempts. Transjugular intrahepatic portasystemic stent shunts reduced portal pressures from 32 +/- 7.5 mmHg (standard deviation) to 25 +/- 7.5 mmHg (p < 0.01)...

"Síndrome pequeño para su tamaño", (small-for-size), como complicación de un trasplante hepático con donante vivo adulto relacionado

Yarur,Andrés; Castro,Lorena; Segovia,Roberto; Roblero,Juan Pablo; Uribe,Mario; Ferrario,Mario; Buckel,Erwin
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2009 ES
Relevância na Pesquisa
36.8%
Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the "small-for-size syndrome" one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.

Fibrosis Hepática congénita: un espectro clínico variable: Casos clínicos

Harris D,Paul; Fodor O,Daniel; Cavagnaro SM,Felipe; Egidio S,Marcia Di; Duarte G De C,Ignacio; Fava P,Mario
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2004 ES
Relevância na Pesquisa
26.95%
Background: Congenital hepatic fibrosis (CHF) is an autosomic dominant disease that has been associated with polycystic kidney disease. Aim: To describe the medical management of 5 children with CHF and to evaluate the presence and extension of the associated renal disease. Patients and methods: Retrospective review of the medical charts of 5 children with CHF, aged 2 to 14 years. Results: Three children presented autosomic recessive polycystic kidney disease, which was diagnosed before the appearance of liver disease manifestations. They presented a more severe liver damage, with a more aggressive clinical course requiring use of transjugular intrahepatic porto-systemic shunts (TIPS) or surgical porto-systemic shunts to control portal hypertension. The other two children, in whom the diagnosed was based on asymptomatic hepatomegaly, had normal renal function and structure with a more benign clinical course. Conclusions: The diagnosis of CHF should be suspected not only in children with polycystic kidney disease but in those children with persistent, hard consistency, left lobe predominance hepatomegaly (Rev Méd Chile 2004; 132: 733-41)