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  1. Portal Vein Thrombosis

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    Hakan Demirci

    2016-01-01

    Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low...

  2. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hakan Demirci

    2016-01-01

    Full Text Available Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low molecular weight heparin achieves recanalization in more than half of acute cases.

  3. Portal Vein Thrombosis

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    Ronny Cohen

    2015-01-01

    Full Text Available Portal vein thrombosis (PVT is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community.

  4. Congenital preduodenal portal vein

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    Lee, Sang Jin; Hwang, Mi Soo; Huh, Young Soo; Park, Bok Hwan [College of Medicine, Youngnam University, Gyeongsan (Korea, Republic of)

    1991-03-15

    Congenital preduodenal portal vein, first reported by Knight in 1921, is an extremely rare congenital anomaly in which the portal vein passes anteriorly to the duodenum rather than posteriorly in its normal location. It is of surgical significance because it may cause difficulties in operations involving the gall bladder, biliary duct, or duodenum. Recently, we experienced 2 cases of preduodenal portal vein. One was found during surgical exploration for the diagnosis and correction of malrotation of the bowels and the other in a 3 day-old male newborn associated with dextrocardia, situs inversus, and duodenal obstruction by diaphragm. We report these 2 cases with a review of the literature.

  5. Mortality after portal vein embolization

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    Lee, Eung Chang; Park, Sang-Jae; Han, Sung-Sik; Park, Hyeong Min; Lee, Seung Duk; Kim, Seong Hoon; Lee, In Joon; Kim, Hyun Beom

    2017-01-01

    Abstract Portal vein embolization (PVE) is increasingly performed worldwide to reduce the possibility of liver failure after extended hepatectomy, by inducing future liver remnant (FLR) hypertrophy and atrophy of the liver planned for resection. The procedure is known to be very safe and to have few procedure-related complications. In this study, we described 2 elderly patients with Bismuth–Corlette type IV Klatskin tumor who underwent right trisectional PVE involving the embolization of the right portal vein, the left medial sectional portal branch, and caudate portal vein. Within 1 week after PVE, patients went into sepsis combined with bile leak and died within 1 month. Sepsis can cause acute liver failure in patients with chronic liver disease. In this study, the common patient characteristics other than sepsis, that is, trisectional PVE; chronic alcoholism; aged >65 years; heart-related comorbidity; and elevated serum total bilirubin (TB) level (7.0 mg/dL) at the time of the PVE procedure in 1 patient, and concurrent biliary procedure, that is, percutaneous transhepatic biliary drainage in the other patient might have affected the outcomes of PVE. These cases highlight that PVE is not a safe procedure. Care should be taken to minimize the occurrence of infectious events because sepsis following PVE can cause acute liver failure. Additionally, prior to performing PVE, the extent of PVE, chronic alcohol consumption, age, comorbidity, long-lasting jaundice, concurrent biliary procedure, etc. should be considered for patient safety. PMID:28178122

  6. Portal vein thrombosis in children and adolescents.

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    Schettino, Graziela C M; Fagundes, Eleonora D T; Roquete, Mariza L V; Ferreira, Alexandre R; Penna, Francisco J

    2006-01-01

    To review the literature on portal vein thrombosis in children and adolescents, focusing on its diagnosis, complications and treatment. The medical literature of the past 10 years was reviewed using the PubMed and MEDLINE search engines, with major focus on portal vein thrombosis and its clinical outcomes. The following keywords or expressions were used for the web search: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Additionally, we also reviewed the articles cited in the references of the initially selected papers, as well as relevant textbooks. Portal vein thrombosis is one of the most common causes of portal hypertension among children. The initial clinical manifestation is characterized either by episodes of upper gastrointestinal bleeding or by splenomegaly on routine clinical examination. The major complications include upper gastrointestinal bleeding, hypersplenism secondary to splenomegaly, growth retardation, and portal biliopathy. The diagnosis is made by abdominal Doppler ultrasonography. Treatment is targeted at the complications and includes primary and secondary prophylaxis against upper gastrointestinal bleeding (which results from the rupture of esophageal varices), and portosystemic shunting in selected cases. Portal vein thrombosis is one of the major triggers of upper gastrointestinal bleeding in children. Bleeding episodes have a remarkable effect on the quality of life of affected patients. Thus, appropriate diagnosis and treatment are needed in order to reduce morbidity and mortality.

  7. Portal Vein Thrombosis in non cirrhotic patients

    NARCIS (Netherlands)

    M.C.W. Spaander (Manon)

    2010-01-01

    textabstractExtrahepatic portal vein thrombosis (EPVT) is the most common cause of portal hypertension in non- cirrhotic patients. EPVT has been defined as an obstruction of the extrahepatic portal vein with or without involvement of the intrahepatic portal veins. Although the portal vein accounts f

  8. Radiological aspects of portal vein embolization

    NARCIS (Netherlands)

    van Lienden, K.P.

    2012-01-01

    This thesis deals with liver regeneration after portal vein embolization (PVE) or portal vein ligation (PVL). Several aspects of these portal vein occlusion techniques are evaluated in clinical and experimental studies. In addition, the role of dynamic liver function tests and CT-volumetry in risk a

  9. Extrahepatic Portal Vein Obstruction and Portal Vein Thrombosis in Special Situations: Need for a New Classification

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    Wani, Zeeshan A.; Bhat, Riyaz A.; Bhadoria, Ajeet S.; Maiwall, Rakhi

    2015-01-01

    Extrahepatic portal vein obstruction is a vascular disorder of liver, which results in obstruction and cavernomatous transformation of portal vein with or without the involvement of intrahepatic portal vein, splenic vein, or superior mesenteric vein. Portal vein obstruction due to chronic liver disease, neoplasm, or postsurgery is a separate entity and is not the same as extrahepatic portal vein obstruction. Patients with extrahepatic portal vein obstruction are generally young and belong mostly to Asian countries. It is therefore very important to define portal vein thrombosis as acute or chronic from management point of view. Portal vein thrombosis in certain situations such as liver transplant and postsurgical/liver transplant period is an evolving area and needs extensive research. There is a need for a new classification, which includes all areas of the entity. In the current review, the most recent literature of extrahepatic portal vein obstruction is reviewed and summarized. PMID:26021771

  10. Extrahepatic portal vein obstruction and portal vein thrombosis in special situations: Need for a new classification

    Directory of Open Access Journals (Sweden)

    Zeeshan A Wani

    2015-01-01

    Full Text Available Extrahepatic portal vein obstruction is a vascular disorder of liver, which results in obstruction and cavernomatous transformation of portal vein with or without the involvement of intrahepatic portal vein, splenic vein, or superior mesenteric vein. Portal vein obstruction due to chronic liver disease, neoplasm, or postsurgery is a separate entity and is not the same as extrahepatic portal vein obstruction. Patients with extrahepatic portal vein obstruction are generally young and belong mostly to Asian countries. It is therefore very important to define portal vein thrombosis as acute or chronic from management point of view. Portal vein thrombosis in certain situations such as liver transplant and postsurgical/liver transplant period is an evolving area and needs extensive research. There is a need for a new classification, which includes all areas of the entity. In the current review, the most recent literature of extrahepatic portal vein obstruction is reviewed and summarized.

  11. Umbilical and portal vein calcification following umbilical vein catheterization

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    Schneider, K.; Fendel, H.; Hartl, M.

    1989-07-01

    Calcifications of the umbilical vein and intrahepatic branches of the portal vein developed in a newborn who had inserted an umbilical vein catheter for 11 days postnatally. The calcified intrahepatic portal veins can still be demonstrated sonographically at the age of three years, whereby these calcifications were no longer detectable radiologically. (orig.).

  12. Preduodenal portal vein: its surgical significance.

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    Makey, D A; Bowen, J C

    1978-11-01

    Preduodenal portal vein is a rare anatomical variant which may be one of many anomalies in the neonate with duodenal "atresia." Preduodenal portal vein also may be an occasional finding in an adult undergoing biliary, gastric, or pancreatic surgery. Awareness and recognition of the anomaly are essential for the avoidance of injury during such operations. We report here a symptomless patient whose preduodenal portal vein was discovered at cholecystectomy.

  13. PORTAL VEIN THROMBOSIS-ULTRASOUND IMAGING

    Directory of Open Access Journals (Sweden)

    Trajkovska Meri

    2016-07-01

    Full Text Available Portal venous system, apart from the main portal vein, includes its tributaries: superior and inferior mesenteric vein, as well as splenic vein, so the term portal venous thrombosis encompasses a broad spectrum of pathological conditions. Usually, one or more causative factors can be recognized, either local endothelial/ flow disturbances, or systemic inherited /acquired conditions. Portal vein thrombosis can be associated with benign or malignant disorders. Weather we are speaking about acute or chronic thrombosis, the clinical presentation is different. Acute thrombosis can be presented in a wide range, from mild abdominal discomfort to a state of intestinal ischemia and life-threatening infarction. Chronic thrombosis is usually recognized when variceal bleeding or other symptoms of portal hypertension express. Fast and accurate diagnosis sometimes is a life-saving procedure, especially in acute vascular alterations. Recently, due to the improvement of imaging procedures the number of patients with diagnosed portal vein thrombosis is increasingly growing. With a negative predictive value of 98% color Doppler ultrasound is considered as imaging modality of choice in detecting portal vein thrombosis. Based on large studies it is presumed that overall risk of getting portal vein thrombosis during lifetime is 1% in general population, but much bigger 5%-15% in cirrhotic patients. Existence of specific ultrasound criteria, if fulfilled, has ensured that diagnosis of portal vein thrombosis is fast and non-invasive. Procedure is convenient for the patient and healthcare providers, and above all, allows prompt treatment preventing further deterioration.

  14. Portal vein gas in emergency surgery

    Directory of Open Access Journals (Sweden)

    Mahmood Hind

    2008-07-01

    Full Text Available Abstract Background Portal vein gas is an ominous radiological sign, which indicates a serious gastrointestinal problem in the majority of patients. Many causes have been identified and the most important was bowel ischemia and mesenteric vascular accident. The presentation of patients is varied and the diagnosis of the underlying problem depends mainly on the radiological findings and clinical signs. The aim of this article is to show the clinical importance of portal vein gas and its management in emergency surgery. Methods A computerised search was made of the Medline for publications discussing portal vein gas through March 2008. Sixty articles were identified and selected for this review because of their relevance. These articles cover a period from 1975–2008. Results Two hundreds and seventy-five patients with gas in the portal venous system were reported. The commonest cause for portal vein gas was bowel ischemia and mesenteric vascular pathology (61.44%. This was followed by inflammation of the gastrointestinal tract (16.26%, obstruction and dilatation (9.03%, sepsis (6.6%, iatrogenic injury and trauma (3.01% and cancer (1.8%. Idiopathic portal vein gas was also reported (1.8%. Conclusion Portal vein gas is a diagnostic sign, which indicates a serious intra-abdominal pathology requiring emergency surgery in the majority of patients. Portal vein gas due to simple and benign cause can be treated conservatively. Correlation between clinical and diagnostic findings is important to set the management plan.

  15. Portal venous stent placement for treatment of portal hypertension caused by benign main portal vein stenosis

    Institute of Scientific and Technical Information of China (English)

    Hong Shan; Xiang-Sheng Xiao; Ming-Sheng Huang; Qiang Ouyang; Zai-Bo Jiang

    2005-01-01

    AIM: To evaluate the value of endovascular stent in the treatment of portal hypertension caused by benign main portal vein stenosis.METHODS: Portal vein stents were implanted in six patients with benign main portal vein stenosis (inflammatory stenosis in three cases, postprocedure of liver transplantation in another three cases). Changes in portal vein pressure, portal vein patency, relative clinical symptoms, complications, and survival were evaluated.RESULTS: Six metallic stents were successfully placed across the portal vein stenotic or obstructive lesions in six patients. Mean portal venous pressure decreased significantly after stent implantation from (37.3±4.7) cm H2O to (18.0±1.9) cm H2O. The portal blood flow restoredand the symptoms caused by portal hypertension were eliminated. There were no severe procedure-related complications. The patients were followed up for 1-48 mo. The portal vein remained patent during follow-up. All patients survived except for one patient who died of other complications of liver transplantation. CONCLUSION: Percutaneous portal vein stent placement for the treatment of portal hypertension caused by benign main portal vein stenosis is safe and effective.

  16. Portal Decompression Using the Inferior Mesenteric Vein

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    Paolo Gorini

    1998-01-01

    Full Text Available We report five patients with variceal hemorrhage, in three cases secondary to diffuse thrombosis of the portal, superior mesenteric and splenic veins. Mesenteric angiography demonstrated patency of the inferior mesenteric vein (IMV in each, and successful portal decompression by anastomosis of the IMV to the left renal vein (n=4 or the inferior vena cava (n=1 was accomplished. Bleeding was permanently controlled: four patients have survived from one to eight years post-operatively. Because shunt procedures utilizing the IMV are technically straightforward, subtotally decompress the portal system and avoid the right upper quadrant, they may be advantageous in certain clinical settings.

  17. Diacylglycerol oil does not affect portal vein transport of nonesterified fatty acids but decreases the postprandial plasma lipid response in catheterized Pigs

    DEFF Research Database (Denmark)

    Kristensen, Janni Brogaard; Jørgensen, Henry; Mu, Huiling

    2006-01-01

    Studies have shown several beneficial effects of dietary diacylglycerol oil (DAG oil), but the mechanism behind these effects is still not clear. One hypothesis is that an increase in portal vein transport of nonesterified fatty acids (NEFA) with subsequent oxidation in the liver might...... on postprandial lipid variables was examined. Portal vein transport of NEFA did not differ when pigs were administered the 2 oil bolus diets, consistent with the similar portal plasma concentrations of oleic and linolenic acids during h 1 after feeding. Glycerol, on the contrary, was transported by the portal...... be responsible for the positive effects. We examined the portal vein transport of NEFA and other lipid related variables, in response to DAG and triacylglycerol (TAG) bolus feeding and a bolus of standard pig feed in 4 portal vein and mesenteric artery catheterized pigs. Also, the effect of the boluses...

  18. Portal vein thrombosis in patients with cirrhosis

    DEFF Research Database (Denmark)

    von Köckritz, Leona; De Gottardi, Andrea; Trebicka, Jonel

    2017-01-01

    Portal vein thrombosis (PVT) is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare, but can be life-threatening. However, different aspects of clinical relevance, diagnosis and management of PVT are still areas of uncertainty and inves......Portal vein thrombosis (PVT) is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare, but can be life-threatening. However, different aspects of clinical relevance, diagnosis and management of PVT are still areas of uncertainty...

  19. Tumoural portal vein thrombosis. Enhancement with MnDPDP

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    Marti-Bonmati, L. [Dept. of Radiology, MR Unit, Dr. Peset Hospital, Valencia (Spain); Lonjedo, E. [Dept. of Radiology, MR Unit, Dr. Peset Hospital, Valencia (Spain); Mathieu, D. [Dept. of Radiology, Henri Mondor Hospital, Paris Univ., Creteil (France); Coffin, C. [Dept. of Radiology, Henri Mondor Hospital, Paris Univ., Creteil (France); Poyatos, C. [Dept. of Radiology, MR Unit, Dr. Peset Hospital, Valencia (Spain); Anglade, M.C. [Dept. of Radiology, Henri Mondor Hospital, Paris Univ., Creteil (France)

    1997-07-01

    Purpose: Intrahepatic thrombus is usually associated with either cirrhosis or hepatocellular carcinoma (HCC). Most HCCs enhance after the administration of MnDPDP (Teslascan). Our objective was to analyze the enhancement characteristics of tumour portal vein thrombi. Material and Methods: Thrombi affecting the main or segmental portal veins (17 cases) and the suprahepatic inferior vena cava (1 case) were retrospectively selected from a series of 128 patients studied with MR imaging before and after the administration of MnDPDP. Enhancement was assessed qualitatively and quantitatively. Results: All tumour thrombi enhanced after MnDPDP administration. The enhancement was more conspicuous in the GRE images. On the quantitative evaluation, the portal thrombus enhancement was greater for GRE images than SE images. Portal thrombi enhanced more than the liver and the HCCs. There was a significant difference between the enhancement of the HCCs and the thrombi with both MR imaging techniques. (orig./AJ).

  20. Diacylglycerol oil does not affect portal vein transport of nonesterified fatty acids but decreases the postprandial plasma lipid response in catheterized Pigs

    DEFF Research Database (Denmark)

    Kristensen, Janni Brogaard; Jørgensen, Henry; Mu, Huiling

    2006-01-01

    Studies have shown several beneficial effects of dietary diacylglycerol oil (DAG oil), but the mechanism behind these effects is still not clear. One hypothesis is that an increase in portal vein transport of nonesterified fatty acids (NEFA) with subsequent oxidation in the liver might be respons......Studies have shown several beneficial effects of dietary diacylglycerol oil (DAG oil), but the mechanism behind these effects is still not clear. One hypothesis is that an increase in portal vein transport of nonesterified fatty acids (NEFA) with subsequent oxidation in the liver might...... be responsible for the positive effects. We examined the portal vein transport of NEFA and other lipid related variables, in response to DAG and triacylglycerol (TAG) bolus feeding and a bolus of standard pig feed in 4 portal vein and mesenteric artery catheterized pigs. Also, the effect of the boluses...... on postprandial lipid variables was examined. Portal vein transport of NEFA did not differ when pigs were administered the 2 oil bolus diets, consistent with the similar portal plasma concentrations of oleic and linolenic acids during h 1 after feeding. Glycerol, on the contrary, was transported by the portal...

  1. [FEATURES LIVER TRANSPLANTATION IN PORTAL VEIN THROMBOSIS].

    Science.gov (United States)

    Abbasov, P A

    2015-07-01

    In 2012 - 2013 years in 265 patients for liver transplantation was performed, including in 224 (84.5%)--from a living donor, in 41 (15.5%)--from the dead body. Using a Foley catheter to stop bleeding, and the imposition of vascular sutures during endovenectomy in portal vein thrombosis (PVT) and its possible damage under all conditions. In particular, PVT IV degree (Grade IV) in order to restore blood flow in the graft using the left gastric and renal vein is an alternative, if they are cryopreserved vein may be suitably used.

  2. Portal vein thrombosis with renal cell carcinoma: a case report.

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    D'Elia, Carolina; Cerruto, Maria Angela; Molinari, Alberto; Piovesan, Raffaella; Cavicchioli, Francesca; Minja, Anila; Novella, Giovanni; Artibani, Walter

    2014-01-01

    Portal vein thrombosis refers to an obstruction of blood flow in the portal vein; this rare disease can be both local and systemic. Local risk factors, accounting for about 70% of cases, can be abdominal cancers, inflammatory of infective diseases, surgical procedures or cirrhosis. A 62-year-old man, affected by hypertension and taking acetylsalicylic acid after a myocardial infarction in 1994, developed deep venous thrombosis on the right leg. Six months later the patient was admitted to the emergency unit due to abdominal pain. A CT scan revealed the presence of a complete splanchnic vein thrombosis and a primary tumor on the right kidney. The patient was treated with total parenteral nutrition and intravenous solution of heparin sodium first and then, because of occurrence of allergy, fondaparinux, with improvement of the abdominal pain. Subsequently he underwent right radical nephrectomy.

  3. Portal vein thrombosis related to Cassia angustifolia.

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    Soyuncu, Secgin; Cete, Yildiray; Nokay, Ali E

    2008-09-01

    Cassia angustifolia (Senna), used as a laxative, is a plant from the Fabaceae family. It includes hydroxyanthracene glycosides, also known as Senna Sennoside. These glycosides stimulate the peristalsis of the colon and alter colonic absorption and secretion resulting in fluid accumulation and expulsion. In the literature, there are reports illustrating the hepatotoxic effects of Cassia angustifolia but there is no report of portal vein thrombosis caused by Cassia Angustifolia. A 42-year-old woman was admitted to the emergency department with a five-day history of worsening epigastric pain, anorexia, episodic vomiting, and intermittent fever. She reported that she had boiled dried senna leaves she had bought from herbalists and drank approximately 200 mL daily for two years. Color Doppler screening found an echogen thrombus obliterating portal vein bifurcation and the right branch. The lumen was obstructed at this level and there was no blood flow through it. Treatment with thrombolytics was unsuccessful. Severe hepatotoxicity senna use is unusual. The cause of senna-related hepatotoxicity is unclear but could be explained by the exposure of the liver to unusual amounts of toxic metabolites of anthraquinone glycosides. Chronic use of Cassia angustifolia may rarely be associated with portal vein thrombosis.

  4. Computed tomographic evaluation of the portal vein in the hepatomas

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    Lee, Kee Hyung; Lee, Seung Chul; Bae, Man Gil; Seo, Heung Suk; Kim, Soon Yong; Lee, Min Ho; Kee, Choon Suhk; Park, Kyung Nam [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1986-10-15

    Computed tomography and pornographic findings of 63 patients with hepatoma, undergone hepatic angiography and superior mesenteric pornography for evaluation of tumor and thrombosis of portal vein and determination of indication of transcatheter arterial embolization for palliative treatment of hepatoma from April, 85 to June, 86 in Hanyang university hospital, were reviewed. The results were as follows: 1. In 36 cases, portal vein thrombosis was detected during photography. Nineteen of 37 cases which revealed localized hepatoma in the right lobe of the liver showed portal vein thrombosis; 9 of 11 cases of the left lobe; 8 of 14 cases which were involved in entire liver revealed thrombosis. One case localized in the caudate lobe showed no evidence of invasion to portal vein. 2. Twenty-four of 34 cases with diffuse infiltrative hepatoma revealed portal vein thrombosis and the incidence of portal vein thrombosis in this type were higher than in the cases of the nodular type. 3. The portal vein thrombosis appeared as filling defects of low density in the lumen of the portal veins in CT and they did not reveal contrast enhancement. 4. CT revealed well the evidence of obstructions in the cases of portal vein thrombosis and the findings were well-corresponded to the findings of the superior mesenteric photography. 5. Five of the cases of the portal vein thrombosis were missed in the CT and the causes were considered as due to partial volume effect of enhanced portal vein with partial occlusion or arterioportal shunts. 6. Six of 13 cases with occlusion of main portal vein showed cavernous transformation and they were noted as multiple small enhanced vascularities around the porta hepatis in the CT. According to the results, we conclude that CT is a useful modality to detect the changes of the portal veins in the patients of the hepatoma.

  5. CT Findings of Completely Regressed Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis after Transcatheter Arterial Chemoembolization

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    Yoon, Jeong Hee; Kim, Hyo Cheol; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Yoon, Jung Hwan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The objective of this study was to determine the sequential CT findings of controlled hepatocellular carcinoma (HCC) with main portal vein (MPV) thrombosis with the use of transcatheter arterial chemoembolization and additional intra-arterial cisplatin infusion. From January 2004 to September 2006, 138 patients with HCC invading MPV were referred to the angiography unit of our institution for chemoembolization and additional intra-arterial cisplatin infusion. Until August 2008, seven (5%) of 138 patients were followed-up and found not to have tumor recurrence. CT scans were retrospectively reviewed by two radiologists, focusing on the following parameters: the extent of portal vein thrombosis, the diameter of the affected portal vein, and enhancement of portal vein thrombosis. The extent of portal vein thrombosis at the initial presentation was variable: left portal vein (LPV) and MPV (n = 1), right portal vein (RPV) and MPV (n = 3), as well as RPV, LPV and MPV (n = 3). The extent and diameter of the affected portal vein decreased during follow-up examinations. In addition, the degree of enhancement for tumor thrombi and serum alpha-feto-protein levels decreased after the transcatheter arterial chemoembolization. Portal vein thrombosis was found to be completely resolved in one patient, whereas residual thrombus without viability was persistent in six patients. If chemoembolization is effective in patients with HCC that invades the portal vein, the extent and enhancement of portal vein thrombosis is reduced, but residual thrombosis frequently persists for months or years, without evidence of a viable tumor.

  6. Portal vein arterialization increases hepatocellular apoptosis and inhibits liver regeneration.

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    Schleimer, Karina; Stippel, Dirk L; Kasper, Hans U; Prenzel, Klaus; Gaudig, Cindy; Tawadros, Samir; Hoelscher, Arnulf H; Beckurts, K Tobias E

    2008-10-01

    Portal vein arterialization is performed in particular situations to guarantee sufficient blood flow in the portal vein. In addition, some authors have postulated a proliferation-promoting influence of portal vein arterialization on the liver tissue. However, portal vein arterialization is an unphysiological procedure: It increases portal blood flow and blood pressure as well as oxygenation of the liver tissue. On the other hand, it reduces the influx of hepatotrophic factors from the portal venous blood. The aim of these experiments was to investigate apoptosis and proliferation of hepatocytes during various conditions of the portal perfusion. After 70% liver resection in Lewis rats, the following four experimental groups were formed differing in portal perfusion: (I) hyperperfused, nonarterialized; (II) flow-regulated, nonarterialized; (III) hyperperfused, arterialized; (IV) flow-regulated, arterialized. A warm ischemia of 30 min was kept in all groups. Portal vein arterialization of 70% reduced rat livers significantly reduced liver regeneration as shown by a significant reduction in liver weight, body weight, and liver function after 6 wk, in contrast to the group with 70% liver mass reduction and portal venous inflow of the portal vein. Furthermore, we found a significantly elevated number of apoptotic hepatocytes after portal vein arterialization. These results were independent from blood flow regulation of the arterialized portal vein, which caused no improvement of the results. Portal vein arterialization should be performed only temporarily and is clinically not recommended as a permanent option, because of the increased hepatocellular apoptosis and the very distinctive, negative long-term effects on liver weight.

  7. Disastrous Portal Vein Embolization Turned into a Successful Intervention

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    Dobrocky, Tomas, E-mail: tomas.dobrocky@insel.ch [University of Bern, Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University Hospital (Switzerland); Kettenbach, Joachim, E-mail: joachim.kettenbach@stpoelten.lknoe.at [Universitätsklinikum St. Pölten-Lilienfeld, Institute of Medical Radiology, Diagnostic, Intervention (Austria); Lopez-Benitez, Ruben, E-mail: Ruben.lopez@insel.ch; Kara, Levent, E-mail: levent.kara@insel.ch [University of Bern, Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University Hospital (Switzerland)

    2015-10-15

    Portal vein embolization (PVE) may be performed before hemihepatectomy to increase the volume of future liver remnant (FLR) and to reduce the risk of postoperative liver insufficiency. We report the case of a 71-year-old patient with hilar cholangiocarcinoma undergoing PVE with access from the right portal vein using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil. During the procedure, nontarget embolization of the left portal vein occurred. An aspiration maneuver of the polymerized plug failed; however, the embolus obstructing portal venous flow in the FLR was successfully relocated into the right portal vein while carefully bypassing the plug with a balloon catheter, inflating the balloon, and pulling the plug into the main right portal vein.

  8. Portal vein embolization induces compensatory hypertrophy of remnant liver

    Institute of Scientific and Technical Information of China (English)

    Jing-Yao Huang; Wei-Zhu Yang; Jian-Jun Li; Na Jiang; Qu-Bin Zheng

    2006-01-01

    AIM: To evaluate the effectiveness and safety of different portal vein branch embolization agents in inducing compensatory hypertrophy of the remnant liver and to offer a theoretic basis for clinical portal vein branch embolization.METHODS: Forty-one adult dogs were included in the experiment and divided into four groups. Five dogs served as a control group, 12 as a gelfoam group, 12as a coil-gelfoam group and 12 as an absolute ethanol group. Left portal vein embolization was performed in each group. The results from the embolization in each group using different embolic agents were compared.The safety of portal vein embolization (PVE) was evaluated by liver function test, computed tomography (CT) and digital subtraction angiography (DSA) of liver and portal veins. Statistical test of variance was performed to analyze the results.RESULTS: Gelfoam used for PVE was inefficient in recanalization of portal vein branch 4 wk after the procedure. The liver volume in groups of coil-gelfoam and absolute ethanol increased 25.1% and 33.18%,respectively. There was no evidence of recanalization of embolized portal vein, hepatic dysfunction, and portal hypertension in coil-gelfoam group and absolute ethanol group.CONCOUSION: Portal vein branch embolization using absolute ethanol and coil-gelfoam could induce atrophy of the embolized lobes and compensatory hypertrophy of the remnant liver. Gelfoam is an inefficient agent.

  9. Endovascular management for significant iatrogenic portal vein bleeding.

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    Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

    2017-01-01

    Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

  10. [Portal perfusion with right gastroepiploic vein flow in liver transplant].

    Science.gov (United States)

    Mendoza-Sánchez, Federico; Javier-Haro, Francisco; Mendoza-Medina, Diego Federico; González-Ojeda, Alejandro; Cortés-Lares, José Antonio; Fuentes-Orozco, Clotilde

    Liver transplantation in patients with liver cirrhosis, portal vein thrombosis, and cavernous transformation of the portal vein, is a complex procedure with high possibility of liver graft dysfunction. It is performed in 2-19% of all liver transplants, and has a significantly high mortality rate in the post-operative period. Other procedures to maintain portal perfusion have been described, however there are no reports of liver graft perfusion using right gastroepiploic vein. A 20 year-old female diagnosed with cryptogenic cirrhosis, with a Child-Pugh score of 7 points (class "B"), and MELD score of 14 points, with thrombosis and cavernous transformation of the portal vein, severe portal hypertension, splenomegaly, a history of upper gastrointestinal bleeding due to oesophageal varices, and left renal agenesis. The preoperative evaluation for liver transplantation was completed, and the right gastroepiploic vein of 1-cm diameter was observed draining to the infrahepatic inferior vena cava and right suprarenal vein. An orthotopic liver transplantation was performed from a non-living donor (deceased on January 30, 2005) using the Piggy-Back technique. Portal vein perfusion was maintained using the right gastroepiploic vein, and the outcome was satisfactory. The patient was discharged 13 days after surgery. Liver transplantation was performed satisfactorily, obtaining an acceptable outcome. In this case, the portal perfusion had adequate blood flow through the right gastroepiploic vein. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  11. Velocity Estimation of the Main Portal Vein with Transverse Oscillation

    DEFF Research Database (Denmark)

    Brandt, Andreas Hjelm; Hansen, Kristoffer Lindskov; Nielsen, Michael Bachmann

    2015-01-01

    This study evaluates if Transverse Oscillation (TO) can provide reliable and accurate peak velocity estimates of blood flow the main portal vein. TO was evaluated against the recommended and most widely used technique for portal flow estimation, Spectral Doppler Ultrasound (SDU). The main portal...

  12. Velocity Estimation of the Main Portal Vein with Transverse Oscillation

    DEFF Research Database (Denmark)

    Brandt, Andreas Hjelm; Hansen, Kristoffer Lindskov; Nielsen, Michael Bachmann;

    2015-01-01

    This study evaluates if Transverse Oscillation (TO) can provide reliable and accurate peak velocity estimates of blood flow the main portal vein. TO was evaluated against the recommended and most widely used technique for portal flow estimation, Spectral Doppler Ultrasound (SDU). The main portal ...

  13. Portal venous arterialization resulting in increased portal inflow and portal vein wall thickness in rats

    Institute of Scientific and Technical Information of China (English)

    Wen-Gang Li; Yong-Liang Chen; Jing-Xi Chen; Lei Qu; Bin-Dang Xue; Zhi-Hai Peng; Zhi-Qiang Huang

    2008-01-01

    AIM:To explore the influence of portal vein hemodynamic changes after portal venous arterialization(PVA) on peribiliary vascular plexus (PVP)morphological structure and hepatic pathology,and to establish a theoretical basis for the clinical application of PVA.METHODS:Sprague-Dawley rats were randomly divided into control and PVA groups.After PVA,hemodynamic changes of the portal vein and morphological structure of hepatohilar PVP were observed using Doppler ultrasound,liver function tests,ink perfusion transparency management and three-dimensional reconstruction of computer microvisualization,and pathological examination was performed on tissue from the bile duct wall and the liver.RESULTS:After PVA,the cross-sectional area and blood flow of the portal vein were increased,and the increase became more significant over time,in a certain range.If the measure to limit the flow in PVA was not adopted,the high blood flow would lead to dilatation of intrahepatic portal vein and its branches,increase in collagen and fiber degeneration in tunica intima.Except glutamic pyruvic transaminase (GPT),other liver function tests were normal.CONCLUSION:Blood with a certain flow and oxygen content is important for filling the PVP and meeting the oxygen requirement of the bile duct wall.After PVA,It is the anatomic basis to maintain normal morphology of hepatohilar bile duct wall that the blood with high oxygen content and high flow in arterialized portal vein may fill PVP by collateral vessel reflux.A adequate measure to limit blood flow is necessary in PVA.

  14. A RARE CASE OF EXTENSIVE THROMBOSIS OF INFERIOR VENA CAVA, PORTAL VEIN, SPLENIC VEIN AND SUPERIOR MESENTRIC VEIN

    Directory of Open Access Journals (Sweden)

    Giridhar

    2015-03-01

    Full Text Available While the most common presentation of venous thromboembolic disease is deep vein thrombosis (DVT or pulmonary thromboembolism, rarer manifestations are thrombosis of jugular vein, cerebral sinus and inferior vena cava. Here we are presenting a rare case of inferior vena caval thrombosis with multiple thrombus in portal vein, splenic vein and superior mesenteric vein

  15. Propranolol for portal hypertension. Evaluation of therapeutic response by direct measurement of portal vein pressure.

    Science.gov (United States)

    Rector, W G

    1985-04-01

    Portal vein pressure was measured before and after a week of oral propranolol hydrochloride therapy in 27 patients with alcoholic liver disease. Mean net portal pressure fell (14.5 +/- 3.3 to 12.5 +/- 4.5 mm Hg), but there was wide variation in individual response to the drug. Simultaneous transhepatic portal vein pressure and wedged hepatic vein pressure were similar before and one hour after a single oral dose of 40 mg of propranolol hydrochloride in six additional patients. Arterial, portal, and hepatic vein oxygen content did not change significantly. Propranolol hydrochloride appears not to dissociate portal and wedged hepatic vein pressure or to impair liver oxygenation. Because of variability of response, the portal hypotensive effect of propranolol should be documented before beginning therapy with the drug.

  16. Portal vein embolization before major hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Hai Liu; Yong Fu

    2005-01-01

    To discuss the rationale, techniques and the unsolved issues regarding preoperative portal vein embolization (PVE) before major hepatectomy. After a systematic search of Pubmed, we reviewed and retrieved literature related to PVE. Preoperative PVE is an approach that is gaining increasing acceptance in the preoperative treatment of selected patients prior to major hepatic resection. Induction of selective hypertrophy of the nondiseased portion of the liver with PVE in patients with either primary or secondary hepatobiliary, malignancy with small estimated future liver remnants (FLR) may result in fewer complications and shorter hospital stays following resection. Additionally, PVE performed in patients initially considered unsuitable for resection due to lack of sufficient remaining normal parenchyma may add to the pool of candidates for surgical treatment. The results suggest that PVE is recomm-endable in treating the cirrhotic patients before major liver resection.

  17. Pancreatic portal cavernoma in patients with cavernous transformation of the portal vein: MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Vilgrain, Valerie [Universite Paris 7 Denis Diderot, Paris (France); AP-HP, Hopital Beaujon, Department of Radiology, Clichy (France); INSERM, Centre de recherche Biomedicale Bichat-beaujon, CRB3, Paris (France); Hopital Beaujon, Department of Radiology, Paris (France); Condat, Bertrand; Plessier, Aurelie [AP-HP, Hopital Beaujon, Department of Gastroenterology, Clichy (France); O' Toole, Dermot [Centre de reference des maladies vasculaires du foie, AP-HP, Hopital Beaujon, Department of Hepatology, PMAD, Clichy (France); Ruszniewski, Philippe [Universite Paris 7 Denis Diderot, Paris (France); INSERM, Centre de recherche Biomedicale Bichat-beaujon, CRB3, Paris (France); Centre de reference des maladies vasculaires du foie, AP-HP, Hopital Beaujon, Department of Hepatology, PMAD, Clichy (France); Valla, Dominique C. [Universite Paris 7 Denis Diderot, Paris (France); INSERM, Centre de recherche Biomedicale Bichat-beaujon, CRB3, Paris (France); AP-HP, Hopital Beaujon, Department of Gastroenterology, Clichy (France)

    2009-11-15

    The purpose of the article was to prospectively evaluate the MR findings of pancreatic portal cavernoma in a consecutive series of patients with cavernous transformation of the portal vein. This study was approved by the review board of our institution, and informed consent was obtained. The clinical and biological data and the MR imaging for 20 patients (11 female, 9 male; median age, 49 years) with cavernous transformation of the portal vein and no evidence of previous pancreatic disease were reviewed. The presence of pancreatic portal cavernoma (defined as intra- and/or peripancreatic portal cavernoma), morphological changes in the pancreas, biliary and ductal pancreatic abnormalities, and extension of the portal venous thrombosis were qualitatively assessed. Fifteen patients (75%) had pancreatic portal cavernoma with collateral formation in the pancreas and/or collaterals around the pancreas seen on dynamic contrast-enhanced MR sequences: three patients had both intra- and peripancreatic portal cavernoma, six had intrapancreatic portal cavernoma alone and six had peripancreatic portal cavernoma only. The presence of intra- or peripancreatic portal cavernoma was significantly associated with extension of the thrombosis to the splenic and superior mesenteric veins (p = 0.05). Morphological changes in the pancreas, heterogeneity on T2-weighted sequences and main ductal pancreatic abnormalities were seen in two, four and two patients, respectively. All these patients had intrapancreatic portal cavernoma. Bile duct dilatation was observed in 13 (65%) patients: among them three had extrahepatic dilatation only and these three patients had associated intrapancreatic portal cavernoma. In patients with cavernous transformation of the portal vein, intra- or peripancreatic portal cavernoma is common. In conclusion, intra- or peripancreatic portal cavernoma was only observed in patients with extension of the thrombosis to the splenic vein and/or the superior mesenteric

  18. Giant Intrahepatic Portal Vein Aneurysm: Leave it or Treat it?

    Science.gov (United States)

    Shrivastava, Amit; Rampal, Jagdeesh S; Nageshwar Reddy, D

    2017-03-01

    Portal vein aneurysm (PVA) is a rare vascular dilatation of the portal vein. It is a rare vascular anomaly representing less than 3% of all visceral aneurysms and is not well understood. Usually, PVA are incidental findings, are asymptomatic, and clinical symptoms are proportionally related to size. Patients present with nonspecific epigastric pain or gastrointestinal bleeding with underlying portal hypertension. PVA may be associated with various complications such as biliary tract compression, portal vein thrombosis/rupture, duodenal compression, gastrointestinal bleeding, and inferior vena cava obstruction. Differential diagnoses of portal vein aneurysms are solid, cystic, and hypervascular abdominal masses, and it is important that the radiologists be aware of their multi-modality appearance; hence, the aim of this article was to provide an overview of the available literature to better simplify various aspects of this rare entity and diagnostic appearance on different modality with available treatment options. In our case, a 55-year-old male patient came to the gastroenterology OPD for further management of pancreatitis with portal hypertension and biliary obstruction with plastic stents in CBD and PD for the same. In this article, we have reported a case of largest intrahepatic portal vein aneurysm and its management by endovascular technique. As per our knowledge, this is the largest intrahepatic portal vein aneurysm and first case where the endovascular technique was used for the treatment of the same.

  19. Duodenal obstruction due to a preduodenal portal vein

    Directory of Open Access Journals (Sweden)

    MNC Vilakazi

    2014-01-01

    Full Text Available An infant presented with clinical signs and symptoms suggestive of a pyloric stenosis. On abdominal ultrasound, pyloric stenosis was excluded, and other causes for proximal duodenal obstruction, such as a duodenal web or annular pancreas, were suspected. At surgery, the cause was found to be due to an anterior portal vein or preduodenal portal vein, compressing the duodenum. There were no associated findings such as midgut malrotation, duodenal web and congenital anomalies. The treatment was a diamond-shaped duodeno-duodenostomy anterior to the portal vein. The patient improved after surgery.

  20. Correlation between contrast enhancement of portal vein and spleen size in dual-phase spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Seung Eon; Choi, Jong Cheol; Nam, Kyung Jin; Jung, Won Jung; Goo, Bong Sik; Park, Byung Ho; Lee, Young Ii; Chung, Duck Hwan [Donga Univ. College of Medicine, Pusan (Korea, Republic of)

    1996-10-01

    To evaluate using spiral CT the effect of spleen size on blood flow in the portal venous system and to know the usefulness of this evaluation. Fifty-one patients without evidence on spiral CT scan of abnormality thought to affect portal venous flow presented between December 1994 and June 1995. We measured spleen size and Hounsfield units of portal vein in dual-phase, and calculated the ratio of the unit in the portal phase to that in the arterial phase. Spleen size was measured, using the length of X-axis by that of Z-axis on spiral CT scan. We then measured the correlation between the two values. CT was performed with a Somatom Plus-S scanner(Siemens, Erlangen, Germany). A total dose of 120ml of non-ionic contrast material(Ultravist) was administered at a rate of 3 ml/sec. Arterial and portal phase were obtained after 30 seconds and 60 seconds from the begining of the contrast agent injection. The correlation between spleen size and contrast enhancement of the portal vein was relatively significant(Pearson's correlation coefficient(r)=0.41801). Spleen size significantly affects portal venous flow on spiral CT scan. The evaluation of spleen size and contrast enhancement of the portal vein could be useful in the differential diagnosis of diseases which affect portal venous flow.

  1. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    Directory of Open Access Journals (Sweden)

    G Raghavendra Prasad

    2013-01-01

    Full Text Available Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric - inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.

  2. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

    Science.gov (United States)

    Tang, Jianlin; Abbas, Jihad; Hoetzl, Katherine; Allison, David; Osman, Mahamed; Williams, Mallory; Zelenock, Gerald B.

    2014-01-01

    62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improved significantly, SMV collateral circulation was diminished. Pancreaticoduodenectomy (PD) and superior mesenteric portal vein (SMPV) confluence resection were performed; A saphenous vein interposition graft thrombosed immediately. The splenic vein remnant was distended and adjacent to the stump of the portal vein. Harvesting an internal jugular vein graft required extra time and using a synthetic graft posed a risk of graft thrombosis or infection. As a result, we chose to perform a direct anastomosis of the portal and splenic vein in a desperate situation. The anastomosis decompressed the mesenteric venous system, so we then ligated the SMV. The patient had an uneventful postoperative course, except transient ascites. She redeveloped ascites more than one year later. At that time a PET scan showed bilateral lung and right femur metastatic disease. She expired 15 months after PD. Conclusion The lessons we learned are (1) Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2) Synthetic graft is an alternative for internal jugular vein graft. (3) Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4) It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival. PMID:25568802

  3. Chylous ascites caused by acute pancreatitis with portal vein thrombosis

    OpenAIRE

    Park, Dong Eun; Chae, Kwon Mook

    2011-01-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also rev...

  4. [Treatment of nontumoral portal vein thrombosis in cirrhosis].

    Science.gov (United States)

    Bañares, Rafael; Catalina, María-Vega

    2014-07-01

    Portal vein thrombosis in cirrhosis is a relatively common complication associated with the presence of an accompanying prothrombotic phenotype of advanced cirrhosis. The consequences of portal vein thrombosis are relevant because it can be associated with impaired hepatic function, might contraindicate hepatic transplantation and could increase morbidity in the surgical procedure. There is controversy concerning the most effective treatment of portal vein thrombosis, which is based on information that is seldom robust and whose primary objective is to achieve a return to vessel patency. Various studies have suggested that starting anticoagulation therapy early is associated with portal vein repatency more frequently than without treatment and has a low rate of complications. There are no proven data on the type of anticoagulant (low-molecular-weight heparins or dicoumarin agents) and the treatment duration. The implementation of TIPS is technically feasible in thrombosis without cavernous transformation and is associated with portal vein recanalization in a significant proportion of cases. Thrombolytic therapy does not appear to present an adequate balance between efficacy and safety; its use is therefore not supported for this indication. The proper definition of treatment for portal vein thrombosis requires properly designed studies to delimit the efficacy and safety of the various alternatives.

  5. Portal vein embolization for hepatocellular carcinoma.

    Science.gov (United States)

    Shindoh, Junichi; D Tzeng, Ching-Wei; Vauthey, Jean-Nicolas

    2012-11-01

    Portal vein embolization (PVE) improves the safety of major hepatectomy through hypertrophy of the future liver remnant (FLR), atrophy of the liver volume to be resected, and improvement in patient selection. Because most patients with hepatocellular carcinoma (HCC) have liver parenchymal injury due to underlying viral hepatitis or alcoholic liver fibrosis/cirrhosis, indication of PVE is relatively complex and sequential procedures, including transarterial chemoembolization, are required to maximize the effect of PVE as well as to minimize tumor progression due to increased arterial flow after PVE. PVE is currently indicated for patients with relatively well-preserved hepatic function [Child-Pugh A and indocyanine green tolerance test (ICG-R15) 40% is the minimal requirement for patients with chronic hepatitis or cirrhosis, and further strict criteria (FLR volume >50%) have been recommended for patients with marginal liver functional reserve (ICG-R15, 10-20%). Recent clinical results have suggested that PVE can be safely performed in patients with HCC and that it contributes to improved survival after major hepatectomy.

  6. Rational classification of portal vein thrombosis and its clinical significance.

    Directory of Open Access Journals (Sweden)

    Jingqin Ma

    Full Text Available Portal vein thrombosis (PVT is commonly classified into acute (symptom duration <60 days and absence of portal carvernoma and portal hypertension and chronic types. However, the rationality of this classification has received little attention. In this study, 60 patients (40 men and 20 women with PVT were examined using contrast-enhanced computed tomography (CT. The percentage of vein occlusion, including portal vein (PV and superior mesenteric vein (SMV, was measured on CT image. Of 60 patients, 17 (28.3% met the criterion of acute PVT. Symptoms occurred more frequently in patients with superior mesenteric vein thrombosis (SMVT compared to those without SMVT (p<0.001. However, there was no significant difference in PV occlusion between patients with and without symptoms. The frequency of cavernous transformation was significantly higher in patients with complete PVT than those with partial PVT (p<0.001. Complications of portal hypertension were significantly associated with cirrhosis (p<0.001 rather than with the severity of PVT and presence of cavernoma. These results suggest that the severity of PVT is only associated with the formation of portal cavernoma but unrelated to the onset of symptoms and the development of portal hypertension. We classified PVT into complete and partial types, and each was subclassified into with and without portal cavernoma. In conclusion, neither symptom duration nor cavernous transformation can clearly distinguish between acute and chronic PVT. The new classification system can determine the pathological alterations of PVT, patency of portal vein and outcome of treatment in a longitudinal study.

  7. CAVERNOUS TRANSFORMATION OF PORTAL VEIN : A RARE ANATOMIC DEVELOPMENT WITH EMPHASIS ON ANATOMY AND PHYSIOLOGY OF PORTAL BLOOD FLOW

    Directory of Open Access Journals (Sweden)

    Ashfaq Ul Hassan

    2014-03-01

    Full Text Available Portal vein contributes to more than 70 % blood flow to the liver the significant increases in portal venous blood pressure is associated with major systemic manifestations. Having a knowledge about Portal Blood supply is important tio any clinician, gastroenterologist or any Hepatic Surgeon. The Article outlines the rare development of Portal Cavernoma in a patient who had Portal Hypertension. Portal cavernoma is a consequence of portal vein thrombosis. We Present a case of a lady with mild Right hypochondriac pain who on evaluation was found to have Cavernomatous transformation of Portal vein without any other abnormality.

  8. Investigating the efficacy of subharmonic aided pressure estimation for portal vein pressures and portal hypertension monitoring.

    Science.gov (United States)

    Dave, Jaydev K; Halldorsdottir, Valgerdur G; Eisenbrey, John R; Merton, Daniel A; Liu, Ji-Bin; Zhou, Jian-Hua; Wang, Hsin-Kai; Park, Suhyun; Dianis, Scott; Chalek, Carl L; Lin, Feng; Thomenius, Kai E; Brown, Daniel B; Forsberg, Flemming

    2012-10-01

    The efficacy of using subharmonic emissions from Sonazoid microbubbles (GE Healthcare, Oslo, Norway) to track portal vein pressures and pressure changes was investigated in 14 canines using either slow- or high-flow models of portal hypertension (PH). A modified Logiq 9 scanner (GE Healthcare, Milwaukee, WI, USA) operating in subharmonic mode (f(transmit): 2.5 MHz, f(receive): 1.25 MHz) was used to collect radiofrequency data at 10-40% incident acoustic power levels with 2-4 transmit cycles (in triplicate) before and after inducing PH. A pressure catheter (Millar Instruments, Inc., Houston, TX, USA) provided reference portal vein pressures. At optimum insonification, subharmonic signal amplitude changes correlated with portal vein pressure changes; r ranged from -0.82 to -0.94 and from -0.70 to -0.73 for PH models considered separately or together, respectively. The subharmonic signal amplitudes correlated with absolute portal vein pressures (r: -0.71 to -0.79). Statistically significant differences between subharmonic amplitudes, before and after inducing PH, were noted (p ≤ 0.01). Portal vein pressures estimated using subharmonic aided pressure estimation did not reveal significant differences (p > 0.05) with respect to the pressures obtained using the Millar pressure catheter. Subharmonic-aided pressure estimation may be useful clinically for portal vein pressure monitoring.

  9. TIPS performed in a patient with complete portal vein thrombosis

    Directory of Open Access Journals (Sweden)

    Ashwani Kumar Sharma, MD

    2017-06-01

    Full Text Available Portal vein thrombosis is common in cirrhotic patients and results in increased morbidity and mortality. Transjugular intrahepatic portosystemic shunt (TIPS creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis. Experience and technical improvements have led to improved TIPS outcomes that have encouraged an expanded application. Complete portal vein thrombosis has come a long way from being a contraindication to an indication for TIPS procedure. As experience and technology have evolved, the ultrasound guidance transvenous access of portal vein from the hepatic vein help in overall higher success rate of performing the TIPS procedure and reducing the procedure-related complications.

  10. Effect of Fluid Shear Stress on Portal Vein Remodeling in a Rat Model of Portal Hypertension

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    Bin Wen

    2015-01-01

    Full Text Available Aims. To explore the effects and mechanisms of fluid shear stress on portal vein remodeling in a rat model of portal hypertension. Methods. Subcutaneous injections of CCl4 were given to establish a rat model of liver cirrhosis and portal hypertension. Biomechanical technology was adopted to determine the dynamic changes of haemodynamic indices and fluid shear stress. Nitric oxide (NO, synthase (NOS, and endothelin-1 (ET-1 of the portal vein blood were measured. Changes in geometric structure and ultrastructure of the portal vein were observed using optical and electron microscopy. Results. After the CC14 injections, rat haemodynamics were notably altered. From week 4 onwards, PVP, PVF, and PVR gradually and significantly increased (P<0.05 versus baseline. The fluid shear stress declined from week 4 onwards (P<0.01 versus control group. NO, NOS, and ET-1 increased after repeated CCI4 injections. Hematoxylin and eosin staining showed thickened portal vein walls, with increased inside and outside diameters. Electron microscopy revealed different degrees of endothelial cell degeneration, destruction of basement membrane integrity, proliferating, and hypertrophic smooth muscle cells. Conclusions. Fluid shear stress not only influenced the biomechanical environment of the portal vein but also participated in vascular remodeling.

  11. Transsplenic portal vein reconstruction–transjugular intrahepatic portosystemic shunt in a patient with portal and splenic vein thrombosis

    Directory of Open Access Journals (Sweden)

    Jason T. Salsamendi, MD

    2016-09-01

    Full Text Available Portal vein thrombosis (PVT is a potential complication of cirrhosis and can worsen outcomes after liver transplant (LT. Portal vein reconstruction–transjugular intrahepatic portosystemic shunt (PVR-TIPS can restore flow through the portal vein (PV and facilitate LT by avoiding complex vascular conduits. We present a case of transsplenic PVR-TIPS in the setting of complete PVT and splenic vein (SV thrombosis. The patient had a 3-year history of PVT complicated by abdominal pain, ascites, and paraesophageal varices. A SV tributary provided access to the main SV and was punctured percutaneously under ultrasound scan guidance. PV access, PV and SV venoplasty, and TIPS placement were successfully performed without complex techniques. The patient underwent LT with successful end-to-end anastomosis of the PVs. Our case suggests transsplenic PVR-TIPS to be a safe and effective alternative to conventional PVR-TIPS in patients with PVT and SV thrombosis.

  12. Transsplenic portal vein reconstruction-transjugular intrahepatic portosystemic shunt in a patient with portal and splenic vein thrombosis.

    Science.gov (United States)

    Salsamendi, Jason T; Gortes, Francisco J; Shnayder, Michelle; Doshi, Mehul H; Fan, Ji; Narayanan, Govindarajan

    2016-09-01

    Portal vein thrombosis (PVT) is a potential complication of cirrhosis and can worsen outcomes after liver transplant (LT). Portal vein reconstruction-transjugular intrahepatic portosystemic shunt (PVR-TIPS) can restore flow through the portal vein (PV) and facilitate LT by avoiding complex vascular conduits. We present a case of transsplenic PVR-TIPS in the setting of complete PVT and splenic vein (SV) thrombosis. The patient had a 3-year history of PVT complicated by abdominal pain, ascites, and paraesophageal varices. A SV tributary provided access to the main SV and was punctured percutaneously under ultrasound scan guidance. PV access, PV and SV venoplasty, and TIPS placement were successfully performed without complex techniques. The patient underwent LT with successful end-to-end anastomosis of the PVs. Our case suggests transsplenic PVR-TIPS to be a safe and effective alternative to conventional PVR-TIPS in patients with PVT and SV thrombosis.

  13. Transjugular intrahepatic portosystemic shunt in patients with active variceal bleeding due to portal hypertension and portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Hyun Woong; Ryeom, Hun Kyu; Lee, Sang Kwon; Lee, Jong Min; Kim, Young Sun; Suh, Kyung Jin; Kim, Tae Hun; Kim, Yong Joo [Kyungpook National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-10-01

    To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with active variceal bleeding due to liver cirrhosis and pre-existing portal vein thrombosis. Of a total of 123 patients who underwent TIPS, 14 patients with intractable variceal bleeding due to portal hypertension and portal vein thrombosis were included in this study. Noncavernomatous portal vein occlusion was seen in eight patients, and complete portal vein occlusion with cavernomatous trans-formation in six. For all patients, the methods used for TIPS placement were the same as those used in patients with patents portal veins. In seven of eight patients with noncavernomatous occlusion, right hepatic vein-right portal vein shunting was performed; in one with knoncavernomatous occlusion, a shunt was created between the right hepatic and left portal vein. In five of six patients with cavernomatous occlusion, the right hepatic and main portal vein were connected via a collateral vein. The procedures were technically successful in all except one patient. Immediate hemostatis was achieved after all technically successful procedures, and no significant complications were encountered. Minor complications were noted in six patients (three biliary tree punctures, one transperitoneal puncture, one splenic vein perforation, one hepatic subcapsular hematoma). TIPS is a technically feasible and hemodynamically effective procedure, even in patients with active variceal bleeding due to cirrhosis and complete portal vein occlusion.

  14. Extrahepatic portal vein aneurysm: Two case reports of surgical intervention

    Institute of Scientific and Technical Information of China (English)

    Bi Jin; Yuan Sun; Yi-Qing Li; Yu-Guo Zhao; Chuan-Shan Lai; Xian-Song Feng; Chi-Dan Wan

    2005-01-01

    We report two cases of extrahepatic portal vein aneurysm,and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Physical examination revealed nothing abnormal. Both of them were diagnosed by magnetic resonance imaging angiography (MRA). One of the aneurysms was located at the main portal vein, the other, at the confluence of the superior mesenteric vein and the splenic vein, and these two places are exactly the most common locations of the extrahepatic portal vein aneurysm reported in the literature (30.7% each site). The first case underwent aneurysmorrhaphy and the second case, aneurysm resection with splenectomy. Both of them recovered soon after the operation, and the symptom of the first case was greatly alleviated. During the follow-up of half a year, no complication and adverse effect of surgical intervention was found and the color Doppler ultrasonography revealed no recurrence of the aneurysmal dilation. We suggest that surgical intervention can alleviate the symptom of the extrahepatic portal vein aneurysm and prevent its complications effectively and safely for low risk patients.

  15. Selection and Outcome of Portal Vein Resection in Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nakao, Akimasa [Department of Surgery II, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550 (Japan)

    2010-11-24

    Pancreatic cancer has the worst prognosis of all gastrointestinal neoplasms. Five-year survival of pancreatic cancer after pancreatectomy is very low, and surgical resection is the only option to cure this dismal disease. The standard surgical procedure is pancreatoduodenectomy (PD) for pancreatic head cancer. The morbidity and especially the mortality of PD have been greatly reduced. Portal vein resection in pancreatic cancer surgery is one attempt to increase resectability and radicality, and the procedure has become safe to perform. Clinicohistopathological studies have shown that the most important indication for portal vein resection in patients with pancreatic cancer is the ability to obtain cancer-free surgical margins. Otherwise, portal vein resection is contraindicated.

  16. Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen

    Directory of Open Access Journals (Sweden)

    Rastogi Rajul

    2008-01-01

    Full Text Available Injuries to the pancreas by blunt trauma are uncommon. The association of pancreatic injury with acute portal vein thrombosis secondary to blunt trauma abdomen is furthermore rare. The early diagnosis of the pancreas with injury to the portal vein is challenging and difficult. These injuries are associated with high morbidity and mortality, particularly if the diagnosis is delayed. Accurate and early diagnosis is therefore imperative and computed tomography plays a key role in detection. We present a case of child with a rare combination of pancreatic laceration and acute portal vein thrombosis following a blunt trauma to the abdomen. With extensive literature search we found no such cases has been described previously.

  17. Uterine myomatosis and portal vein thrombosis: a rare association

    Directory of Open Access Journals (Sweden)

    Elamurugan Sujindra

    2016-09-01

    Full Text Available Uterine leiomyomas are the most common pelvic tumors in women and occur in 20 and ndash;30% of women over 30 years of age. Many complications are seen with fibroid. We report a rare case of a large uterine leiomyoma associated with portal vein thrombosis. 50-year patient presented lower abdomen swelling associated with pain and breathlessness, diagnosed as multiple fibroids. She had massive splenomegaly. Abdomen Doppler revealed splenomegaly with thrombosis of portal, splenic and superior mesenteric vein. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Iron deficiency anaemia with thrombocytosis caused by fibroid was the identified cause for portal vein thrombosis. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3265-3267

  18. Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment

    Science.gov (United States)

    Ponziani, Francesca R; Zocco, Maria A; Campanale, Chiara; Rinninella, Emanuele; Tortora, Annalisa; Maurizio, Luca Di; Bombardieri, Giuseppe; Cristofaro, Raimondo De; Gaetano, Anna M De; Landolfi, Raffaele; Gasbarrini, Antonio

    2010-01-01

    Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a patient’s outcome. In this review, we analyze the physiopathological mechanisms of PVT development, together with the hemodynamic and functional alterations related to this condition. Moreover, we describe the principal factors most frequently involved in PVT development and the recent knowledge concerning diagnostic and therapeutic procedures. Finally, we analyze the implications of PVT in the setting of liver transplantation and its possible influence on patients’ future prognoses. PMID:20066733

  19. Chylous ascites caused by acute pancreatitis with portal vein thrombosis.

    Science.gov (United States)

    Park, Dong Eun; Chae, Kwon Mook

    2011-12-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.

  20. PORTAL VEIN EMBOLIZATION USING AN ADAPTED HYSTEROSALPINGOGRAPHY CATHETER

    Science.gov (United States)

    STEINBRÜCK, Klaus; ALVES, Jefferson; FERNANDES, Reinaldo; ENNE, Marcelo; PACHECO-MOREIRA, Lúcio Filgueiras

    2014-01-01

    Background Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. Aim To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. Methods Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam® powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. Results An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. Conclusions The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective. PMID:25184773

  1. Abernethy malformation with portal vein aneurysm in a child

    OpenAIRE

    Sheragaru H Chandrashekhara; Ashu Seith Bhalla; Arun Kumar Gupta; Vikash, C. S.; Susheel Kumar Kabra

    2011-01-01

    Abernethy malformation is an extremely rare anomaly of the splanchnic venous system. We describe multidetector computed tomography findings of an incidentally detected Abernethy malformation with portal vein aneurysm in a two-and-half-year old child. The computed tomography scan was performed for the evaluation of respiratory distress, poor growth, and loss of appetite.

  2. Abernethy malformation with portal vein aneurysm in a child

    Directory of Open Access Journals (Sweden)

    Sheragaru H Chandrashekhara

    2011-01-01

    Full Text Available Abernethy malformation is an extremely rare anomaly of the splanchnic venous system. We describe multidetector computed tomography findings of an incidentally detected Abernethy malformation with portal vein aneurysm in a two-and-half-year old child. The computed tomography scan was performed for the evaluation of respiratory distress, poor growth, and loss of appetite.

  3. Portal vein thrombosis; risk factors, clinical presentation and treatment

    DEFF Research Database (Denmark)

    Sogaard, Kirstine K; Astrup, Lone B; Vilstrup, Hendrik

    2007-01-01

    BACKGROUND: Portal vein thrombosis (PVT) is increasingly frequently being diagnosed, but systematic descriptions of the natural history and clinical handling of the condition are sparse. The aim of this retrospective study was to describe risk factors, clinical presentation, complications...... and treatment of portal vein thrombosis in a single-centre. METHODS: Sixty-seven patients were identified in the electronic records from 1992 to 2005. All data were obtained from the patient records. RESULTS: One or more risk factors (e.g. prothrombotic disorder or abdominal inflammation) were present in 87......%. Symptoms were abdominalia, splenomegaly, fever, ascites, haematemesis, and weight loss. Abdominalia and fever occurred more frequently in patients with acute PVT. Frequent complications were splenomegaly, oesophageal- and gastric varices with or without bleeding, portal hypertensive gastropathy and ascites...

  4. An anomaly in persistent right umbilical vein of portal vein diagnosed by ultrasonography

    Institute of Scientific and Technical Information of China (English)

    Shigeo Nakanishi; Katsuya Shiraki; Kouji Yamamoto; Mutsumi Koyama; Takeshi Nakano

    2005-01-01

    AIM: To detect the anomaly in the persistent right umbilical vein (PRUV) of portal vein (PV) with deviation of the ligamentum tere and left-sided gallbladder.METHODS: A total of 5783 candidates for routine analysis were evaluated for hepatic vascular abnormalities by ultrasonography.RESULTS: Ten candidates (0.17%) had a portal vein anomaly with a rightward-deviated ligamentum tere.The blood-flow velocity in the PRUV of the portal vein (17.7±3.0 cm/s) of the 10 cases was similar to that of the right anterior portal trunk (17.6±4.1 cm/s). However,the vessel diameter of the PRUV (ψ12.4±4.4 mm) was larger than the right anterior portal trunk (ψ6.1±0.9 mm).Therefore, flow volume in the anomalous portion (0.97±0.30 L/min) was more than that in the right anterior portal trunk (0.18±0.05 L/min).CONCLUSION: The anomaly plays an important role in intra-hepatic PV flow.

  5. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

    Directory of Open Access Journals (Sweden)

    Jianlin Tang

    2014-12-01

    Conclusion: The lessons we learned are (1 Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2 Synthetic graft is an alternative for internal jugular vein graft. (3 Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4 It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival.

  6. [Portal vein thrombosis in patients with thrombophilia--own observations].

    Science.gov (United States)

    Swiatkowska-Stodulska, Renata; Kazimierska, Ewa; Weyer-Hepka, Jolanta; Dworakowska, Dorota; Lubińska, Monika; Gnacińska, Maria; Bakowska, Alicja; Czestochowska, Eugenia

    2005-04-01

    Portal vein thrombosis is one of the main prehepatic causes of portal hypertension. The most frequent causes of thrombosis in this localization, apart from hepatic cirrhosis, are the following: acute inflammatory diseases and abdominal cancers, traumas, proliferative diseases of the hematopoietic system. In recent years attention was given to disorders in hemostasis, such as thrombophilia, in the course of which thrombosis development is particularly common. The authors present 10 patients after an incident of portal vein thrombosis, in which primary hepatic pathology was excluded and tests directed at thrombophilia were performed. In seven patients abnormalities in the examined parameters were found, and what is more, in two cases they had a complex character and involved more than one parameter. In five patients hyperhomocysteinemia was found. Among them, in two patients there was also a decreased protein S activity and in one of them there was also APC-resistance. In the next two patients there were abnormalities in one of the examined parameters - APC-resistance. Hyperhomocysteinemia was found in all patients with idiopathic thrombosis, and in one of them there were concurrent changes in protein S activity and APC-resistance. In patients with the history of portal vein thrombosis diagnostics of thrombophilia should be performed.

  7. Etiology and portal vein thrombosis in Budd-Chiari syndrome

    Institute of Scientific and Technical Information of China (English)

    Oguz Uskudar; Meral Akdogan; Nurgul Sasmaz; Sevinc Yilmaz; Muharrem Tola; Burhan Sahin

    2008-01-01

    AIM: To research the etiology, portal vein thrombosis and other features of Budd-Chiari syndrome (BCS)patients prospectively.METHODS: A total of 75 patients (40 female, 35 male) who were diagnosed between January 2002 and July 2004 as having BCS were studied prospectively.Findings from on physical examination, ultrasonography,duplex ultrasonography and venography were analyzed.Hemogram and blood chemistry were studied at the time of diagnosis and on each hospital visit. Bone marrow examination and immune phenotyping were performed by a hematologist when necessary. Protein C, S, antithrombin Ⅲ, activated protein C resistance,and anticardiolipin antibodies, antinuclear antibodies,and anti ds-DNA were studied twice. The presence of ascite, esophageal varices, and portal thrombosis were evaluated at admission and on every visit.RESULTS: At least one etiological factor was determined in 54 (72%) of the patients. The etiology could not be defined in 21 (28%) patients. One etiological factor was found in 39, 2 factors in 14 and 3 factors in 1 patient.The most common cause was the web (16%), the second was Hydatid disease (11%), the third was Behcet's disease (9%). Portal vein thrombosis was present in 11 patients and at least one etiology was identified in 9 of them (82%).CONCLUSION: Behcet's disease and hydatid disease are more prominent etiological factors in Turkey than in other countries. Patients with web have an excellent response to treatment without signs of portal vein thrombosis while patients having thrombofilic factors more than one are prone to develop portal vein thrombosis with worse clinical outcome.

  8. A STUDY OF CORRELATION OF ESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS WITH PORTAL HAEMODYNAMICS WITH SPECIAL REFERENCE TO PORTAL VEIN DIAMETER, PORTAL VEIN VELOCITY, CONGESTION INDEX, LIVER VASCULAR INDEX

    Directory of Open Access Journals (Sweden)

    Arvind

    2014-12-01

    Full Text Available OBJECTIVE : Approximately two thirds of patients with decompensated cirrhosis and one third of those with compensated cirrhosis have varices at the time of diagnosis. Therefore , it is essential to identify and treat those patients at highest risk because each episode of variceal hemorrhage carries a 20% to 30% risk of death , and 70% of patients not receiving treatment will die within 1 year of the initial bleeding episode . (1 METH OD S: For this study , patients with cirrhosis with or without the evidence of any upper Gastrointestinal bleed , admitted in the department of medicine , JA Group of Hospitals , GR Medical College were taken. The study was conducted between September 2011 and November 2012 and cases were evaluated on the basis of clinical , haematological , ultrasonographic and endoscopic findings. Total number of cases were 100. RESULT : The prevalence of esophageal varices was 75% in cirrhotic patients out of which 28% had bleeding. The prevalence of gastric varices was 1.33%. The portal vein diameter correlated with the presence of varices while portal vein velocity , congestion index and liver vascular index had no significant correlation with esophageal varices. The Portal vein diameter more than 1.4 cm can predict varices with sensitivity 76 % (p<0.05 and Portal vein diameter more than 1.5 cm can detect bleeding varices in cirrhotic patients with sensitivity 55.56% and specificity 80.70% . CONCLUSION : This study showed tha t duration of illness , spleen size and tense ascitis on ultrasonography and portal vein diameter correlated with the presence of esophageal varices. The duration of illness and portal vein diameter are also correlated with bleeding manifestation

  9. Diagnostic Value of 16 Slices Spiral-CT for Portal Vein Disorders

    Institute of Scientific and Technical Information of China (English)

    李震; 胡道予; 肖明

    2004-01-01

    Summary: The diagnostic value of 16-slices spiral computed tomography (CT) for portal vein disorders was evaluated. Forty-one patients were scanned by the 16-slices spiral-CT. The celiac trunk,portal vein and their branches were reconstructed by volume rendering (VR), multiplanar volume reconstruction (MPVR) and maximum intensity projection (MIP) technique, and the results were compared with digital subtraction angiography (DSA). VR, MPVR and MIP could display celiac trunk, portal vein, inferior vena cava and their branches and extent of portal vein-vena cava shunt,portal vein emboli and the fistula of hepatic artery-portal vein. The results from 16-slices CT were better than DSA and identical with pathologic ones. The vessel three-dimension reconstruction technique of 16-slices spiral CT is valuable for evaluating the portal systemic disorders.

  10. TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

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    Natanel Jourabchi

    2013-01-01

    Full Text Available Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS. Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely. Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies.

  11. Surgical Implications of Portal Vein Variations and Liver Segmentations: A Recent Update.

    Science.gov (United States)

    Iqbal, Showkathali; Iqbal, Raiz; Iqbal, Faiz

    2017-02-01

    The Couinaud's liver segmentation is based on the identification of portal vein bifurcation and origin of hepatic veins. It is widely used clinically, because it is better suited for surgery and is more accurate in localizing and monitoring various intra parenchymal lesions. According to standard anatomy, the portal vein bifurcates into right and left branches; the left vein drains segment II, III and IV and the right vein divides into two secondary branches - the anterior portal vein drains segments V and VIII, and the posterior drains segments VI and VII. The portal vein variants such as portal trifurcation, with division of the main portal vein into the left, right anterior, and posterior branches, and the early origin of the right posterior branch directly from the main portal vein were found to be more frequent and was seen in about 20 - 35% of the population. Accurate knowledge of the portal variants and consequent variations in vascular segments are essential for intervention radiologists and transplant surgeons in the proper diagnosis during radiological investigations and in therapeutic applications such as preparation for biopsy, Portal Vein Embolization (PVE), Transjugular Intrahepatic Porto-Systemic Shunt (TIPS), tumour resection and partial hepatectomy for split or living donor transplantations. The advances in the knowledge will reduce intra and postoperative complications and avoid major catastrophic events. The purpose of the present review is to update the normal and variant portal venous anatomy and their implications in the liver segmentations, complex liver surgeries and various radiological intervention procedures.

  12. Nitroglycerine effects on portal vein mechanics and oxidative stress in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Andreja Vujanac; Vladimir Jakovljevic; Dusica Djordjevic; Vladimir Zivkovic; Mirjana Stojkovic; Dragan Celikovic; Nebojsa Andjelkovic; Aleksandra Jurisic Skevin; Dragan Djuric

    2012-01-01

    vein haemodynamics and oxidative stress in patients with portal hypertension. METHODS: Thirty healthy controls and 39 patients with clinically verified portal hypertension and increasedvascular resistance participated in the study. Liver diameters, portal diameters and portal flow velocities were recorded using color flow imaging/pulsed Doppler detection. Cross-section area, portal flow and index of vascular resistance were calculated. In collected blood samples, superoxide anion radical (O2 -), hydrogen peroxide (H2O2), index of lipid peroxidation (measured as TBARS) and nitric oxide (NO) as a marker of endothelial response (measured as nitrite-NO2 -) were determined. Time-dependent analysis was performed at basal state and in 10th and 15th min after nitroglycerine (sublingual 0.5 mg) administration. RESULTS: Oxidative stress parameters changed significantly during the study. H2O2 decreased at the end of study, probably via O2 -mediated disassembling in Haber Weiss and Fenton reaction; O2 -increased significantly probably due to increased diameter and tension and decreased shear rate level. Consequently O2 -and H2O2 degradation products, like hydroxyl radical, initiated lipid peroxidation. Increased blood flow was to some extent lower in patients than in controls due to double paradoxes, flow velocity decreased, shear rate decreased significantly indicating non Newtonian characteristics of portal blood flow. CONCLUSION: This pilot study could be a starting point for further investigation and possible implementation of some antioxidants in the treatment of portal hypertension.

  13. Treatment of portal vein tumor thrombus using ~(125)Iodine seed implantation brachytherapy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    We reported two cases of liver metastasis with portal vein tumor thrombus that developed after liver transplantation for hepato cellular carcinoma (HCC). Both the patients were women aged 43 and 55 years, who had liver metastasis and portal vein tumor thrombus formation after liver transplantations for HCC. For the treatment of portal vein tumor thrombus, 125I seeds were implanted into the hepatic tissue under the guidance of preoperative computed tomography (CT) images with a total radiation dose of 130 Gy...

  14. Portal vein thrombosis:Insight into physiopathology,diagnosis,and treatment

    Institute of Scientific and Technical Information of China (English)

    Francesca; R; Ponziani; Maria; A; Zocco; Chiara; Campanale; Emanuele; Rinninella; Annalisa; Tortora; Luca; Di; Maurizio; Giuseppe; Bombardieri; Raimondo; De; Cristofaro; Anna; M; De; Gaetano; Raffaele; Landolfi; Antonio; Gasbarrini

    2010-01-01

    Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a pa...

  15. Portal vein and mesenteric vein gas: CT features; Aeroportie ety aeromesenterie: donnees TDM

    Energy Technology Data Exchange (ETDEWEB)

    Schmutz, G.; Fournier, L.; Le Pennec, V.; Provost, N.; Hue, S.; Phi, I.N. [Centre Hospitalier Universitaire, 14 - Caen (France)

    2001-04-01

    Portal vein and mesenteric vein gas are unusual conditions with a complex and nuclear pathogenesis. Mesenteric ischemia frequently causes such pathological conditions but a variety of other causes are known: inflammatory bowel disease, bowel distension, traumatic and iatrogenic injury, intra-abdominal sepsis, and idiopathic conditions. This pathologic entity is favored by intestinal wall alterations, bowel distension and sepsis. The prognosis is frequently fatal, especially when associated with extended bowel necrosis although in the majority of the cases, outcome is favorable without surgery. (author)

  16. Blood infection with Enterobacter aerogenes--an unusual cause of portal vein gas.

    Science.gov (United States)

    Fayyaz, Afshan

    2011-01-01

    Portal vein gas was once thought of as an invariably fatal condition. Now, with the availability of better equipment and expertise, the condition is more frequently diagnosed. A case of fever with rigors is presented and on ultrasound and CT examination was found to have portal venous gas which resolved with adequate antibiotic treatment. Blood culture revealed growth of gram negative bacillus; Enterobacter aerogenes. Patient was investigated further for portal vein gas, and although no other cause for the development of portal vein gas was found, she was treated with antibiotics and showed an immediate response. The aim of this case report is to highlight the benign causes of portal vein gas as well as to discuss the causes which warrant immediate surgery. Portal vein gas may herald a more ominous condition, which if intercepted in its course may result in complete cure.

  17. Portal Vein Inflow From Enlarged Coronary Vein in Liver Transplantation: Surgical Approach and Technical Tips: A Case Report.

    Science.gov (United States)

    Safwan, M; Nagai, S; Abouljoud, M S

    2016-11-01

    Portal vein thrombosis is common in patients with end-stage liver disease, with an incidence as high as 26% in liver transplant candidates. It is known to be associated with a high risk of morbidity and mortality posttransplantation, and its management can be challenging. The management options range from a simple thrombendvenectomy to multivisceral transplantation in cases with diffuse portomesenteric thrombosis. We report a case of liver transplantation in which we performed a rare reconstruction of the portal vein. Briefly, the patient had diffuse portomesenteric thrombosis, calcified aneurysmosis, and a large collateral coronary vein, to which we directly anastomosed the donor portal vein in an end-to-side fashion. This report describes a unique surgical approach for similar cases of severe portal vein thrombosis in liver transplant candidates.

  18. Use of Left Gastric Vein as an Alternative for Portal Flow Reconstruction in Liver Transplantation

    Science.gov (United States)

    Goldoni, Marcos Bertozzi; Kruse, Cristine; Diedrich, João Alfredo; Giacomazzi, Caroline Becker; Negri, Estéfano Aurélio; Koop, Matheus; Sampaio, José Artur; Fontes, Paulo Roberto Ott; Waechter, Fábio Luiz

    2016-01-01

    Portal vein thrombosis is observed in up to 10% of liver transplant candidates, hindering execution of the procedure. A dilated gastric vein is an alternative to portal vein reconstruction and decompression of splanchnic bed. We present two cases of patients with portal cavernoma and dilated left gastric vein draining splanchnic bed who underwent liver transplantation. The vein was dissected and sectioned near the cardia; the proximal segment was ligated with suture and the distal segment was anastomosed to the donor portal vein. Gastroportal anastomosis is an excellent option for portal reconstruction in the presence of thrombosis or hypoplasia. It allows an adequate splanchnic drainage and direction of hepatotrophic factors to the graft. PMID:27595034

  19. Portal vein branching order helps in the recognition of anomalous right-sided round ligament: common features and variations in portal vein anatomy.

    Science.gov (United States)

    Yamashita, Rikiya; Yamaoka, Toshihide; Nishitai, Ryuta; Isoda, Hiroyoshi; Taura, Kojiro; Arizono, Shigeki; Furuta, Akihiro; Ohno, Tsuyoshi; Ono, Ayako; Togashi, Kaori

    2017-07-01

    This study aimed to evaluate the common features and variations of portal vein anatomy in right-sided round ligament (RSRL), which can help propose a method to detect and diagnose this anomaly. In this retrospective study of 14 patients with RSRL, the branching order of the portal tree was analyzed, with special focus on the relationship between the dorsal branch of the right anterior segmental portal vein (PA-D) and the lateral segmental portal vein (PLL), to determine the common features. The configuration of the portal vein from the main portal trunk to the right umbilical portion (RUP), the inclination of the RUP, and the number and thickness of the ramifications branching from the right anterior segmental portal vein (PA) were evaluated for variations. In all subjects, the diverging point of the PA-D was constantly distal to that of the PLL. The portal vein configuration was I- and Z-shaped in nine and five subjects, respectively. The RUP was tilted to the right in all subjects. In Z-shaped subjects, the portal trunk between the branching point of the right posterior segmental portal vein and that of the PLL was tilted to the left in one subject and was almost parallel to the vertical plane in four subjects. Multiple ramifications were radially distributed from the PA in eight subjects, whereas one predominant PA-D branched from the PA in six subjects. Based on the diverging points of the PA-D and PLL, we proposed a three-step method for the detection and diagnosis of RSRL.

  20. Nephrotic syndrome complicated with portal, splenic, and superior mesenteric vein thrombosis.

    Science.gov (United States)

    Park, Bong Soo; Park, Sihyung; Jin, Kyubok; Choi, Gibok; Park, Kang Min; Jo, Kyeong Min; Kim, Yang Wook

    2014-09-01

    Thromboembolism is a major complication of nephrotic syndrome. Renal vein thrombosis and deep vein thrombosis are relatively common, especially in membranous nephropathy. However, the incidence of portal vein and superior mesenteric vein (SMV) thrombosis in patients with nephrotic syndrome is very rare. To date, several cases of portal vein thrombosis treated by anticoagulation therapy, not by thrombolytic therapy, have been reported as a complication of nephrotic syndrome. Here, we report a case of portal, splenic, and SMV thrombosis in a patient with a relapsed steroid dependent minimal change disease who was treated successfully with anticoagulation and thrombolytic therapy using urokinase. Radiologic findings and his clinical conditions gradually improved. Six months later, a complete remission of the nephrotic syndrome was observed and the follow-up computed tomography scan showed the disappearance of all portal vein, splenic vein, and SMV thrombi.

  1. Nephrotic syndrome complicated with portal, splenic, and superior mesenteric vein thrombosis

    Directory of Open Access Journals (Sweden)

    Bong Soo Park

    2014-09-01

    Full Text Available Thromboembolism is a major complication of nephrotic syndrome. Renal vein thrombosis and deep vein thrombosis are relatively common, especially in membranous nephropathy. However, the incidence of portal vein and superior mesenteric vein (SMV thrombosis in patients with nephrotic syndrome is very rare. To date, several cases of portal vein thrombosis treated by anticoagulation therapy, not by thrombolytic therapy, have been reported as a complication of nephrotic syndrome. Here, we report a case of portal, splenic, and SMV thrombosis in a patient with a relapsed steroid dependent minimal change disease who was treated successfully with anticoagulation and thrombolytic therapy using urokinase. Radiologic findings and his clinical conditions gradually improved. Six months later, a complete remission of the nephrotic syndrome was observed and the follow-up computed tomography scan showed the disappearance of all portal vein, splenic vein, and SMV thrombi.

  2. Preoperative portal vein embolization for hepatocellular carcinoma: consensus and controversy

    Institute of Scientific and Technical Information of China (English)

    Taku; Aoki; Keiichi; Kubota

    2016-01-01

    Thirty years have passed since the first report of portal vein embolization(PVE),and this procedure is widely adopted as a preoperative treatment procedure for patients with a small future liver remnant(FLR).PVE has been shown to be useful in patients with hepatocellular carcinoma(HCC)and chronic liver disease.However,special caution is needed when PVE is applied prior to subsequent major hepatic resection in cases with cirrhotic livers,and volumetric analysis of the liver segments in addition to evaluation of the liver functional reserve before PVE is mandatory in such cases.Advances in the embolic material and selection of the treatment approach,and combined use of PVE and transcatheter arterial embolization/chemoembolization have yielded improved outcomes after PVE and major hepatic resections.A novel procedure termed the associating liver partition and portal vein ligation for staged hepatectomy has been gaining attention because of the rapid hypertrophy of the FLR observed in patients undergoing this procedure,however,application of this technique in HCC patients requires special caution,as it has been shown to be associated with a high morbidity and mortality even in cases with essentially healthy livers.

  3. Vasculogenic mimicry in hepatocellular carcinoma contributes to portal vein invasion.

    Science.gov (United States)

    Jue, Chen; Zhifeng, Wu; Zhisheng, Zhang; Lin, Cui; Yayun, Qian; Feng, Jin; Hao, Gu; Shintaro, Ishikawa; Hisamitsu, Tadashi; Shiyu, Guo; Yanqing, Liu

    2016-11-22

    Portal vein invasion (PVI) is common in hepatocellular carcinoma (HCC) and largely contributes to tumor recurrence after radical tumor resection or liver transplantation. Vasculogenic mimicry (VM) was an independent vascular system lined with tumor cells and associated with poor prognosis of HCC. The present study was conducted to evaluate the relationship between VM and portal vein invasion. A total of 44 HCC cases receiving anatomic liver resection were included in the study and were divided into groups with and without PVI. The prevalence of VM in each group was examined by CD34-PAS dual staining. The regulatory molecules of VM formation such as Notch1, Vimentin and matrix metalloproteinases (MMPs) were investigated by immunohistochemical staining. Analysis was performed to explore the association of PVI, VM and the VM regulatory molecules. PVI was found in 40.91% (18/44) cases and VM was found in 38.64% (17/44) cases in total samples. The incidence of VM was 72.22% (13/18) in PVI group while it was 15.38% (4/26) in non-PVI group (PPVI (r=0.574, PPVI in HCC patients. Taken together, our results suggested that VM formation, alone with its regulatory molecules, is the promoting factor of PVI in hepatocellular carcinoma.

  4. Clinical and experimental studies on portal vein embolization / Diagnosis of hepatocellular adenoma and focal nodular hyperplasia

    NARCIS (Netherlands)

    van den Esschert, J.W.

    2011-01-01

    The first part of this thesis concerns liver regeneration after portal vein embolization (PVE). The use of PVE over the past 20 years is reviewed and its effect on tumor growth and (postresectional) hypertrophy response discussed. The effects of several portal vein occlusion techniques are evaluated

  5. Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    D. Henne-Bruns

    1993-01-01

    four or more organs. Additionally, in 11.8% of these cases (n = 8 a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1 was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68 and 0% for patients with additional portal venous injuries.

  6. Withania somnifera ameliorates lead-induced augmentation of adrenergic response in rat portal vein

    Directory of Open Access Journals (Sweden)

    Subrata Kumar Hore

    2013-01-01

    Full Text Available Objectives: Present study was undertaken to elucidate the ameliorating potential of Withania somnifera root extract (WRE against lead-induced augmentation of adrenergic response in rat portal vein. Materials and Methods: In-vitro studies were conducted on effect of lead alone and lead+WRE on rat-isolated portal vein while in-vivo studies were done in three groups of 12 rats each; Group-II and III received 0.5% lead acetate and 1.0% WRE + 0.5% lead acetate, respectively, in drinking water for 12 weeks whereas group-I served as control. Adrenaline and noradrenaline levels in brain and blood were determined by HPLC assay while vascular reactivity of portal vein to lead and WRE was determined by measuring the isometric tension. Results: Following in-vitro exposure, lead did not alter the contractile effect of phenylephrine. In-vivo studies revealed that contractile effect of lead on portal vein was significantly potentiated and it was antagonized by prazosin (10 -7 M and WRE (1%. WRE treatment significantly reduced elevated blood noradrenaline (37.80% and restored noradrenaline level in brain (39.39% in lead-exposed animals. These values were almost comparable to the control group. But it failed to significantly affect the blood and brain adrenaline levels. Conclusions: Results suggest that following pre-exposure of rats to WRE, lead-induced augmentation of alpha 1 -adrenoceptors mediated response was reversed possibly by regulating catecholamine release from nerve endings. Thus, WRE may be useful in therapeutic management of lead-induced hypertension.

  7. Liver transplantation in patients with portal vein thrombosis.

    Science.gov (United States)

    Manzanet, G; Sanjuán, F; Orbis, P; López, R; Moya, A; Juan, M; Vila, J; Asensi, J; Sendra, P; Ruíz, J; Prieto, M; Mir, J

    2001-02-01

    The aim of this study is to analyze the incidence, risk factors, management, and follow-up of patients with portal vein thrombosis (PVT) undergoing primary orthotopic liver transplantation (OLT). Four hundred fifteen OLTs were performed in 391 patients. In 62 patients, partial (group 1; n = 48) or complete (group 2; n = 14) PVT was found at the time of surgery. Portal flow was reestablished by venous thrombectomy. In this study, we compare 62 primary OLTs performed in patients with PVT at the time of OLT with a group of 329 primary OLTs performed in patients without PVT (group 3) and analyze the incidence of PVT, use of diagnostic methods, surgical management, and outcome. We found no significant differences among the 3 groups for length of surgery, cold and warm ischemic times, and postoperative stay in the intensive care unit. With the piggyback technique, groups 1 and 2 had greater blood losses and required more blood transfusions than group 3. The early reoperation rate was greater in group 2. The incidence of rethrombosis was 4.8% (group 1, 2%; group 2, 14.3%). Reexploration and thrombectomy (2 patients) and retransplantation (1 patient) had a 100% mortality rate. In particular, the mortality rate of patients with complete PVT with extension into the splanchnic veins is high (33%). Three-month and 4-year patient survival rates were statistically similar in the 3 groups. The presence of PVT at the time of OLT is not a contraindication for OLT. However, if PVT extends into the splanchnic veins, the outcome is guarded.

  8. Percutaneous implantation of (125)iodine seeds for treatment of portal vein tumor thrombosis in hepatocellular carcinoma.

    Science.gov (United States)

    Liu, Yan; Liu, Ruibao; Wang, Ping; Li, Shijie; Shen, Haiyang

    2015-08-01

    The aim of the study is to evaluate the practicability and therapeutic efficacy of (125)iodine seeds implantation percutaneously for portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC). Nineteen patients with HCC accompanied with PVTT received ultrasound-guided implantation of 8-30 (125)iodine seeds, 8 mm apart within the portal vein tumor thrombi. The patients were followed up postoperatively for a period of 3-22 months. The successful rates of the procedure, postoperative changes of liver and renal function, hemogram, complications and therapeutic response were monitored. (125)I seeds were successfully implanted in the portal veins in all patients without serious complications. During the follow-up period, the portal vein tumor thrombi all shrunk obviously. Percutaneous implantation of (125)iodine seeds into the portal vein is an effective and safe treatment for PVTT accompanying HCC.

  9. Effective Endovascular Stenting of Malignant Portal Vein Obstruction in Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Christian M. Ellis

    2009-01-01

    Full Text Available We report herein the case of a patient successfully treated by transhepatic portal venous stent placement for malignant portal vein obstruction with associated gastric and small bowel varices and repeated gastrointestinal bleeding. CT angiography and portography showed severe portal vein obstruction from recurrent pancreatic cancer 15 months following pancreaticoduodenectomy with tumor encasement and dilated collateral veins throughout the gastric and proximal small bowel wall as the suspected cause of the GI bleeding. Successful transhepatic endovascular stent placement of the splenic vein at the portal vein confluence followed by balloon dilation was performed with immediate decompression of the gastric and small bowel varices and relief of GI hemorrhage in this patient until his death four months later. The treatment for patients with this dilemma can prove to be difficult, but as we have shown endovascular stenting of the portal system is an effective treatment option.

  10. The portal vein in children: radiological review of congenital anomalies and acquired abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Corness, Jonathan A.G.; McHugh, Kieran; Roebuck, Derek J. [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Taylor, Andrew M. [Institute of Child Health, Cardiothoracic Unit, London (United Kingdom)

    2006-02-01

    A variety of portal vein anomalies that occur in children can be identified by US, CT, MRI and portal venography. Although these abnormalities can also occur in adults, there are certain pathological processes and aberrations within the portal system that are specific to children. Knowledge of the embryology and anatomy of the portal vein is of benefit in the understanding of these anomalies. Identifying deviations from normal portal architecture is important in the work-up for surgery such as liver transplantation, and prior to interventional procedures such as stent placement or embolization. The aim of this paper is to summarize the various types of congenital and acquired portal vein abnormalities that occur in children, describe their radiological features and provide images to demonstrate the differences from normal portal venous anatomy. (orig.)

  11. Novel Image Guidance Techniques for Portal Vein Targeting During Transjugular Intrahepatic Portosystemic Shunt Creation.

    Science.gov (United States)

    Farsad, Khashayar; Kaufman, John A

    2016-03-01

    The most challenging part of transjugular intrahepatic portosystemic shunt creation is arguably the transvenous access from the hepatic vein to the portal vein. As experience and technology have evolved, the image guidance aspect of this critical step in the procedure has become more robust. Improved means to target the portal vein include both direct and indirect methods of portal vein opacification, cross-sectional imaging for both targeting and access, and novel use of transabdominal and intravascular ultrasound guidance. These techniques are described herein.

  12. Portal flow into the liver through veins at the site of biliary-enteric anastomosis.

    Science.gov (United States)

    Hashimoto, M; Heianna, J; Yasuda, K; Tate, E; Watarai, J; Shibata, S; Sato, T; Yamamoto, Y

    2005-07-01

    The aim of this study was to establish the role played by jejunal veins in hepatopetal flow after biliary-enteric anastomosis and to evaluate the helical CT features of hepatopetal flow through the anastomosis. We retrospectively analyzed helical CT images of the liver in 31 patients with biliary-enteric anastomosis who underwent hepatic angiography with (n=13) or without (n=18) CT arterial portography within 2 weeks of the CT examination during the last 4 years. Arterial portography showed hepatopetal flow through small vessels located (communicating veins) between the elevated jejunal veins and the intrahepatic portal branches in two (9%) of 22 patients with a normal portal system. Helical CT showed focal parenchymal enhancement around the anastomosis in these two patients. All nine patients with extrahepatic portal vein occlusion (100%) had hepatopetal flow through the anastomosis, and four of the nine had decreased portal flow. CT revealed small communicating veins in two of these four patients. In five patients with normal portal perfusion despite extrahepatic portal vein occlusion, CT detected dilated communicating veins and elevated jejunal veins. The presence of communicating veins and/or focal parenchymal enhancement around the anastomosis indicates hepatopetal flow through the elevated jejunal veins.

  13. Application of cystoscope in surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus.

    Science.gov (United States)

    Li, Nan; Wei, Xu-Biao; Cheng, Shu-Qun

    2016-06-14

    Development of portal vein tumor thrombus deteriorates the prognosis of hepatocellular carcinoma, while surgical treatment can offer a promising prognosis for selected patients. However, the possibility of residual lesions in portal vein after conventional thrombectomy is a main risk factor leading to postoperative recurrence. Therefore, ensuring the complete removal of tumor thrombus during operation is critical to improve prognosis. For the first time, we report here one case of hepatocellular carcinoma with portal vein tumor thrombus in which cystoscope was successfully applied as a substitute of intravascular endoscope to visualize the cavity of the portal vein. The patient was a 61-year-old man with a 7-cm tumor in the right lobe of the liver, with tumor thrombus invading the right branch and adjacent to the conjunction of the portal vein. After removal of the tumor, the Olympus CYF-VA2 cystoscope was used to check the portal vein from the opening stump of the right branch of the portal vein. In this case, residual thrombus tissue was found near the opening stump and the conjunction of the portal vein. The residual lesion was carefully retrieved from the stump after retraction of the cystoscope. The procedure was repeated until no residual lesion was found. The whole duration time of thrombectomy was 22.5 (15 + 7.5) min. The patient was free from recurrence at 8 months after the procedure. Our work indicated that the cystoscope is a suitable substitute, with a proper size and function to check the portal vein system and ensure the curability of thrombectomy. Although well-designed clinic trails are still needed, this procedure may further improve the postoperative prognosis of hepatocellular carcinoma with portal vein tumor thrombus.

  14. Application of cryopreserved vein grafts as a conduit between the coronary vein and liver graft to reconstruct portal flow in adult living liver transplantation.

    Science.gov (United States)

    Wu, Tsung-Han; Chou, Hong-Shiue; Pan, Kuang-Tse; Lee, Ching-Song; Wu, Ting-Jun; Chu, Sung-Yu; Chen, Miin-Fu; Lee, Wei-Chen

    2009-01-01

    Adult-to-adult living donor liver transplantation is an alternative to donation from a deceased individual, and can help relieve the shortage of liver donations available for adult patients in Asian countries. When transplant candidates have thrombosis and deterioration of the portal vein, living donor liver transplantation is relatively contraindicated because portal veins in the grafts are short and vein grafts may not be available to reconstruct the portal vein. From June 2003 to May 2007, 82 adult living donor liver transplantations were performed at Chang-Gung Memorial Hospital. Three patients had portal vein thrombosis and marked fibrosis of the portal vein and cryopreserved vein grafts were used to reconstruct portal flow from the engorged coronary vein to the graft portal vein. All vein grafts are patent and all patients have normal liver function at 21-36 months after transplantation. When cryopreserved vein grafts are available, adult living donor liver transplantation can be successfully performed in patients with marked deterioration of the portal vein. The short distance from the engorged coronary vein to the graft portal vein may decrease the incidence of re-thrombosis of the venous conduit.

  15. Relationship between encephalopathy and portal vein-vena cava shunt:Value of computed tomography during arterial portography

    Institute of Scientific and Technical Information of China (English)

    Qian Chu; Zhen Li; Su-Ming Zhang; Dao-Yu Hu; Ming Xiao

    2004-01-01

    AIM: To assess the value of computed tomography during arterial portography (CTAP) in portal vein-vena cava shunt,and analysis of the episode risk in encephalopathy.METHODS: Twenty-nine patients with portal-systemic encephalopathy due to portal hypertension were classified by West Haven method into grade Ⅰ(29 cases), gradeⅡ(16 cases), grade Ⅲ(10 cases), grade Ⅳ( 4 cases). All the patients were scanned by spiral-CT. Plane scans, artery phase and portal vein phase enhancement scans were performed, and the source images were thinly reconstructed to 1.25 mm. We reconstructed the celiac trunk, portal vein,inferior vena cava and their branches and subjected them to three-dimensional vessel analysis by volume rendering(VR) technique and multiplanar volume reconstruction(MPVR) technique. The blood vessel reconstruction technique was used to evaluate the scope and extent of portal vein-vena cava shunt, portal vein emboli and the fistula of hepatic artery- portal vein. The relationship between the episode risk of portal-systemic encephalopathy and the scope and extent of portal vein-vena cava shunt,portal vein emboli and fistula of hepatic artery- portal vein was studied.RESULTS: The three-dimensional vessel reconstruction technique of spiral-CT could display celiac trunk, portal vein,inferior vena cava and their branches at any planes and angles and the scope and extent of portal vein-vena cava shunt, portal vein emboli and the fistula of hepatic artery- portal vein. In twenty-nine patients with portal-systemic encephalopathy, grade Ⅰ accounted for 89.7% esophageal varices, 86.2% paragastric varices; grade Ⅱ accounted for68.75% cirsomphalos, 56.25% paraesophageal varices,62.5% retroperitoneal varices and 81.25% dilated azygos vein; grade Ⅲ accounted for 80% cirsomphalos, 60%paraesophageal varices, 70% retroperitoneal varices, 90%dilated azygos vein, and part of the patients in grades Ⅱand Ⅲ had portal vein emboli and fistula of hepatic arteryportal vein

  16. Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry.

    Science.gov (United States)

    Violi, Francesco; Corazza, Roberto Gino; Caldwell, Stephen Hugh; Perticone, Francesco; Gatta, Angelo; Angelico, Mario; Farcomeni, Alessio; Masotti, Michela; Napoleone, Laura; Vestri, Annarita; Raparelli, Valeria; Basili, Stefania

    2016-12-01

    Portal vein thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the "Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry" (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the portal area to evaluate the prevalence and incidence of portal vein thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child-Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected portal vein thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the portal vein thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous portal vein thrombosis (p portal vein thrombosis. Portal vein thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate-severe liver failure. The apparent undertreatment of patients with portal vein thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.

  17. Total anomalous connection of pulmonary veins to the portal vein. Value of multislice angiotomography. Report on three cases

    Directory of Open Access Journals (Sweden)

    Sara Alejandra Solórzano-Morales

    2014-07-01

    15 and 26% if all its varieties. Multislice angiotomography allows us to view the blood vessels and adjacent organs under consideration and obtain high-definition anatomic information. In the patients in this study, total anomalous connection of pulmonary veins to the portal vein was viewed with three-dimensional volumetric tomographic reconstructions and their correlation with ultrasonography studies.

  18. Multiple hyperplastic nodules in the liver with congenital absence of portal vein: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Turkbey, Baris; Karcaaltincaba, Musturay; Haliloglu, Mithat [Hacettepe University School of Medicine, Department of Radiology, Ankara (Turkey); Demir, Hulya; Yuce, Aysel [Hacettepe University School of Medicine, Department of Paediatric Gastroenterology, Ankara (Turkey); Akcoren, Zuhal [Hacettepe University School of Medicine, Department of Paediatric Pathology, Ankara (Turkey)

    2006-05-15

    We describe a 10-year-old girl with congenital absence of the portal vein (CAPV) and multiple hyperplastic nodules in the liver. MRI appearances of the liver lesions and the portocaval anastomosis between the inferior mesenteric vein and internal iliac veins are presented. In addition, the relevance of CAPV and nodular lesions of the liver is reviewed. (orig.)

  19. MANAGEMENT OF PORTAL VEIN THROMBOSIS IN CIRRHOTIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Lucio Amitrano

    2009-11-01

    Full Text Available Portal vein thrombosis (PVT not associated with hepatocellular carcinoma is considered a frequent complication of liver cirrhosis but, unlike PVT occurring in non-cirrhotic patients, very few data are available on its natural history and management.  The reduced portal blood flow velocity is the main determinant of PVT but, as in other venous thromboses, multiple factors local and systemic, inherited or acquired often can concur with. PVT has a variety of clinical presentations ranging from asymptomatic to life-threatening diseases like gastroesophageal bleeding or acute intestinal ischemia. It is usually diagnosed by Doppler ultrasound but computed tomography and magnetic resonance imaging are useful to study the extent of thrombosis and the involvement of the abdominal organs. The risk of bleeding mainly determined by the presence of gastroesophageal varices and clotting alterations causes concern for the treatment of PVT in cirrhotic patients. To date, anticoagulant therapy seems to be indicated only in patients awaiting liver transplantation. This review focuses on the definition of the subgroups of patients with cirrhosis that might benefit from treatment of PVT and examines the pros and cons of the available treatments in terms of efficacy, monitoring and safety, providing also perspectives for future studies.

  20. MANAGEMENT OF PORTAL VEIN THROMBOSIS IN CIRRHOTIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Maria Anna Guardascione

    2009-11-01

    Full Text Available

    Portal vein thrombosis (PVT not associated with hepatocellular carcinoma is considered a frequent complication of liver cirrhosis but, unlike PVT occurring in non-cirrhotic patients, very few data are available on its natural history and management.  The reduced portal blood flow velocity is the main determinant of PVT but, as in other venous thromboses, multiple factors local and systemic, inherited or acquired often can concur with. PVT has a variety of clinical presentations ranging from asymptomatic to life-threatening diseases like gastroesophageal bleeding or acute intestinal ischemia. It is usually diagnosed by Doppler ultrasound but computed tomography and magnetic resonance imaging are useful to study the extent of thrombosis and the involvement of the abdominal organs. The risk of bleeding mainly determined by the presence of gastroesophageal varices and clotting alterations causes concern for the treatment of PVT in cirrhotic patients. To date, anticoagulant therapy seems to be indicated only in patients awaiting liver transplantation. This review focuses on the definition of the subgroups of patients with cirrhosis that might benefit from treatment of PVT and examines the pros and cons of the available treatments in terms of efficacy, monitoring and safety, providing also perspectives for future studies.

  1. Portal vein thrombosis after laparoscopic splenectomy during childhood.

    Science.gov (United States)

    Gelas, Thomas; Scalabre, Aurélien; Hameury, Frédéric; Dubois, Rémi; Grosos, Céline; Mouriquand, Pierre D; Mure, Pierre-Yves

    2014-01-01

    Portal vein thrombosis (PVT) is a rare but potentially life-threatening complication of laparoscopic splenectomy (LS) and can lead to bowel ischemia or portal hypertension. In childhood, this complication is reported in 5-10 % of the cases whereas it can be up to 50 % in adult population. Our aim was to evaluate PVT incidence after LS and associated risks factors. A retrospective chart review identified 37 children who underwent elective LS from 2005 to 2013. The main indications were spherocytosis or sickle cell disease. Median age and weight were respectively 7.4 years and 25.1 kg. Thromboembolic prophylaxis was not routinely given. Duration of surgery was 129 min and hospital length of stay 4 days. Doppler ultrasound scan (USS) was performed post-operatively in 26 cases. Post-operative course was uneventful in all but one patient. She was a 17 year-old girl previously operated for an ovarian tumor with hyperandrogenism. Histopathology revealed a splenic lymphoma. At day 4, a systematic USS showed a PVT extending in the portal branches. Therapeutic low molecular weight heparin was used and then transitioned to fluindione for 3 months. Follow-up USS performed at 1 and 4 months demonstrated complete resolution of the PVT. PVT after pediatric LS is a rare event in our series. Clinician should be cautious in oncologic cases and if very large spleen or if thrombocythemia >650.10(9)/L is present. If detected early, PVT can be treated efficiently. We therefore recommend a systematic USS during the first postoperative week.

  2. Risk Factors for Portal Vein Thrombosis in Patients With Cirrhosis Awaiting Liver Transplantation in Shiraz, Iran

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    Bagheri Lankarani

    2015-12-01

    Full Text Available Background Portal vein thrombosis is a fairly common and potentially life-threatening complication in patients with liver cirrhosis. The risk factors for portal vein thrombosis in these patients are still not fully understood. Objectives This study aimed to investigate the associations between various risk factors in cirrhotic patients and the development of portal vein thrombosis. Patients and Methods In this case-control study performed at the Shiraz organ transplantation center, Iran, we studied 219 patients (> 18 years old with liver cirrhosis, who were awaiting liver transplants in our unit, from November 2010 to May 2011. The patients were evaluated by history, physical examination, and laboratory tests, including factor V Leiden, prothrombin gene mutation, Janus Kinase 2 (JAK2 mutation, and serum levels of protein C, protein S, antithrombin III, homocysteine, factor VIII, and anticardiolipin antibodies. Results There was no statistically significant difference in the assessed hypercoagulable states between patients with or without portal vein thrombosis. A history of previous variceal bleeding with subsequent endoscopic treatment in patients with portal vein thrombosis was significantly higher than in those without it (P = 0.013, OR: 2.526, 95% CI: 1.200 - 5.317. Conclusions In our population of cirrhotic patients, treatment of variceal bleeding predisposed the patients to portal vein thrombosis, but hypercoagulable disorders by themselves were not associated with portal vein thrombosis.

  3. [Experimental study of partial arterialization of the portal vein on the dearterialized liver].

    Science.gov (United States)

    Maeda, K

    1991-06-01

    The influence of hepatic arterial obstruction on the hepatic circulation and tissue metabolism was studied between animals with and without partial arterialization of the portal vein. Mongrel dogs were divided into these groups: a group in which the collaterals to the liver were obstructed and the hepatic artery was dissected (hepatic artery ligated group); two groups in which an extracorporeal femoral artery-portal vein shunt was produced, and blood was sent by a Biopump at a rate of 100 or 200 ml/min (100 ml/min and 200 ml/min portal arterialized groups). The hepatic artery ligated group showed CO2 accumulation and acidosis in hepatic venous blood, reduction of oxygen supply, increase of oxygen consumption and marked increase of GOT and GPT. In the portal arterialized groups, sufficient oxygenation of portal blood was noted, and the oxygen demand and supply and tissue metabolism were kept approximately normal. The optimum flow rate for partial arterialization of the portal vein seemed to be 100 ml/min. At the flow rate of 200 ml/min, the original portal blood was reduced, leading to portal hypertension and increase of GOT and GPT. These results indicate that partial arterialization of the portal vein effectively preserves the liver function during the operation and in the early period after dissection of the hepatic artery.

  4. Prevention and treatment of rethrombosis after liver transplantation with an implantable pump of the portal vein.

    Science.gov (United States)

    Shi, Zhengrong; Yan, Lunan; Zhao, Jichun; Li, Bo; Wen, Tianfu; Xu, Mingqing; Wang, Wentao; Chen, Zheyu; Yang, Jiaying

    2010-03-01

    Implantable pumps have been used to prevent deep vein thrombosis and other diseases. In this article, we report for the first time the prevention and treatment of rethrombosis of the portal vein in liver transplantation with an implantable pump of the portal vein. Four hundred four orthotopic liver transplantation cases were retrospectively reviewed and divided into 3 groups: portal vein thrombosis (PVT) patients with an implantable pump (n = 28), PVT patients without an implantable pump (n = 20), and patients without preexisting PVT (n = 356). The following parameters for the 3 groups of patients were calculated and compared: (1) preoperative parameters, including baseline data of the donors and recipients and times of graft ischemia; (2) intraoperative and postoperative parameters, including surgery time, red blood cell and plasma transfusion, platelet concentrate transfusion, bleeding and primary graft malfunction, and duration of the hospital and intensive care unit stays; and (3) follow-up information for the patency of the portal vein, rethrombosis rate, stenosis and reoperation (relaparotomy or retransplantation), in-hospital mortality, and actuarial 1-year survival rate. Among the 3 groups of recipients, no significant differences were detected in preoperative and intraoperative parameters. However, compared to PVT patients without an implantable pump, PVT patients with an implantable pump showed remarkable reductions in their postoperative hospital stay, rethrombosis, reoperation rate, and in-hospital mortality. An implantable pump of the portal vein in liver transplantation patients can prevent and facilitate the treatment of portal vein rethrombosis and is associated with a reduction of in-hospital mortality.

  5. Effect of propranolol on portal vein pressure in patients with chronic liver disease: evaluation by perrectal portal scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Rho, Young Ho; Han, Shin; Kim, Hak Su [National Police Hospital, Seoul (Korea, Republic of)] [and others

    1999-08-01

    Propranolol is known to decrease portal pressure by reducing blood flow of portal vein. Per-rectal portal scintigraphy with Tc-99m pertechnetate has been introduced to evaluate the portal circulation and early diagnosis of liver cirrhosis. We evaluated the effects of propranolol on portal circulation by using per-rectal portal scintigraphy. We analyzed the portal hemodynamics by per-rectal portal scintigraphy in 51 patients with liver cirrhosis, 10 chronic hepatitis and 10 normal subjects. 38 patients with cirrhosis underwent per-rectal portal scintigraphy before and after propranolol medication. Per-rectal portal scintigraphy was performed after per-rectal administration of 370 MBq of Tc-99m pertechnetate. The shunt index was calculated as the ratio, expressed as a percentage of heart radioactivity to the sum of heart and liver radioactivity during the first 30 seconds. The shunt index in 40 patients with cirrhosis (59.8{+-}27.2%) was significantly higher than that of normal control (5.0{+-}1.2%, p<0.01) and chronic hepatitis (11.4{+-}3.5%, p<0.01). Shunt index was significantly different according to Child's classification and the degree of esophgageal varix (p<0.01). After propranolol medication, shunt index was significantly decreased from 59.9{+-}27.3% to 51.3{+-}15.3% (p<0.01) in 38 patients with liver cirrhosis. There was no significant difference of the amount of shunt index reduction after propranolol according to Child's classification and the degree of esophageal varix. The effect of propranolol on portal circulation was demonstrated as decreasing shunt index on per-rectal portal scintigraphy in patients with liver cirrhosis. Per-rectal portal scintigraphy may be useful to evaluate the portal circulation and to predict the effect of propranolol in patients with liver cirrhosis.

  6. Very Early Presentation of Extrahepatic Portal Vein Obstruction Causing Portal Hypertension in an Infant: Uncertainties in the Management and Therapeutic Limitations.

    Science.gov (United States)

    Khodayar-Pardo, Parisá; Peña Aldea, Andrés; Ramírez González, Ana; Meseguer Carrascosa, Adela; Calabuig Bayo, Cristina

    2016-01-01

    Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound. Neither signs of thrombosis in arteriovenous system, nor affectation of biliary tract were identified in the magnetic resonance imaging study. A significant enlargement of the caudate lobe of the liver was reported. No risk factors were detected. The differential diagnosis performed was extensive. Inherited thrombophilia and storage disorders were especially considered. Liver biopsy was normal. Upper gastrointestinal esophagogastroduodenoscopy detected two small varicose cords on the distal third of the esophagus. Finding a cavernous transformation of the portal vein with evidence of collateral circulation in such an early age is a challenging condition for professionals, since PHT may lead to severe complications during childhood and can compromise growth and development. Evidence-based guidelines for the management of PHT in adults have been published. However, follow-up and treatment of pediatric patients have not yet been standardized. Moreover, management of PHT in infants faces particular difficulties such as technical restrictions that could hinder their treatment.

  7. Very Early Presentation of Extrahepatic Portal Vein Obstruction Causing Portal Hypertension in an Infant: Uncertainties in the Management and Therapeutic Limitations

    Directory of Open Access Journals (Sweden)

    Parisá Khodayar-Pardo

    2016-07-01

    Full Text Available Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound. Neither signs of thrombosis in arteriovenous system, nor affectation of biliary tract were identified in the magnetic resonance imaging study. A significant enlargement of the caudate lobe of the liver was reported. No risk factors were detected. The differential diagnosis performed was extensive. Inherited thrombophilia and storage disorders were especially considered. Liver biopsy was normal. Upper gastrointestinal esophagogastroduodenoscopy detected two small varicose cords on the distal third of the esophagus. Finding a cavernous transformation of the portal vein with evidence of collateral circulation in such an early age is a challenging condition for professionals, since PHT may lead to severe complications during childhood and can compromise growth and development. Evidence-based guidelines for the management of PHT in adults have been published. However, follow-up and treatment of pediatric patients have not yet been standardized. Moreover, management of PHT in infants faces particular difficulties such as technical restrictions that could hinder their treatment.

  8. Very Early Presentation of Extrahepatic Portal Vein Obstruction Causing Portal Hypertension in an Infant: Uncertainties in the Management and Therapeutic Limitations

    Science.gov (United States)

    Khodayar-Pardo, Parisá; Peña Aldea, Andrés; Ramírez González, Ana; Meseguer Carrascosa, Adela; Calabuig Bayo, Cristina

    2016-01-01

    Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound. Neither signs of thrombosis in arteriovenous system, nor affectation of biliary tract were identified in the magnetic resonance imaging study. A significant enlargement of the caudate lobe of the liver was reported. No risk factors were detected. The differential diagnosis performed was extensive. Inherited thrombophilia and storage disorders were especially considered. Liver biopsy was normal. Upper gastrointestinal esophagogastroduodenoscopy detected two small varicose cords on the distal third of the esophagus. Finding a cavernous transformation of the portal vein with evidence of collateral circulation in such an early age is a challenging condition for professionals, since PHT may lead to severe complications during childhood and can compromise growth and development. Evidence-based guidelines for the management of PHT in adults have been published. However, follow-up and treatment of pediatric patients have not yet been standardized. Moreover, management of PHT in infants faces particular difficulties such as technical restrictions that could hinder their treatment. PMID:27504083

  9. Congenital absence of the portal vein in a child with Turner syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Noe, Jacob A.; Burton, Edward M. [Department of Radiology, University of Tennessee College of Medicine-Chattanooga Branch, Chattanooga, TN (United States); Pittman, Heather C. [Department of Pediatrics, University of Tennessee College of Medicine-Chattanooga Branch, Chattanooga, TN (United States)

    2006-06-15

    Congenital absence of the portal vein (CAPV) is a rare malformation associated with hepatic encephalopathy and liver function abnormalities. We report a case of a 2-year-old with Turner syndrome, CAPV, and congenital heart malformations. (orig.)

  10. Splenic and portal vein thrombosis in pancreatic metastasis from Renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Loos Martin

    2006-05-01

    Full Text Available Abstract Background Pancreatic metastases from previously treated renal cell carcinoma are uncommon. Surgical resection of pancreatic metastasis remains the only worthwhile modality of treatment. Case presentation A case where pancreatic metastasis from previously resected right sided renal cell carcinoma was resected with a subtotal left pancreatectomy is described. An unusual feature was the presence of a large splenic vein tumor thrombus extending into the portal vein with associated portal hypertension. The patient underwent an uneventful portal vein resection with primary anastomosis. Conclusion This is possibly the first documented case of portal vein renal tumor thrombosis in a case of isolated pancreatic metastasis from previously operated renal cell carcinoma in published world surgical literature.

  11. Veia gástrica posterior: hipertensão porta Posterior gastric vein: portal hipertension

    Directory of Open Access Journals (Sweden)

    Alcino Lázaro da Silva

    1999-10-01

    Full Text Available A veia gástrica posterior não é muito citada nos livros de anatomia e nos trabalhos sobre hipertensão porta. Estudou-se sua anatomia, freqüência e desembocadura. Ela foi encontrada em 54% dos casos e, em 100%, desembocava na veia esplênica. Discute-se a vantagem ou não de sua ligadura ou preservação no tratamento cirúrgico da hipertensão porta.The posterior gastric vein has not been mentioned very often neither in anatomy textbooks nor in portal hypertension papers. The authors studied the anatomy, frequency and confluence of this vein because is a huge variety in the presentation of esophageal varices. Twenty-six adult preserved corpses (twenty females and six males had a wide abdominal incision allowing the dissection of the portal system, identifying the frequency and confluence of its tributaries, notably the posterior gastric vein. The portal vein, in all cases, was formed by the confluence of the superior mesenteric vein with the splenic vein and had a mean length of 6.4 cm. The splenic vein had a mean length of 6.5 cm. The left gastric vein was tributary of the portal vein in 50% of the cases and in 30% of the cases in the splenic vein. The right gastric vein had it's confluence to portal vein in 30 % of the cases and to the splenic vein in 4 %. The inferior mesenteric vein was tributary of the splenic vein in 54% of the cases and in the superior mesenteric vein in 46%. The left gastro-omental vein had its confluence to the splenic vein in 50% of the cases and to the inferior polar vein in 34 %. The middle colic vein had its confluence to superior mesenteric vein in 42% of the cases, to inferior mesenteric vein in 12% and to splenic vein in 8%. The posterior gastric vein was found in 54% of the corpses, and in all cases it was a tributary of the splenic vein, in retropancreatic position, coming from the esophageal-gastric junction. These findings agree with previous papers describing a prevalence of 60% of posterior gastric

  12. Pancreaticoduodenectomy assisted by 3-D visualization reconstruction and portal vein arterialization

    OpenAIRE

    Su, Zhao-jie; Li, Wen-Gang; Huang, Jun-li; Xiao, Lin-feng; Chen, Fu-zhen; WANG, BO-LIANG

    2016-01-01

    Abstract Background: Three-dimensional visualization reconstruction, the 3-D visualization model reconstructed by software using 2-D CT images, has been widely applied in medicine; but it has rarely been applied in pancreaticoduodenectomy. Although the hepatic artery is very important for the liver, it has to be removed when tumor invades it. Therefore, portal vein arterialization has been used in clinic as a remedial measure, but there still is professional debate on portal vein arterializat...

  13. Trombose de veia porta em crianças e adolescentes Portal vein thrombosis in children and adolescents

    Directory of Open Access Journals (Sweden)

    Graziela C. M. Schettino

    2006-06-01

    literature of the past 10 years was reviewed using the PubMed and MEDLINE search engines, with major focus on portal vein thrombosis and its clinical outcomes. The following keywords or expressions were used for the web search: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Additionally, we also reviewed the articles cited in the references of the initially selected papers, as well as relevant textbooks. SUMMARY OF THE FINDINGS: Portal vein thrombosis is one of the most common causes of portal hypertension among children. The initial clinical manifestation is characterized either by episodes of upper gastrointestinal bleeding or by splenomegaly on routine clinical examination. The major complications include upper gastrointestinal bleeding, hypersplenism secondary to splenomegaly, growth retardation, and portal biliopathy. The diagnosis is made by abdominal Doppler ultrasonography. Treatment is targeted at the complications and includes primary and secondary prophylaxis against upper gastrointestinal bleeding (which results from the rupture of esophageal varices, and portosystemic shunting in selected cases. CONCLUSIONS: Portal vein thrombosis is one of the major triggers of upper gastrointestinal bleeding in children. Bleeding episodes have a remarkable effect on the quality of life of affected patients. Thus, appropriate diagnosis and treatment are needed in order to reduce morbidity and mortality.

  14. Doppler-ultrasonographic finding of air in the portal vein: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ki Soon; Lee, Kwan Sup; Lee, Yul; Chung, Soo Young; Bae, Sang Hoon [College of Medicine, Hallym University, Seoul (Korea, Republic of)

    1994-03-15

    Classically air in the portal vein has been detected on plain radiography, but computed tomography and ultrasonography have been shown to be more sensitive. We report a case of air in the PV in a 10-day-old infant with pneumatosis intestinalis with its ultrasonographic and Doppler findings. The patient was a 10-day-old infant born by cesarean section at 41 weeks. Simple abdomen film revealed branching pattern of radiolucent air shadows within in contour of liver, gas distention of bowel loops and thickenod bowel walls with lincar intraluminal air shadows in abdomen, suggesting necrotizing enterocolitis. So we performed Doppler ultrasonography. Ultrasonography showed branching pattern of hyperechogenic dots and along the lumen of left portal vein. The color Doppler study revealed an aliasing duo to increased velocity and whirling pattern of blood flow, and the Duplex Doppler spectral display showed sharp, vertical bidirectional spikes by air in portal vein. Air in the portal vein can be easily diagnosed by the following signs: hyperechogenic dots in the portal vein on ultrasonography and vertical, sharp bidirectional spikes superimposed on the usual Doppler tracing of the portal vein on Duplex ultrasonography.

  15. Nodular regenerative hyperplasia, portal vein thrombosis, and avascular hip necrosis due to hyperhomocysteinaemia

    OpenAIRE

    2005-01-01

    A male patient with portal hypertension, portal vein thrombosis, spontaneous splenorenal shunt formation, and encephalopathy, thought to have post-hepatitis B cirrhosis, is described. His condition deteriorated and necessitated liver transplantation. In the explant liver, nodular regenerative hyperplasia with pronounced vascular lesions both in portal venules and in arterioles was found instead of classical cirrhosis. Two years post-transplant he developed bilateral ischaemic femur head necro...

  16. SUPERIOR MESENTERIC AND PORTAL VEIN THROMBOSIS WITH HYPERHOMOCYSTEINEMIA

    Directory of Open Access Journals (Sweden)

    Tumma

    2015-02-01

    Full Text Available Superior mesenteric venous thrombosis is a rare & life threatening condition. We report a case of 18 years old boy presented to emergency department with pain abdomen, fever, Melena for almost week duration. Bowel sounds were absent since two days. With a preoperative diagnosis of peritonitis Patient was taken up for emergency laparotomy. Resection of gangrenous small bowel and end to end anastomosis was done. Intra operatively thrombus in SMV was found. Coagulation profile was normal except for elevated homocystine levels. Early postoperative period was stormy. Patient was started on LMV Heparin from day - 1. Pregangrenous changes were seen in contrast CT abdomen on Day - 4. We managed conservatively with anticoagulation therapy in the postoperative period. Pregangrenous changes disappeared with conservative management. Patient was shifted to oral warfarin and discharged on 3 rd week. Follow up Doppler USG abdomen revealed a portal vein of normal size & caliber with no evidence of thrombus. On postoperative follow up for one year, patient is doing well. Hyperhomocycteinemia is an independent predisposing factor to superior mesenteric venous thrombus.

  17. Portal Vein Embolization: Impact of Chemotherapy and Genetic Mutations

    Science.gov (United States)

    Deipolyi, Amy R.; Zhang, Yu Shrike; Khademhosseini, Ali; Naidu, Sailendra; Borad, Mitesh; Sahin, Burcu; Mathur, Amit K.; Oklu, Rahmi

    2017-01-01

    We characterized the effect of systemic therapy given after portal vein embolization (PVE) and before hepatectomy on hepatic tumor and functional liver remnant (FLR) volumes. All 76 patients who underwent right PVE from 2002–2016 were retrospectively studied. Etiologies included colorectal cancer (n = 44), hepatocellular carcinoma (n = 17), cholangiocarcinoma (n = 10), and other metastases (n = 5). Imaging before and after PVE was assessed. Chart review revealed systemic therapy administration, SNaPshot genetic profiling, and comorbidities. Nine patients received systemic therapy; 67 did not. Tumor volume increased 28% in patients who did not receive and decreased −24% in patients who did receive systemic therapy (p = 0.026), with no difference in FLR growth (28% vs. 34%; p = 0.645). Among 30 patients with genetic profiling, 15 were wild type and 15 had mutations. Mutations were an independent predictor of tumor growth (p = 0.049), but did not impact FLR growth (32% vs. 28%; p = 0.93). Neither cirrhosis, hepatic steatosis, nor diabetes impacted changes in tumor or FLR volume (p > 0.20). Systemic therapy administered after PVE before hepatic lobectomy had no effect on FLR growth; however, it was associated with decreasing tumor volumes. Continuing systemic therapy until hepatectomy may be warranted, particularly in patients with genetic mutations. PMID:28257031

  18. Balloon occlusion retrograde transvenous obliteration of gastric varices in two-cirrhotic patients with portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Borhei, Peyman; Kim, Seung Kwon; Zukerman, Darryl A [Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2014-02-15

    This report describes two non-cirrhotic patients with portal vein thrombosis who underwent successful balloon occlusion retrograde transvenous obliteration (BRTO) of gastric varices with a satisfactory response and no complications. One patient was a 35-year-old female with a history of Crohn's disease, status post-total abdominal colectomy, and portal vein and mesenteric vein thrombosis. The other patient was a 51-year-old female with necrotizing pancreatitis, portal vein thrombosis, and gastric varices. The BRTO procedure was a useful treatment for gastric varices in non-cirrhotic patients with portal vein thrombosis in the presence of a gastrorenal shunt.

  19. Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Bercu, Zachary L., E-mail: zachary.bercu@mountsinai.org; Sheth, Sachin B., E-mail: sachinsheth@gmail.com [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States); Noor, Amir, E-mail: amir.noor@gmail.com [The George Washington University School of Medicine and Health Sciences (United States); Lookstein, Robert A., E-mail: robert.lookstein@mountsinai.org; Fischman, Aaron M., E-mail: aaron.fischman@mountsinai.org; Nowakowski, F. Scott, E-mail: scott.nowakowski@mountsinai.org; Kim, Edward, E-mail: edward.kim@mountsinai.org; Patel, Rahul S., E-mail: rahul.patel@mountsinai.org [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States)

    2015-10-15

    The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation.

  20. Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization

    Institute of Scientific and Technical Information of China (English)

    Yu Zhang; Tian-Fu Wen; Lu-Nan Yan; Hong-Ji Yang; Xiao-Fan Deng; Chuan Li; Chuan Wang; Guan-Lin Liang

    2012-01-01

    AIM:To evaluate the predictive value of preoperative predictors for portal vein thrombosis (PVT) after splenectomy with periesophagogastric devascularization.METHODS:In this prospective study,69 continuous patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy with periesophagogastric devascularization in West China Hospital of Sichuan University from January 2007 to August 2010.The portal vein flow velocity and the diameter of portal vein were measured by Doppler sonography.The hepatic congestion index and the ratio of velocity and diameter were calculated before operation.The prothrombin time (PT) and platelet (PLT) levels were measured before and after operation.The patients' spleens were weighed postoperatively.RESULTS:The diameter of portal vein was negatively correlated with the portal vein flow velocity (P < 0.05).Thirty-three cases (47.83%) suffered from postoperative PVT.There was no statistically significant difference in the Child-Pugh score,the spleen weights,the PT,or PLT levels between patients with PVT and without PVT.Receiver operating characteristic curves showed four variables (portal vein flow velocity,the ratio of velocity and diameter,hepatic congestion index and diameter of portal vein) could be used as preoperative predictors of postoperative portal vein thrombosis.The respective values of the area under the curve were 0.865,0.893,0.884 and 0.742,and the respective cut-off values (24.45 cm/s,19.4333/s,0.1138 cm/s-1 and 13.5 mm)were of diagnostically efficient,generating sensitivity values of 87.9%,93.9%,87.9% and 81.8%,respectively,specificities of 75%,77.8%,86.1% and 63.9%,respectively.CONCLUSION:The ratio of velocity and diameter was the most accurate preoperative predictor of portal vein thrombosis after splenectomy with periesophagogastric devascularization in hepatitis B cirrhosis-related portal hypertension.

  1. Is portal vein cavernous transformation a component of congenital hepatic fibrosis?

    Institute of Scientific and Technical Information of China (English)

    Ozlem Yonem; Yusuf Bayraktar

    2007-01-01

    Congenital hepatic fibrosis (CHF) is an autosomal recessive disorder that belongs to the family of fibropolycystic liver diseases. This family includes a spectrum of disorders which are usually found in combination with each other and are usually inherited.Clinically fibropolycystic diseases have three effects being present in different proportions, those of a space occupying lesion, of portal hypertension and of cholangitis. In most patients, the first manifestations of CHF are signs and symptoms related to portal hypertension such as splenomegaly and varices. Portal hypertension in these patients has been attributed to the hypoplasia or compression of the portal vein radicles in the fibrous bands. Cavernous transformation of the portal vein (CTPV) is a relatively rare condition resulting from extrahepatic portal vein obstruction with recanalization or collateral vein formation to bypass the obstruction. It has been found that patients with CHF having an accompanying CTPV have relatively large splenomegaly and suffers more frequent episodes of bleeding from esophageal varices. We believe that CTPV is a congenital component of CHF and also one of the important causative factors of portal hypertension in these patients.

  2. Effects of albendazole nanoparticles in mice with hepatic echinococosis: Portal vein cannulation versus intravenous administration.

    Science.gov (United States)

    Zhu, Di-Wen; Zhang, Ming-Xing; Bao, Ying-Jun; Gu, Jun-Peng; Ji, Wei-Zheng; Zhang, Hai-Xiao; Ren, Wei-Xin

    2015-07-01

    To compare the ABZ and its metabolites concentration in cyst tissue of hepatic alveolar echinococcosis administered by different routes, forty male Wistar rats receiving albendazole nanoparticles from tail vein and portal vein were divided into two groups, the concentration of ABZ and its metabolites ABZSO, ABZSO2, in the cyst tissue, were analyzed by HPLC at 2, 4, 8, 24, 36 h after administration. The parent drug and its metabolites were detected in plasm and the cyst tissue after portal cannulation and intravenous administration. The last results were the concentration of ABZ in the portal cannulation group was higher than in the intravenous group at every time point (p < 0.05). Compared to the intravenous group, the portal cannulation administration of ABZ led to a lower plasm concentration of ABZ. The concentration of ABZ and the active ABZSO were significantly higher in the portal cannulation group than that of the intravenous group.

  3. Balloon occlusion versus wedged hepatic venography using iodinated contrast for targeting the portal vein during TIPS.

    Science.gov (United States)

    Caporossi, J-M; Vidal, V; Jacquier, A; Reyre, A; Flavian, A; Muller, C; Gaubert, J-Y; Bartoli, J-M; Moulin, G; Varoquaux, A

    2015-04-01

    To assess the efficacy, safety and gain in procedure time of the technique of balloon occlusion hepatic venography with iodinated contrast used to target the portal vein during TIPS. The technique is assessed versus wedged hepatic venography. Fifty-eight TIPS were prospectively included. The portal vein was located in 30 cases by the wedged hepatic venography (group 1) and in 28 cases by balloon occlusion hepatic venography (group 2). To compare both techniques a "portogram quality" score was defined using a 5 points scale. The time required to achieve portal puncture was also recorded. The complications of both procedures were assessed and classified in groups as intrahepatic hematoma or intraperitoneal hemorrhage. The right portal vein was visualized in a significantly higher number of patients using balloon than with wedged retrograde venography 71.3% (20/28) versus 13.3% (4/30) respectively (P=0.002). The quality score for the portogram was significantly higher for balloon hepatic venography 2.21 than for wedged hepatic venography 1.07 (P=0.002). The mean time required to puncture the portal vein was significantly shorter when the right branch of the portal vein was visualized 21 min versus 33.5 min (P=0.046). We recorded one intrahepatic hematoma (3.3%) and 4 intraperitoneal hemorrhage (13.3%) secondary to wedged hepatic venography. There were no complications with balloon occlusion hepatic venography (P=0.053). The use of balloon occlusion hepatic venography improves the quality of the retrograde portal venography to target the portal vein and decreases procedure time. The balloon technique is also burdened with fewer complications than the standard wedged hepatic venography. Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  4. Portal Vein Embolization Before Liver Resection: A Systematic Review

    Energy Technology Data Exchange (ETDEWEB)

    Lienden, K. P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands); Esschert, J. W. van den; Graaf, W. de [Academic Medical Center, Department of Surgery (Netherlands); Bipat, S.; Lameris, J. S. [Academic Medical Center, Department of Radiology (Netherlands); Gulik, T. M. van [Academic Medical Center, Department of Surgery (Netherlands); Delden, O. M. van [Academic Medical Center, Department of Radiology (Netherlands)

    2013-02-15

    This is a review of literature on the indications, technique, and outcome of portal vein embolization (PVE). A systematic literature search on outcome of PVE from 1990 to 2011 was performed in Medline, Cochrane, and Embase databases. Forty-four articles were selected, including 1,791 patients with a mean age of 61 {+-} 4.1 years. Overall technical success rate was 99.3 %. The mean hypertrophy rate of the FRL after PVE was 37.9 {+-} 0.1 %. In 70 patients (3.9 %), surgery was not performed because of failure of PVE (clinical success rate 96.1 %). In 51 patients (2.8 %), the hypertrophy response was insufficient to perform liver resection. In the other 17 cases, 12 did not technically succeed (0.7 %) and 7 caused a complication leading to unresectability (0.4 %). In 6.1 %, resection was cancelled because of local tumor progression after PVE. Major complications were seen in 2.5 %, and the mortality rate was 0.1 %. A head-to-head comparison shows a negative effect of liver cirrhosis on hypertrophy response. The use of n-butyl cyanoacrylate seems to have a greater effect on hypertrophy, but the difference with other embolization materials did not reach statistical significance. No difference in regeneration is seen in patients with cholestasis or chemotherapy. Preoperative PVE has a high technical and clinical success rate. Liver cirrhosis has a negative effect on regeneration, but cholestasis and chemotherapy do not seem to have an influence on the hypertrophy response. The use of n-butyl cyanoacrylate may result in a greater hypertrophy response compared with other embolization materials used.

  5. Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical and Technical Considerations for Successful Outcomes

    Directory of Open Access Journals (Sweden)

    Sonia Tewani Orcutt

    2016-03-01

    Full Text Available Preoperative portal vein embolization (PVE is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other’s techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient’s anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications and how to avoid the complications in each step is of great importance for safe and successful PVE, and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

  6. Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical, and Technical Considerations.

    Science.gov (United States)

    Orcutt, Sonia T; Kobayashi, Katsuhiro; Sultenfuss, Mark; Hailey, Brian S; Sparks, Anthony; Satpathy, Bighnesh; Anaya, Daniel A

    2016-01-01

    Preoperative portal vein embolization (PVE) is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other's techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient's anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications, and how to avoid the complications in each step is of great importance for safe and successful PVE and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

  7. Acute portal vein thrombosis due to chronic relapsing pancreatitis: a fistula between a pancreatic pseudocyst and the splenic vein.

    Science.gov (United States)

    Kikuchi, Masahiro; Nishizaki, Yasuhiro; Tsuruya, Kota; Hamada, Ikuko; Higashi, Toru; Sakuma, Keiko; Shiozawa, Hirokazu; Aoki, Jun; Nagashima, Rena; Koizumi, Jun; Arase, Yoshitaka; Shiraishi, Koichi; Matsushima, Masashi; Mine, Tetsuya

    2014-02-01

    Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but several other causes might play an important role in PVT pathogenesis. We present a case of alcoholic chronic pancreatitis complicated by acute extensive PVT. The patient was managed conservatively with danaparoid sodium at first, but the thrombosis gradually extended. We then tried radiological intervention using the direct transhepatic and transjugular intrahepatic postsystemic shunt approaches. Although we were able to successfully catheterize the percutaneous transhepatic portal vein (PTP), we could not achieve recanalization of the portal vein. Therefore, PTP catheterization and systemic intravenous infusion of urokinase and heparin was performed to prevent further progression of the thrombosis and cavernous transformation was finally achieved. Computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a pancreatic stone which had possibly induced dilatation of the tail duct and formation of a pancreatic pseudocyst and caused intractable pancreatitis. We performed endoscopic retrograde cholangiopancreatography and placed a stent in the pancreatic duct, which completely cured the pancreatitis. Retrospectively, the previous CT with curved multi-planar reconstruction was reviewed and a fistula was detected between the pancreatic pseudocyst and splenic vein. We concluded that the etiology of the PVT was not only inflammatory extension from pancreatitis but also a fistula between the pancreatic duct and the splenic vein.

  8. Imaging and radiological interventions in extra-hepatic portal vein obstruction

    Institute of Scientific and Technical Information of China (English)

    Sudheer S Pargewar; Saloni N Desai; S Rajesh; Vaibhav P Singh; Ankur Arora; Amar Mukund

    2016-01-01

    Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension(PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt(PSS) and revision of PSS.

  9. Imaging and radiological interventions in extra-hepatic portal vein obstruction.

    Science.gov (United States)

    Pargewar, Sudheer S; Desai, Saloni N; Rajesh, S; Singh, Vaibhav P; Arora, Ankur; Mukund, Amar

    2016-06-28

    Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS.

  10. The value of ultrasonography in the diagnosis of portal vein thrombosis by umbilical venous catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kwang Keun; Kim, Young Tong; Kim, Il Young [Chonan Hospital, Soonchunhyang University, Chonan (Korea, Republic of)

    2000-12-15

    To evaluate the usefulness of ultrasonography for diagnosis of portal vein thrombosis (PVT) associated with the umbilical venous catheterization (UVC). We reviewed the abnormal ultrasonography of 54 patients with UVC. We observed echogenic thrombus in the portal vein by ultrasonography which has a 5-10 MHz linear transducer. We evaluated the frequency of PVT, the relationship between PVT and duration of UVC, and the location of catheter tip (Group I (n=41): above the diaphragm, Group II (n=9): between the diaphragm and the liver, Group III (n=4): below the liver), the location of thrombus on US, and the change of PVT on the follow-up ultrasonography. PVT was identified in the 7 neonates (13%) among the 54 neonates with UVC. The frequency of PVT was 5% on group I, 45% on group II and 25% on group III. The 6 cases among the 7 cases(86%) of PVT were localized to the umbilical portion of the left portal vein, and there were completely resolved (n=4) or regressed (n=1) on the follow-up ultrasonography(n=5). Remaining one case of PVT was located in the right, left, and main portal veins with collateral formation, and cavernous transformation occurred on the follow-up. Most PVTs by UVC are localized to the umbilical portion of left portal vein. Ultrasonography is a useful modality to diagnose PVT by UVC.

  11. Percutaneous angioplasty of portal vein stenosis that complicated liver transplantation: the mid-term therapeutic results

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kwang Bo; Choo, Sung Wook; Do, Young Soo; Shin, Sung Wook; Cho, Sung Gi; Choo, In Wook [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-09-15

    We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation. From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography. The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach. Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique.

  12. Extended Hemi-Hepatectomy with Portal Vein Reconstruction in a Patient with Situs Ambiguous

    Directory of Open Access Journals (Sweden)

    Keishi Sugimachi

    2008-03-01

    Full Text Available We report a case of far-advanced hepatocellular carcinoma (HCC with situs ambiguous, complex visceral and vascular anomalies, who was successfully managed by extended hemi-hepatectomy. A 67-year-old man was referred to our hospital with a large liver mass. Abdominal ultrasonography, computed tomography and angiography revealed HCC with a diameter of 10 cm, with tumor thrombus in the main and first branch of the portal vein. Multiple complex anomalies in the abdomen were determined preoperatively. He had right-sided spleens-stomach-duodenum, liver at midline, inferior vena cava interruption with azygous continuation, and hepatic arterial anomaly. Extended left lobectomy of the liver with reconstruction of the portal vein was performed. Postoperatively, the patient recovered without major complications, and he was discharged on postoperative day 21. We report the first successful extended hepatectomy with portal vein reconstruction for HCC in a patient with rare situs anomalies.

  13. Splenic and portal vein thrombosis following laparoscopic splenectomy in a pediatric patient with chronic myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Henrique Manoel Lederman

    Full Text Available CONTEXT: Splenic or portal vein thrombosis is a rare complication following splenectomy. CASE REPORT: We report a case of splenic and portal venous thrombosis in a 10-year-old girl with chronic myeloid leukemia who underwent laparoscopic splenectomy prior to bone marrow transplant. Clinical suspicion of such thrombosis should be high for patients who have had splenectomy. The diagnosis is confirmed by Doppler ultrasound or contrast-enhanced computed tomography; magnetic resonance imaging magnetic resonance angiography or arteriography can also be used. Proposals for postoperative screening protocols are discussed. Patients with primary myeloproliferative disorders are at increased risk of portal vein thrombosis, independent of surgical intervention, perhaps due to platelet dysfunction resulting from abnormalities of pluripotent stem cells. Marked splenomegaly (with larger draining veins is thought to increase the risk of thrombosis.

  14. Multidetector CT venography and contrast-enhanced MR venography of the inferior mesenteric vein in paediatric extrahepatic portal vein obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Chennur, Vikash SrinivasaiahSetty; Sharma, Raju; Gamanagatti, Shivanand; Gupta, Arun Kumar [All India Institute of Medical Sciences (AIIMS), Department of Radiology, New Delhi (India); Bhatnagar, Veereshwar [AIIMS, Department of Paediatric Surgery, New Delhi (India); Vishnubhatla, Sreenivas [AIIMS, Department of Biostatistics, New Delhi (India)

    2011-03-15

    Extrahepatic portal vein obstruction (EHPVO) is a common cause of paediatric portal hypertension and the only permanent treatment is shunt surgery. The inferior mesenteric vein (IMV) is a portal venous channel that can be used for the shunt when the splenic vein/superior mesenteric vein is thrombosed or when a lienorenal shunt is not possible. To compare MDCT venography (MDCTV) and contrast-enhanced MR venography (CEMRV) for visualisation of the IMV in children with EHPVO. This was a prospective study of 26 children (4-12 years, median 10 years) who underwent MDCTV and CEMRV. The IMV visualisation was graded using 4- and 2-point scales and the difference in visualisation was assessed by calculating the exact significance probability (P). The IMV was visualised in all children on MDCTV and 25/26 children on CEMRV (96%). The images were diagnostic in 23/26 children (88%) on MDCTV and in 18/26 (69%) children on CEMRV (P = 0.063). MDCTV and CEMRV are comparable for IMV visualisation with a tendency toward MDCTV being superior. (orig.)

  15. Hyperbaric oxygenation after portal vein emobilization for regeneration of the predicted remnant liver.

    Science.gov (United States)

    Uwagawa, T; Unemura, Y; Yamazaki, Y

    2001-09-01

    Liver failure often develops after extensive liver resection. Preoperative portal vein embolization to induce compensatory hypertrophy in the predicted remnant liver decreases clinical complications after hepatectomy. The aim of this study was to examine whether hyperbaric oxygenation (HBO) after portal vein embolization increases compensatory hypertrophy of the predicted liver remnant. We performed portal vein ligation and HBO in rats to investigate whether HBO after portal vein embolization increases compensatory hypertrophy of the predicted remnant liver. Rats were divided into four groups that underwent (1) laparotomy only (control group); (2) right portal vein ligation (RPL group); (3) RPL followed by HBO at 2 atm (HBO-2 atm group; 1 h/day, 5 days/week for 2 weeks); or (4) RPL followed by HBO at 3 atm (HBO-3 atm group). Laparotomy was repeated after 2 weeks in each group; serum levels of albumin and hepatocyte growth factor (HGF) were measured, and the ratio of the weights of nonligated to ligated hepatic segments and the percentage of hepatocytes expressing proliferating cell nuclear antigen (PCNA) in ligated hepatic segments were determined. In rats that had received HBO after RPL, serum levels of HGF, weight ratios of nonligated to ligated hepatic segments, and the percentage of PCNA-positive hepatocytes in nonligated liver were significantly higher than those in the control group. Furthermore, rats that had undergone 3-atm HBO after RPL had significantly higher serum levels of HGF and percentages of PCNA-positive hepatocytes in nonligated hepatic segments. Preoperative HBO after portal vein embolization may be useful for inducing compensatory hypertrophy of the predicted remnant liver. Copyright 2001 Academic Press.

  16. Improved technique of heterotopic auxiliary rat liver transplantation with portal vein arterialization.

    Science.gov (United States)

    Schleimer, Karina; Stippel, Dirk L; Tawadros, Samir; Hölzen, J; Hölscher, A H; Beckurts, K Tobias E

    2006-04-01

    In acute, potentially reversible hepatic failure, auxiliary liver transplantation is a promising alternative approach. Using the auxiliary partial orthotopic liver transplantation (APOLT) method--the orthotopic implantation of auxiliary segments--most of the technical problems (lack of space for the additional liver mass, the portal vein reconstruction, and the venous outflow) are avoided, but extensive resections of the native liver and the graft are necessary. Erhard described the heterotopic auxiliary liver transplantation (HALT) with portal vein arterialization (PVA). Initial clinical results demonstrated that an adequate liver function can be achieved using this technique. We developed and improved a technique of HALT with flow-regulated PVA in the rat to perform further investigations. The aim of this paper is to explain in detail this improved experimental surgical technique. Liver transplantations were performed in 122 male Lewis rats: After a right nephrectomy, the liver graft, which was reduced to about 30% of the original size, was implanted into the right upper quadrant of the recipient's abdomen. The infrahepatic caval vein was anastomosed end-to-side. The donor's portal vein was completely arterialized to the recipient's right renal artery in stent technique. Using a stent with an internal diameter of 0.3 mm, the flow in the arterialized portal vein was regulated to achieve physiologic parameters. The celiac trunk of the graft was anastomosed to the recipient's aorta, end-to-side. The bile duct was implanted into the duodenum. After improvements of the surgical technique, we achieved a perioperative survival of 90% and a 6-week survival of 80% in the last 112 transplantations. We developed a standardized and improved technique, which can be used for experiments of regeneration and inter-liver competition in auxiliary liver transplantation. Furthermore, this technique is suitable for the investigation of the influence of portal vein arterialization and

  17. Reconstruction of the portal vein with 64-slice spiral CT of bile duct obstruction

    OpenAIRE

    Xia, Yunbao; PAN, GONGMAO; Xue, Feng; Geng, Chengjun

    2013-01-01

    The aim of this study was to evaluate 64-slice spiral CT image reconstruction of the portal vein in biliary obstruction. A total of 34 clinical patients with biliary obstruction were confirmed by 64-slice spiral CT scanning with portal venous phase multi-planar reconstruction (MPR) of the biliary tract, curved planar reconstruction (CPR), thin-slab minimum-intensity projection (TS-MinIP) and maximum intensity projection (MIP). The reconstructed images were reviewed to further assess the posit...

  18. Intrahepatic Left to Right Portoportal Venous Collateral Vascular Formation in Patients Undergoing Right Portal Vein Ligation

    Energy Technology Data Exchange (ETDEWEB)

    Lienden, K. P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Center, University of Amsterdam, Department of Interventional Radiology (Netherlands); Hoekstra, L. T. [Academic Medical Center, University of Amsterdam, Department of Surgery (Netherlands); Bennink, R. J. [Academic Medical Center, University of Amsterdam, Department of Nuclear Medicine (Netherlands); Gulik, T. M. van [Academic Medical Center, University of Amsterdam, Department of Surgery (Netherlands)

    2013-12-15

    Purpose: We investigated intrahepatic vascular changes in patients undergoing right portal vein ligation (PVL) or portal vein embolization (PVE) in conjunction with the ensuing hypertrophic response and function of the left liver lobe. Methods: Between December 2008 and October 2011, 7 patients underwent right PVL and 14 patients PVE. Computed tomographic (CT) volumetry to assess future remnant liver (FRL) and functional hepatobiliary scintigraphy were performed in all patients before and 3 weeks after portal vein occlusion. In 18 patients an intraoperative portography was performed to assess perfusion through the occluded portal branches. Results: In all patients after initially successful PVL, reperfused portal veins were observed on CT scan 3 weeks after portal occlusion. This was confirmed in all cases during intraoperative portography. Intrahepatic portoportal collaterals were identified in all patients in the PVL group and in one patient in the PVE group. In all other PVE patients, complete occlusion of the embolized portal branches was observed on CT scan and on intraoperative portography. The median increase of FRL volume after PVE was 41.6 % (range 10-305 %), and after PVL was only 8.1 % (range 0-102 %) (p = 0.179). There were no differences in FRL function between both groups. Conclusion: Preoperative PVE and PVL are both methods to induce hypertrophy of the FRL in anticipation of major liver resection. Compared to PVE, PVL seems less efficient in inducing hypertrophy of the nonoccluded left lobe. This could be caused by the formation of intrahepatic portoportal neocollateral vessels, through which the ligated portal branches are reperfused within 3 weeks.

  19. Extralobar pulmonary sequestration with venous drainage to the portal vein: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kamata, S.; Sawai, T.; Nose, K.; Hasagawa, T.; Nakajima, K.; Soh, H.; Okada, A. [Department of Paediatric Surgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan)

    2000-07-01

    Venous drainage to the portal vein in pulmonary sequestration is rare. A 7-month-old girl was referred to our hospital following surgery for ventricular septal defect because of a left upper abdominal mass with a large feeding artery from the abdominal aorta and venous drainage to the portal vein. She had had frequent pulmonary infections and was growth retarded. MRI demonstrated that the mass was above the left diaphragm, suggesting extralobar sequestration. An extralobar sequestered lung was resected at thoracotomy. Diagnostic problems and clinical features are presented. (orig.)

  20. The role of the preoperative portal vein embolization in major hepatectomy

    Energy Technology Data Exchange (ETDEWEB)

    Bang, Sun Woo; Sung, Kyu Bo; Song, Ho Young; Cho, Kyoung Sik; Lee, Sung Gyu; Kwon, Tae Won [University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    1995-05-15

    To assess the role of the preoperative portal vein embolization (PVE) in patients in need of major hepatectomy. Total of 11 cases consisted of Klatskin tumor (n = 6), gallbladder cancer (n = 2), and hepatocellular carcinoma (n = 3). After percutaneous transhepatic puncture of portal vein (right: 7, left: 4), the embolization of 1st order branch of right portal vein was done with Gentamicin soaked Gelfoam cubes. Radiologically, the angle between the middle hepatic vein and the inferior vena cava was measured on pre-and post-PVE CT (F/U: 10 days) to evaluate the hypertrophy of the left lobe. Clinically, amount and nature of the drained bile through the PTBD tube of both lobes were analyzed in 5 patients with Klatskin tumor. The interval between PVE and operation was 10-24 days. Operative findings and the changes of postop, total bilirubin were analyzed and the complication after procedure was checked. There was decrease in mean angle between the middle hepatic vein and the inferior vena cava from 35.9 degree to 23.9 degree, but it was insignificant statistically ({rho} = 0.09). The embolization of right portal vein was done and there was increase in amount of drained bile from the nonembolized left lobe by 2-3 folds 8-14 days after PVE. The color and consistency between both lobes were significantly different; right lobe was darker in color and softer in consistency. Postoperative total bilirubin increased by 2-3 folds 1 to 4 days after PVE and normalized 10 to 14 days after PVE. Most of the patients had mild abdominal pain and fever after PVE and 1 patient had localized hematoma at puncture site which was subsided spontaneously. The preoperative portal vein embolization is a useful method for minimizing postoperative liver failure in patients in need of major hepatectomy.

  1. Liver volume, portal vein flow, and clearance of indocyanine green and antipyrine in hyperthyroidism before and after antithyroid treatment

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Sonne, J; Court-Payen, M

    1999-01-01

    The aim of the study was to examine liver volume, portal vein flow, and indocyanine green (ICG) and antipyrine clearance in hyperthyroidism before and after antithyroid drug treatment.......The aim of the study was to examine liver volume, portal vein flow, and indocyanine green (ICG) and antipyrine clearance in hyperthyroidism before and after antithyroid drug treatment....

  2. Catheterisation of the biliary tract and portal vein by Seldinger-technique following ultrasonic guided fine needle puncture

    Energy Technology Data Exchange (ETDEWEB)

    Elgeti, H.; Luska, G.; Kleine, P.

    1981-11-01

    The article describes an easier technique of biliary tract and portal vein catheterisation following fine needle puncture. Special biopsy equipment has been compiled for this purpose by the authors. Initial experiences revealed a considerable simplification of hepatic duct and portal vein puncture using a real time biopsy applicator. The procedure is explained by two characteristic cases.

  3. Liver volume, portal vein flow, and clearance of indocyanine green and antipyrine in hyperthyroidism before and after antithyroid treatment

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Sonne, J; Court-Payen, M

    1999-01-01

    The aim of the study was to examine liver volume, portal vein flow, and indocyanine green (ICG) and antipyrine clearance in hyperthyroidism before and after antithyroid drug treatment.......The aim of the study was to examine liver volume, portal vein flow, and indocyanine green (ICG) and antipyrine clearance in hyperthyroidism before and after antithyroid drug treatment....

  4. Three minimally invasive methods of measuring of portal vein pressure in healthy dogs.

    Science.gov (United States)

    Sakamoto, Yumi; Sakai, Manabu; Watari, Toshihiro

    2012-10-01

    We compared wedged hepatic venous pressure (WHVP), splenic pulp pressure (SPP) and trans-splenic portal vein pressure (TSPVP) in healthy dogs. We found that portal blood pressure could be measured in dogs using any of these techniques. The WHVP, SPP and TSPVP were 7.8 ± 1.0, 6.2 ± 0.8 and 6.8 ± 1.2 mmHg, respectively. Measuring SPP using ultrasound is most simple and minimally invasive, and it might be useful for evaluating portal hypertension in dogs with liver diseases.

  5. Associated Liver Partition and Portal Vein Ligation (ALPPS) vs Selective Portal Vein Ligation (PVL) for Staged Hepatectomy in a Rat Model. Similar Regenerative Response?

    Science.gov (United States)

    García-Pérez, Rocío; Revilla-Nuin, Beatriz; Martínez, Carlos M; Bernabé-García, Angel; Baroja Mazo, Alberto; Parrilla Paricio, Pascual

    2015-01-01

    Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a two-stage hepatectomy technique which can be associated with a hypertrophic stimulus on the future liver remnant (FLR) stronger than other techniques--such as portal vein ligation (PVL). However, the reason of such hypertrophy is still unclear, but it is suggested that liver transection combined with portal vein ligation (ALPPS) during the first stage of this technique may play a key role. The aim of this study is to compare the hypertrophic stimulus on the FLR and the clinical changes associated with both ALPPS and PVL in a rat surgical model. For this purpose, three groups of SD rats were used, namely ALPPS (n = 30), PVL (n = 30) and sham-treated (n = 30). The second stage of ALPPS (hepatectomy of the atrophic lobes), was performed at day 8. Blood and FLR samples were collected at 1, 24, 48 hours, 8 days and 12 weeks after the surgeries. ALPPS provoked a greater degree of hypertrophy of the FLR than the PVL at 48 hours and 8 days (pstimulus at 12 weeks, with a higher expression of HGF and TGF-β (presponse seems to be leaded by a complex interaction between pro-mitogenic (IL-6, HGF, TNF-α) and antiproliferative (IL1-β and TGF-β) cytokines.

  6. Portal vein thrombosis with protein C-S deficiency in a noncirrhotic patient

    Institute of Scientific and Technical Information of China (English)

    Gustavo; A; Rodríguez-Leal; Segundo; Morán; Roberto; Corona-Cedillo; Rocío; Brom-Valladares

    2014-01-01

    There are several conditions that can lead to portal vein thrombosis(PVT), including including infection, malignancies, and coagulation disorders. Anew condition of interest is protein C and S deficiencies, associated with hypercoagulation and recurrent venous thromboembolism. We report the case of a non-cirrhotic 63-year-old male diagnosed with acute superior mesenteric vein thrombosis and PVT and combined deficiencies in proteins C and S, recanalized by short-term low molecular heparin plus oral warfarin therapy.

  7. Multidetector-Row CT Findings of a Preduodenal Portal Vein Associated with Polysplenic Syndrome in an Adult: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Song, Hyun; Lee, Su Lim; Ku, Young Mi; Chun, Chang Woo [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu (Korea, Republic of)

    2012-03-15

    Preduodenal portal vein (PDPV) is a rare developmental anomaly in which the portal vein runs at the ventral side of the duodenum instead of at an intrapancreatic location. Understanding of this anomaly is of considerable surgical importance, because it may cause unintended portal vein injury during operations involving the gall bladder or duodenum. We recently experienced PDPV associated with polysplenia syndrome in a 49-year-old male patient who complained of persistent epigastric pain. CT portal venography with thin slab maximal intensity projection and volume rendering demonstrated the unique feature of convex anastomosis between the L-shaped mesenterico-portal vein and mesenterico-splenic vein in the mid abdomen. We report here the Multidetector-row CT findings of a rare case of PDPV.

  8. Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center

    Directory of Open Access Journals (Sweden)

    Priscila Menezes Ferri

    2012-03-01

    Full Text Available CONTEXT: Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication - the upper gastrointestinal bleeding. OBJECTIVE: To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. METHODS: This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound. RESULTS: Of the 55 studied patients, 30 (54.5% were male. In 29 patients (52.7%, none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%. In 20 patients (36.4%, the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9% showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. CONCLUSIONS: The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an

  9. The occurrence of a pseudoaneurysm of the hepatic artery within the thrombosed portal vein of a patient with chronic pancreatitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Soo; Jang, Kyung Mi; Kim, Min Jeong; Yoon, Hoi Soo; Lee, Hyun; Jeon, Eui Yong; Lee, Kwan Seop; Lee, Yul [College of Medicine, Hallym University, Anyang (Korea, Republic of)

    2008-04-15

    A pseudoaneurysm is an uncommon but important life threatening complication of chronic pancreatitis. The arteries most commonly affected by a pseudoaneurysm are (in decreasing percent occurrence), the splenic (40%), gastroduodenal (30%), pancreaticoduodenal (20%), gastric (5%), hepatic (2%), and others (superior mesenteric, jejunal, ileocecal, and aorta) (1-3%). Thrombosis of the splenic or portal vein is another important complication of chronic pancreatitis. In this case report, we present a rare complication in the form of a right hepatic artery pseudoaneurysm which developed within the thrombosed right portal vein of a 35-year-old woman afflicted with chronic pancreatitis.

  10. Portal vein thrombosis and arterioportal shunts: Effects on tumor response after chemoembolization of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Thomas J Vogl; Nour-Eldin Nour-Eldin; Sally Emad-Eldin; Nagy NN Naguib; Joerg Trojan; Hans Ackermann; Omar Abdelaziz

    2011-01-01

    AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology, Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.

  11. Significance of hepatic arterial responsiveness for adequate tissue oxygenation upon portal vein occlusion in cirrhotic livers.

    Science.gov (United States)

    Mücke, I; Richter, S; Menger, M D; Vollmar, B

    2000-11-01

    We investigated sinusoidal blood flow and hepatic tissue oxygenation during portal vein occlusion in cirrhotic rat livers to examine the effect of cirrhosis on the properties of hepatic microvascular blood flow regulation. After 8 weeks of CCl4/phenobarbital sodium treatment to induce cirrhosis Sprague-Dawley rats were prepared surgically to allow assessment of portal venous and hepatic arterial inflow using miniaturized flow probes with simultaneous analysis of hepatic microcirculation and tissue oxygenation by fluorescence microscopy and polarographic oxymetry. Age-matched noncirrhotic animals served as controls. Upon portal vein occlusion in cirrhotic livers (flow reduction to portal vein occlusion did not cause a deterioration in hepatic tissue pO2 (11 +/- 3 vs. 10 +/- 3 mmHg at baseline). Sinusoidal diameters were found unchanged, disproving a major role of the sinusoidal tone in the regulation of HABR. Microvascular response of cirrhotic livers did not generally differ from that in noncirrhotic livers upon portal inflow restriction. We conclude that HABR in cirrhotic livers operates sufficiently to meet the liver tissue oxygen demand, most probably by an increased relative contribution of arterial perfusion of hepatic sinusoids.

  12. GI ischemia in patients with portal vein thrombosis: A prospective cohort study

    NARCIS (Netherlands)

    J. Harki (Jihan); E.P.C. Plompen (Elisabeth); D. van Noord (Désirée); J.W. Hoekstra; E.J. Kuipers (Ernst); H.L.A. Janssen (Harry); E.T.T.L. Tjwa (Eric)

    2016-01-01

    textabstractBackground and Aims GI ischemia is a concerning adverse event of portal vein thrombosis (PVT). Minimally invasive techniques, such as visible light spectroscopy (VLS), have greatly improved the ability to diagnose GI ischemia. The aim of this study was to assess the clinical presentation

  13. GI ischemia in patients with portal vein thrombosis: a prospective cohort study

    NARCIS (Netherlands)

    Harki, J.; Plompen, E.P.; Noord, D. van; Hoekstra, J.; Kuipers, E.J.; Janssen, H.L.; Tjwa, E.T.

    2016-01-01

    BACKGROUND AND AIMS: GI ischemia is a concerning adverse event of portal vein thrombosis (PVT). Minimally invasive techniques, such as visible light spectroscopy (VLS), have greatly improved the ability to diagnose GI ischemia. The aim of this study was to assess the clinical presentation and

  14. CT guided 125iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Fu-jun; LI Chuan-xing; JIAO De-chao; ZHANG Nian-hua; WU Pei-hong; DUAN Guang-feng; WU Yue-xia

    2008-01-01

    Background This study evaluated the clinical application of CT guided 125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma.Methods The ten patients (9 males and 1 female,aged from 36 to 72 years) with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery,transcatheter arterial chemoembolization,radiotherapy ablation,microwave ablation or percutaneous ethanol injection.The average diameter of each tumor thrombus was 21.5 mm×30.5 mm.Seeds of 30 MBq 125I were implanted 5 mm apart within the portal vein tumor thrombus.The follow-up after 4 months included enhanced spiral CT.Results CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy,5 partial response and 1 stable disease.Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase,which were controlled by medical management.Severe complications such as haemorrhage,biliary fistula,hepatic abscess,pancreatic fistula and hepatic function failure were not observed.Implanted seeds migrated to lung and left hepatic lobe in 1 case.Conclusion CT guided implantation of 125iodine seeds,can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.

  15. Quantitative Portal Vein Velocity of Liver Cancer Patients with Transcatheter Arterial Chemoembolization on Angiography

    Directory of Open Access Journals (Sweden)

    Yung-Jen Ho

    2012-01-01

    Full Text Available Objective. We applied optical flow method (OFM to quantify relative velocities of blood flow using digital subtraction angiography (DSA in the vascular analysis of hepatocellular carcinoma (HCC patients who underwent transarterial chemoembolization (TACE treatment. Methods. A total of 40 HCC patients treated by TACE were analyzed in this study. DSA imaging with a 12-inch field of view, 1024 × 1024 pixels and 4 frames/second was acquired. OFM developed for motion estimation is applied for blood flow estimation. Two acrylic phantoms were built to validate the method. Results. The relationship between the OFM and Doppler measurements was found linear with R2=0.99 for both straight and curved tube phantoms. Quantitative blood flow distribution images of the portal vein region were presented. After TACE, the minimum, maximum and mean velocities in the portal vein all decreased (P<0.05. Additionally, the velocity in the portal vein is significantly lower with a higher Child-Pugh score (P<0.01. Conclusions. The present technique provides add-on quantitative information of flows to DSA and the hemodynamic analysis in relative quantifications of blood flow in portal vein of hepatocellular carcinoma patients using DSA.

  16. Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Jonathan; G; Stine; Puja; M; Shah; Scott; L; Cornella; Sean; R; Rudnick; Marwan; S; Ghabril; George; J; Stukenborg; Patrick; G; Northup

    2015-01-01

    AIM: To determine the clinical impact of portal vein thrombosis in terms of both mortality and hepatic decompensations(variceal hemorrhage, ascites, portosystemic encephalopathy) in adult patients with cirrhosis.METHODS: We identified original articles reported through February 2015 in MEDLINE, Scopus, Science Citation Index, AMED, the Cochrane Library, and relevant examples available in the grey literature. Two independent reviewers screened all citations for inclusion criteria and extracted summary data. Random effects odds ratios were calculated to obtain aggregate estimates of effect size across included studies, with 95%CI.RESULTS: A total of 226 citations were identified and reviewed, and 3 studies with 2436 participants were included in the meta-analysis of summary effect. Patients with portal vein thrombosis had an increased risk of mortality(OR = 1.62, 95%CI: 1.11-2.36, P = 0.01). Portal vein thrombosis was associated with an increased risk of ascites(OR = 2.52, 95%CI: 1.63-3.89, P < 0.001). There was insufficient data available to determine the pooled effect on other markers of decompensation including gastroesophageal variceal bleeding or hepatic encephalopathy. CONCLUSION: Portal vein thrombosis appears to increase mortality and ascites, however, the relatively small number of included studies limits more generalizable conclusions. More trials with a direct comparison group are needed.

  17. [Non-contrast-Enhanced MR angiography for selective evaluation of the hepatic portal vein].

    Science.gov (United States)

    Wu, Bing; Sun, JiayU; Wang, Chenglong; Xia, Chuncao; Li, Changxian

    2011-08-01

    This study was aimed to compare and evaluate the diagnostic performance of non-contrast-enhanced MR angiography (NCE-MRA) with contrast-enhanced MR angiography (CE-MRA) in the anatomic assessment of hepatic portal vein. Thirty people, ten patients with hepatic cirrhosis without ascites and twenty normal physical examination donors as control group were included in the NCE-MRA and CE-MRA with the same 1.5T MR scanner. Anatomic angiographic images were reconstructed and their datasets available for analysis independently performed by two radiologists. Assessment of data quality of hepatic portal vein vessels was rated with a four-point scale. After consensus reading, a total 27 images (90%) scored more than 3 point were observed in NCE-MRA and 28 (93.3%) in CE-MRA, respectively. Segmental branch vessels were visualized on MR angiography in the majority of cases. Both NCE-MRA and CE-MRA correctly characterized the hepatic portal veins with grade 5 and without false positive cases. Only 4 false negatives with grade 6 were missed in NCE-MRA group. There were no statistically significant differences between NCE-MRA and CE-MRA for characterization of hepatic vasculature (P < 0.05). Kappa value was larger than 0.75 for both reviewers. A conclusion could be drawn that NCE-MRA is a non-invasive and effective method that provides a comprehensive assessment of the hepatic portal vein.

  18. Effect of liver cirrhosis on percutaneous selective portal vein embolization for primary liver cancer

    Institute of Scientific and Technical Information of China (English)

    孙军辉

    2014-01-01

    Objective To evaluate the clinical value of PVE(portal vein embolism)prior to surgery in primary liver cancer(PLC)patients and the effect of liver cirrhosis on1iver lobe hyperplasia after PVE.Methods 13 patientswith primary liver cancer non-suitable for curative hepatectomy underwent k sequential transcatheter arterial chemoembolization(TACE)(1-3 times)

  19. Portal vein thrombosis: Etiology and clinical outcome of cirrhosis and malignancy-related non-cirrhotic, non-tumoral extrahepatic portal venous obstruction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The etiology and pathogenesis of portal vein thrombosis are unclear. Portal venous thrombosis presentation differs in cirrhotic and tumor-related versus non-cirrhotic and non-tumoral extrahepatic portal venous obstruction (EHPVO). Non-cirrhotic and non-tumoral EHPVO patients are young and present with well tolerated bleeding.Cirrhosis and tumor-related portal vein thrombosis patients are older and have a grim prognosis. Among the 118 patients with portal vein thrombosis, 15.3% had cirrhosis, 42.4% had liver malignancy (primary or metastatic), 6% had pancreatitis (acute or chronic), 5% had hypercoagulable state and 31.3% had idiopathy,12% had hypercoagulable state in the EHPVO group.

  20. Insight into congenital absence of the portal vein: Is it rare?

    Institute of Scientific and Technical Information of China (English)

    Guo-Hua Hu; Lai-Gen Shen; Jin Yang; Jin-Hua Mei; Yue-Feng Zhu

    2008-01-01

    Congenital absence of portal vein (CAPV) was a rare event in the past. However, the number of detected CAPV cases has increased in recent years because of advances in imaging techniques. Patients with CAPV present with portal hypertension (PH) or porto- systemic encephalopathy (PSE), but these conditions rarely occur until the patients grow up or become old. The patients usually visit doctors for the complications of venous shunts, hepatic or cardiac abnormalities detected by ultrasonography (US), computed tornography (CT) and magnetic resonance imaging (MRI). The etiology of this disease is not clear, but most investigators consider that it is associated with abnormal embryologic development of the portal vein. Usually, surgical intervention can relieve the symptoms and prevent occurrence of complications in CAPV patients. Moreover, its management should be stressed on a case-by-case basis, depending on the type or anatomy of the disease, as well as the symptoms and clinical conditions of the patient.

  1. Bovine pericardium for portal vein reconstruction in abdominal surgery: a surgical guide and first experiences in a single center.

    Science.gov (United States)

    Jara, Maximilian; Malinowski, Maciej; Bahra, Marcus; Stockmannn, Martin; Schulz, Antje; Pratschke, Johann; Puhl, Gero

    2015-01-01

    Resection and reconstruction of infiltrated vessels achieve resectability of extended pancreatic tumors. The aim of the present study was to assess the feasibility of bovine pericardium as graft material for the individualised portal vein reconstruction and demonstrate a surgical technique for abdominal vein repair. We performed a MEDLINE search to review the methods for complex abdominal vein reconstruction in the course of extended pancreatectomy. Moreover, clinical data of patients receiving portal vein reconstruction using a bovine pericardial patch at our institution were retrospectively analyzed. Based on the results of a review of the literature, autologous venous grafts using the internal jugular vein represent the most popular option for segmental portal vein reconstruction in case of impossible direct suture. At our center, segmental portal vein reconstruction with bovine pericardial patch in course of pancreatic surgery was performed in 4 patients. No case of vascular complications such as occlusion, segmental stenosis or thrombosis occurred. Our experience suggests a surgical procedure for an individual size-matched portal vein reconstruction using bovine pericardium. Although first results appear promising, prospective studies are required to objectively assess the patency of bovine pericardium compared with autologous and synthetic interposition grafts for portal vein reconstruction. © 2015 S. Karger AG, Basel.

  2. Comparison of Morphology and Microstructural Components of Hepatic Portal Vein between Human and Pig

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yifei; HUANG Tiezhu; WANG Peijun; LI Wenchun; YU Minghua

    2005-01-01

    In order to provide morphological data and theoretical basis for pig-to-human hepatic xenotransplantation, the difference in morphological parameters and vessel wall structural factors between human and porcine hepatic portal vein was studied. From human subjects and pigs of varying ages, hepatic portal veins were collected, paraffin-embedded and cut into sections. The histological structures were stained with HE, and elastin, collagen and smooth muscles were stained with Weigert, Aniline blue and orange G, respectively. Morphological parameters and relative contents of structural components were determined under microscopy and by computer image analysis system, respectively. The results showed that histological structures of human and porcine hepatic portal vein wall were similar. Caliber, wall thickness, lumen and wall area in pigs increased with age, all in linear correlation to months. Morphological parameters of 6- month-old pigs were similar to those of human. In pigs, collagen content increased gradually with months, elastin content remained relatively stable, smooth muscle content reached the peak at the 3rd month, and collagen/elastin (C/E) rose gradually. The contents of collagen and elastin in porcine hepatic portal vein wall were lower, while the content of smooth muscle was higher than in human, and C/E at the 5th and 6th month was similar to that in human. It is concluded that morphological parameters and contents of structural components of porcine hepatic portal vein vary with age. At the 6 month, its caliber, wall thickness, lumen and wall area are similar to those of human. There are differences in contents of structural components between human and pigs. However, in terms of C/E, mechanic properties of pigs at the 5th and 6th month mimic those of human, hence inosculation is viable in xenotransplantation between pigs and human.

  3. A single hospital study on portal vein thrombosis in cirrhotic patients - clinical characteristics & risk factors

    Directory of Open Access Journals (Sweden)

    Huisong Chen

    2014-01-01

    Full Text Available Background & objectives: Discrepancies exist in the reported prevalence of portal vein thrombosis (PVT, and its clinical characteristics and sites of occurrence need to be elucidated. The risk factors for PVT are also poorly understood. This single centre study was undertaken to determine the clinical characteristics, sites of occurrence, and risk factors associated with PVT in patients with liver cirrhosis. Methods: Hospitalized cirrhotic patients (N = 162 were segregated into the PVT and non-PVT groups. Indices possibly associated with PVT were measured and PVT was detected by both Doppler ultrasonography and computed tomography portal angiography. The portal vein diameter and flow velocity and splenic thickness were measured by ultrasonography. Results: PVT was found in 40 patients (24.7%; in 34 PVT patients (85%, the liver cirrhosis resulted from hepatitis B virus infections. Most (90% patients were Child-Pugh classes B and C, with similar distribution between the groups. PVT was seen in 20 patients in the portal and superior mesenteric veins; ascites, abdominal pain, gastrointestinal bleeding, and jaundice were common findings in PVT patients. Haemoglobin levels and blood platelet counts (BPCs were significantly lower and splenic thickness was greater in PVT than in non-PVT patients (P<0.01. There was a significant positive correlation between BPCs and platelet aggregation rates (R = 0.533, P<0.01. Interpretation & conclusions: The occurrence of PVT was 24.7 per cent, primarily in post-hepatitis B liver cirrhosis patients. PVT occurred mainly in the portal vein trunk and superior mesenteric vein. Different PVT sites may account for the differing clinical presentations. The lower levels of haemoglobin and BPCs as well as splenic thickening were associated with PVT. Splenic thickening may be a risk factor for PVT.

  4. Extrahepatic portal vein obstruction with parkinsonism and symmetric hyperintense basal ganglia on T1 weighted MRI

    Directory of Open Access Journals (Sweden)

    Jayalakshmi Sita

    2006-01-01

    Full Text Available Abnormal high signal in the globus pallidus on T1 weighted magnetic resonance imaging (MRI of the brain has been well described in patients with chronic liver disease. It may be related to liver dysfunction or portal-systemic shunting. We report a case of extra hepatic portal vein obstruction with portal hypertension and esophageal varices that presented with extra pyramidal features. T1 weighted MRI brain scans showed increased symmetrical signal intensities in the basal ganglia. Normal hepatic function in this patient emphasizes the role of portal- systemic communications in the development of these hyperintensities, which may be due to deposition of paramagnetic substances like manganese in the basal ganglia.

  5. Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery.

    Science.gov (United States)

    Shim, Dong Jae; Shin, Ji Hoon; Ko, Gi-Young; Kim, Yook; Han, Kichang; Gwon, Dong-Il; Ko, Heung-Kyu

    2017-04-01

    Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7-1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.

  6. Sixty-four-slice computed tomography in surgical strategy of portal vein cavernous transformation

    Institute of Scientific and Technical Information of China (English)

    Ming-Man Zhang; Cong-Lun Pu; Ying-Cun Li; Chun-Bao Guo

    2011-01-01

    AIM:To investigate the role of 64-slice computed tomography (CT) in portal vein cavernous transformation to determine surgical strategy.METHODS:The site of lesions and extent of collateral circulation in 12 pediatric cases of cavernous transformation of the portal vein with surgical treatment were analyzed.RESULTS:Eleven of 12 children had esophageal vari-ces and were treated with lower esophageal and gastric devascularization and splenectomy,and the other case was only treated with splenectomy.There were eight cases with spontaneous spleen/stomach-renal shunt,four with Retzius vein opening,which was reserved during surgery.Three cases of lesions involving the intrahepatic portal vein (PV) were treated with livingdonor liver transplantation.One patient died from PV thrombosis after liver transplantation,and the rest had no significant complications.CONCLUSION:The PV,its branches and collateral circulation were clearly seen by 64-slice spiral CT angi-ography,which helped with preoperative surgical planning.

  7. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    Feng-Yong Liu; Mao-Qiang Wang; Qing-Sheng Fan; Feng Duan; Zhi-Jun Wang; Peng Song

    2009-01-01

    AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior mesenteric vein thrombosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females,aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were accurately diagnosed with Doppler ultrasound scans, computed tomography and magnetic resonance imaging.They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutaneous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization).RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased significantly. Symptoms in these 45 patients were improved dramatically without severe operational complications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment.In 3 patients with interventional treatment, thrombi re-formed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful.CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

  8. 门静脉血栓的MRI诊断%MRI Diagnosis of Portal Vein Thrombosis

    Institute of Scientific and Technical Information of China (English)

    覃智颖; 张应和; 范真真; 梁晓芬; 苏敏仪

    2012-01-01

    目的 探讨MRI诊断门静脉血栓(PVT)的价值.方法 回顾性分析经临床随访证实的9例PVT患者的资料,所有病例均行常规MRI平扫及三维容积超快速多期动态增强扫描( LAVA).结果 9例肝PVT中,4例位于门静脉左支,2例门静脉右支,3例位于门静脉主干,其中1例同时累及门静脉右支.MRI均能显示门静脉及其分支内血栓异常信号,平扫T1WI及T2WI流空信号消失,增强扫描各期血栓均无强化,管腔内出现充盈缺损.结论 MRI是诊断PVT的有效影像学检查方法.%Objective To discuss the diagnostic value of MR Imaging for portal vein thrombus. Methods Retrospective analysis of 9 cases of portal vein thrombosis confirmed by clinical follow-up, all the cases were performed by plain scan and Liver Acquisition with Volume Acceleration MRI. Results During these 9 PVT, 4 cases thrombus located in the left branch of portal vein, 2 in the right branch of portal vein,3 in the trunk of portal, and lease two branchs of portal compromised. MRI can well demonstrate the abnormal signals of the thrombus in the portal vein or its branch, normal flowing void disappeared in the TlWI and T2WI of the MR plain scan, and there were no enhancement in any phases of the thronbus. showed filling defect within the lumen. Conclusion MRI is the effective radiographie technique for the diagnosis of PVT.

  9. Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease

    Energy Technology Data Exchange (ETDEWEB)

    Chu, Hee Ho; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Jae, Hwan Jun [Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute (Korea, Republic of); Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk [Seoul National University College of Medicine and Seoul National University Hospital, Department of Surgery (Korea, Republic of); Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute (Korea, Republic of)

    2012-12-15

    Purpose: To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases. Methods: Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue. Results: Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients. Conclusion: Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.

  10. Effect of glibenclamide on membrane response to metabolic inhibition in smooth muscle of rat portal vein.

    Science.gov (United States)

    Lydrup, M L; Swärd, K; Hellstrand, P

    1994-01-01

    Vascular smooth muscle tone is dependent on oxidative metabolism, a phenomenon of potential importance for the metabolic regulation of blood flow to tissues. The response of the rat portal vein to inhibition of cell respiration by cyanide (0.1-1 mM) is a reduction of its spontaneous myogenic activity. The trains of action potentials triggering phasic contractions are reduced in duration, while the frequency of trains is often somewhat increased as the resting membrane potential in the intervals between spike trains is less negative by 6.5 mV. Glibenclamide (10(-7) M) did not affect the resting membrane potential or spontaneous mechanical activity of oxygenated portal veins, but partly restored the depressed myogenic activity in the presence of cyanide (0.5 mM). The spike trains were longer, while the membrane was depolarized by 3 mV compared with the effects of cyanide alone. Inhibition of both oxidative and glycolytic metabolism by 2 mM NaCN in a medium where glucose was replaced by beta-hydroxybutyrate caused a hyperpolarization which was abolished by 10(-7) M glibenclamide. The relaxing effect of the K+ channel opener cromakalim (5 x 10(-9) to 6.25 x 10(-7) M) was partly antagonized by glibenclamide. Basal cytosolic [Ca2+] was increased by cyanide, while the Ca2+ transients associated with phasic contractions were reduced in duration. This latter effect was partially reversed by glibenclamide. The effect of cyanide on high-K+ contractures, which are associated with sustained membrane depolarization and not dependent on repetitive spike activity, was not influenced by 10(-7) M glibenclamide. The effects of inhibited cell respiration on spontaneous electrical activity seem to reflect a depolarizing drive caused by inhibited active ion exchange mechanisms, modified by a repolarizing drive, possibly from ATP-regulated K+ channels, causing reduced duration of the spike trains. While glibenclamide affects spontaneous activity at all levels of oxidative blockade

  11. Liver transplantation in a patient with complete portal vein thrombosis, is there a surgical way out? A case report

    Directory of Open Access Journals (Sweden)

    Tommaso Maria Manzia

    2016-11-01

    Conclusion: The presence of a Grade III PVT associated with a large SRS should not be considered a contraindication for LT, and the use of the shunt vein should be considered a feasible option to perform portal anastomosis.

  12. Concurrent biliary drainage and portal vein embolization in preparation for extended hepatectomy in patients with biliary cancer

    DEFF Research Database (Denmark)

    Nilsson, Jan; Eriksson, Sam; Nørgaard Larsen, Peter

    2015-01-01

    BACKGROUND: Patients with perihilar cholangiocarcinoma and gallbladder cancer extending into the hilum often present with jaundice and a small future liver remnant (FLR). If resectable, preoperative biliary drainage and portal vein embolization (PVE) are indicated. Classically, these measures have...

  13. Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Murad Baba

    2015-01-01

    Full Text Available Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG. It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT after LSG. Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation. Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.

  14. The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Bong Kyung; Kim, Jae Chul [Dept. of Radiation Oncology, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2016-09-15

    The purpose of current study is to evaluate the response of the patients with portal vein thrombosis (PVT) or hepatic vein thrombosis (HVT) in hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiation therapy (3D-CRT). In addition, survival of patients and potential prognostic factors of the survival was evaluated. Forty-seven patients with PVT or HVT in HCC, referred to our department for radiotherapy, were retrospectively reviewed. For 3D-CRT plans, a gross tumor volume (GTV) was defined as a hypodense filling defect area in the portal vein (PV) or hepatic vein (HV). Survival of patients, and response to radiation therapy (RT) were analyzed. Potential prognostic factors for survival and response to RT were evaluated. The median survival time of 47 patients was 8 months, with 1-year survival rate of 15% and response rate of 40%. Changes in Child-Pugh score, response to RT, Eastern cooperative oncology group performance status (ECOG PS), hepatitis C antibody (HCVAb) positivity, and additional post RT treatment were statistically significant prognostic factors for survival in univariate analysis (p = 0.000, p = 0.018, p = 0.000, p = 0.013, and p = 0.047, respectively). Of these factors, changes in Child-Pugh score, and response to RT were significant for patients' prognosis in multivariate analysis (p = 0.001 and p = 0.035, respectively). RT could constitute a reasonable treatment option for patients with PVT or HVT in HCC with acceptable toxicity. Changes in Child-Pugh score, and response to RT were statistically significant factors of survival of patients.

  15. Comparative Study of Compensatory Liver Regeneration in a Rat Model: Portal Vein Ligation Only versus Sequential Ligation of the Portal Vein and Hepatic Artery

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Soo Young [Dept. of Pathology, Dongnam Institute of Radiological and Medical Sciences, Busan (Korea, Republic of); Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Lee, Byung Mo [Dept. of Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2013-04-15

    To compare the volume change and the regenerative capacity between portal vein ligation (embolization) (PVL) and heterochronous PVL with hepatic artery ligation (HAL) in a rodent model. The animals were separated into three groups: group I, ligation of the left lateral and median portal vein branches; group II, completion of PVL, followed by ligation of the same branches of the hepatic artery after 48 h; control group, laparotomy without ligation was performed. Five rats from each group were sacrificed on 1, 3, 5, and 7 days after the operation. Volume change measurement, liver function tests and immunohistochemical analysis were performed. The volume of the nonligated lobe between groups I and II was not significantly different by day 5 and day 7. Mean alanine aminotransferase and total bilirubin levels were significantly higher in group II, while the albumin level was higher in group I. Both c-kit- and MIB-5-positive cells used in the activity detection of regeneration were more prevalent in group I on day 1, 3, and 5, with statistical significance. There was no operation related mortality. PVL alone is safe and effective in compensatory liver regeneration. Performing both PVL and HAL does not confer any additional benefits.

  16. Pancreatic pseudocyst-portal vein fistula: Serial imaging and clinical follow-up from pseudocyst to fistula

    Energy Technology Data Exchange (ETDEWEB)

    Jee, Keun Nahn [Dept. of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan (Korea, Republic of)

    2015-03-15

    Pancreatic pseudocyst-portal vein fistula is an extremely rare complication of pancreatitis. Only 18 such cases have been previously reported in the medical literature. However, a serial process from pancreatic pseudocyst to fistula formation has not been described. The serial clinical and radiological findings in a 52-year-old chronic alcoholic male patient with fistula between pancreatic pseudocyst and main portal vein are presented.

  17. Pregnancy in the Setting of Asymptomatic Non-Cirrhotic Chronic Portal Vein Thrombosis Complicated by Pre-Eclampsia

    Directory of Open Access Journals (Sweden)

    Işık Üstüner

    2013-01-01

    Full Text Available Portal vein thrombosis (PVT can be chronic or acute in nature; it is characterized by a thrombus formation in the main portal vein and/or its right or left branches. Herein, we present a 36-year-old woman with asymptomatic noncirrhotic chronic PVT who developed preeclampsia in the later stage of pregnancy. This report will emphasize the clinical differential diagnosis, outcome, and management of pregnancies complicated by noncirrhotic PVT.

  18. Positron emission tomography/computed tomography with 18F-fluorodeoxyglucose identifies tumor growth or thrombosis in the portal vein with hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Long Sun; Hua Wu; Wei-Ming Pan; Yong-Song Guan

    2007-01-01

    Patients suffering from hepatocellular carcinoma (HCC) with tumor thrombus in the portal vein generally have a poor prognosis. Portal vein tumor thrombus must be distinguished from portal vein blood thrombus, and this identification plays a very important role in management of HCC. Conventional imaging modalities have limitations in discrimination of portal vein tumor thrombus. The application of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) for discrimination between tumor extension and blood thrombus has been reported in few cases of HCC, while portal tumor thrombosis and portal vein clot identified by 18F-FDG PET/CT in HCC patients has not been reported so far.We present two HCC cases, one with portal vein tumor thrombus and one thrombosis who were identified with 18F-FDG PET/CT. This report illustrates the complimentary value of combining the morphological and functional imaging in achieving a correct diagnosis in such clinical situations.

  19. Ultrasound-guided catheterization of the portal vein in 11 cows using the Seldinger technique.

    Science.gov (United States)

    Braun, U; Camenzind, D; Ossent, P

    2003-02-01

    Catheterization of the portal vein using the Seldinger technique [Acta Radiol. (1958) 38, 368] was performed in 11 cows. Ultrasound-guided percutaneous portocentesis, using a 25-cm, 14-gauge steel cannula, was performed from the 10th, 11th or 12th intercostal space on the right side. A stylet was placed through the cannula, which was then removed, and a polyurethane balloon-tipped catheter was advanced over the stylet into the portal vein and sutured to the skin (Seldinger, 1952). Blood samples were collected from the catheter at least once daily. The catheter was removed 9-15 days later when blood could no longer be aspirated. The cows were then slaughtered and a post-mortem examination was performed. During the study, appetite remained normal in nine of 11 cows. In three cows, the general behaviour and demeanour were mildly, but transiently, abnormal. Four cows had leucopoenia. The most frequently encountered problem was occlusion of the catheter, which usually was resolved by flushing with heparinized saline. The most common post-mortem lesion observed was an increase in fibrous connective tissue at the site of cannulation. In nine of 11cows, there was a thrombus in the portal vein at the site of catheterization. Generally, the severity of the lesions was mild. The results of this study demonstrated that ultrasound-guided percutaneous catheterization of the portal vein, using the Seldinger technique, is possible in cows. The catheter may be left in place for collection of blood samples for up to 15 days.

  20. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  1. Tumor Regression in HCC Patient with Portal Vein Tumor Thrombosis after Intraportal Radiofrequency Thermal Ablation

    Directory of Open Access Journals (Sweden)

    Malkhaz Mizandari

    2016-01-01

    Full Text Available Hepatocellular carcinoma (HCC is the third leading cause of cancer-related death worldwide. Portal vein tumor thrombosis (PVTT is a frequent entity in HCC, which strictly limits the gold standard treatment options such as surgical resection and transarterial chemoembolization. Therefore, the prognosis of patients with PVTT is extremely poor and an emergence of seeking an alternative option for intervention is inevitable. We present a case of a 60-year-old male patient with HCC induced PVTT who was subjected to the intraportal RFA and stenting-VesOpen procedure. No additional medical intervention was performed. The repeated CT performed 5 months after the VesOpen procedure revealed significant decrease of the tumor size, patent right, and main portal vein and a recanalization of the left portal vein, which was not processed. At this time point, liver functional tests, appetite, and general condition of the patient were improved evidently. This report designates the RFA as an instrumental option of therapeutic intervention for HCC patients with PVTT.

  2. Tumor Regression in HCC Patient with Portal Vein Tumor Thrombosis after Intraportal Radiofrequency Thermal Ablation

    Science.gov (United States)

    2016-01-01

    Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Portal vein tumor thrombosis (PVTT) is a frequent entity in HCC, which strictly limits the gold standard treatment options such as surgical resection and transarterial chemoembolization. Therefore, the prognosis of patients with PVTT is extremely poor and an emergence of seeking an alternative option for intervention is inevitable. We present a case of a 60-year-old male patient with HCC induced PVTT who was subjected to the intraportal RFA and stenting-VesOpen procedure. No additional medical intervention was performed. The repeated CT performed 5 months after the VesOpen procedure revealed significant decrease of the tumor size, patent right, and main portal vein and a recanalization of the left portal vein, which was not processed. At this time point, liver functional tests, appetite, and general condition of the patient were improved evidently. This report designates the RFA as an instrumental option of therapeutic intervention for HCC patients with PVTT. PMID:27579192

  3. Should anticoagulants be administered for portal vein thrombosis associated with acute pancreatitis?

    Institute of Scientific and Technical Information of China (English)

    Won-Seok Park; Hyeong-Il Kim; Byung-Jun Jeon; Seong-Hun Kim; Seung-Ok Lee

    2012-01-01

    Venous complications in patients with acute pancreatitis typically occur as a form of splenic,portal,or superior mesenteric vein thrombosis and have been detected more frequently in recent reports.Although a well-organized protocol for the treatment of venous thrombosis has not been established,anticoagulation therapy is commonly recommended.A 73-year-old man was diagnosed with acute progressive portal vein thrombosis associated with acute pancreatitis.After one month of anticoagulation therapy,the patient developed severe hematemesis.With endoscopy and an abdominal computed tomography scan,hemorrhages in the pancreatic pseudocyst,which was ruptured into the duodenal bulb,were confirmed.After conservative treatment,the patient was stabilized.While the rupture of a pseudocyst into the surrounding viscera is a well-known phenomenon,spontaneous rupture into the duodenum is rare.Moreover,no reports of upper gastrointestinal bleeding caused by pseudocyst rupture in patients under anticoagulation therapy for venous thrombosis associated with acute pancreatitis have been published.Herein,we report a unique case of massive upper gastrointestinal bleeding due to pancreatic pseudocyst rupture into the duodenum,which developed during anticoagulation therapy for portal vein thrombosis associated with acute pancreatitis.

  4. Chemotherapy for Liver Metastasis Originating from Colorectal Cancer with Portal Vein Tumor Thrombosis: A Case Report

    Directory of Open Access Journals (Sweden)

    Atsushi Kawasaki

    2013-05-01

    Full Text Available The patient was a male in his 70s with a history of chronic renal failure and dilated cardiomyopathy. In January 2011, he underwent abdominoperineal resection of the rectum, right hepatic lobectomy, and resection of a portal vein tumor thrombus with a diagnosis of rectal cancer and metastatic liver cancer accompanied by portal vein tumor thrombosis. Although 5-fluorouracil + l-leucovorin therapy (RPMI regimen was carried out as postoperative adjuvant chemotherapy, the tumor marker (CEA and VA19-9 levels increased 8 months after surgery. Since the functions of major organs were impaired, UFT® + UZEL® therapy was started. The tumor marker levels decreased temporarily, but increased again 12 months after surgery, and so intravenous instillation of panitumumab was initiated. Nine administrations have been performed to date, with no increase in tumor marker levels or exacerbation of the condition. Also, no grade 2 or severer adverse event has been noted according to CTCAE v.4.0. The experience with this patient suggests the possibility that exacerbation of the condition of patients with liver metastasis of colorectal cancer accompanied by portal vein tumor thrombosis with abnormalities in the functions of major organs can be controlled temporarily by the administration of panitumumab alone.

  5. Portal vein-circulating tumor cells predict liver metastases in patients with resectable pancreatic cancer.

    Science.gov (United States)

    Bissolati, Massimiliano; Sandri, Maria Teresa; Burtulo, Giovanni; Zorzino, Laura; Balzano, Gianpaolo; Braga, Marco

    2015-02-01

    Pancreatic cancer patients underwent surgical resection often present distant metastases early after surgery. Detection of circulating tumor cells (CTCs) has been correlated to a worse oncological outcome in patients with advanced pancreatic cancer. The objective of this pilot study is to investigate the possible prognostic role of CTCs in patients undergoing surgery for pancreatic cancer. In 20 patients undergoing pancreatic resection, 10 mL blood sample was collected intraoperatively from both systemic circulation (SC) and portal vein (PV). Blood sample was analyzed for CTCs with CellSearch® system. All patients underwent an oncologic follow-up for at least 3 years, quarterly. CTCs were detected in nine (45%) patients: five patients had CTCs in PV only, three patients in both SC and PV, and one patient in SC only. CTC-positive and CTC-negative patients were similar for demographics and cancer stage pattern. No significant differences were found in both overall and disease-free survival between CTC-positive and CTC-negative patients. At 3-year follow-up, portal vein CTC-positive patients presented a higher rate of liver metastases than CTC-negative patients (53 vs. 8%, p = 0.038). CTCs were found in 45% of the patients. No correlation between CTCs and survival was found. The presence of CTCs in portal vein has been associated to higher rate of liver metastases after surgery.

  6. Yttrium-90 glass microspheres injected via the portal vein; An experimental study

    Energy Technology Data Exchange (ETDEWEB)

    Yan, Z.P. (Dept. of Radiology, Zhong Shan Hospital, Shanghai Medical Univ. (China)); Lin, G. (Dept. of Radiology, Zhong Shan Hospital, Shanghai Medical Univ. (China)); Zhao, H.Y. (Dept. of Radiology, Zhong Shan Hospital, Shanghai Medical Univ. (China)); Dong, Y.H. (Dept. of Radiology, Zhong Shan Hospital, Shanghai Medical Univ. (China))

    1993-07-01

    Nondegradable glass microspheres (35 [mu]) were injected into the portal vein for toxicity test in 15 rabbits. In 10 animals the microspheres were loaded with [sup 90]Y, giving liver absorbed doses between 24.6 and 437.4 Gy, and in 5 with [sup 89]Y (control group). The total amount of microspheres injected in each animal varied between 35 and 140 mg. The rabbits in the experimental group tolerated the effect of radioembolization in a dose 4 times higher than the upper limit of the clinical dose (100 Gy). After injection of [sup 90]Y glass microspheres into the portal vein of rats with diethylnitrosamine (DEN)-induced hepatic carcinoma, the microspheres, in addition to the liver parenchyma, accumulated in central and peripheral parts of the cancer nodules, causing necrosis. The internal radiation therapy of [sup 90]Y glass microspheres delivered via the portal vein may be an effective nonsurgical method for the treatment of liver cancer, especially in small nodules. (orig.).

  7. Arterialization of the portal vein improves hepatic microcirculation and tissue oxygenation in experimental cirrhosis.

    Science.gov (United States)

    Yang, W; Koti, R; Glantzounis, G; Davidson, B R; Seifalian, A M

    2003-10-01

    Arterialization of the portal vein (APV) has shown beneficial effects on liver regeneration and function in selected patients undergoing liver resection and transplantation. Whether APV improves liver perfusion and function in cirrhosis is unclear. This study investigated the effect of APV on hepatic haemodynamics and liver function in a rat model of cirrhosis. Male Sprague-Dawley rats (250-300 g) were divided into three groups: normal controls (n = 7), cirrhosis with sham laparotomy (sham; n = 7) and cirrhosis with APV (APV; n = 9). Portal venous blood flow, portal vein pressure and hepatic parenchymal microcirculation (HPM) were measured before and after APV. Hepatic parenchymal oxygenation was assessed by near-infrared spectroscopy and hepatocellular injury by standard liver function tests. Measurements were taken at baseline, after APV and 7 days after surgery. APV increased portal blood flow and pressure in cirrhotic rats without altering intrahepatic portal resistance. APV increased the HPM in cirrhotic rats by a mean(s.e.m.) of 28.5(0.1) per cent on day 0 and 54.6(0.1) per cent by day 7 (P = 0.001). Liver tissue oxygenation was increased by APV and the plasma gamma-glutamyltranspeptidase level was reduced (mean(s.e.m.) 6.0(0.5) versus 3.8(0.3) units/l before and after APV respectively; P = 0.006) at day 7. APV increases portal blood flow, tissue perfusion and oxygenation in cirrhosis. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  8. Portal vein blood flow is related to characteristics of the migrating motor complex of the gastrointestinal tract

    DEFF Research Database (Denmark)

    Qvist, Niels; Rafaelsen, Søren Rafael; Troensegaard, P.

    1994-01-01

    Objective: To measure variation in portal blood flow during the interdigestive state in relation to the migrating motor complex (MMC) in healthy volunteers. Design: Portal blood flow was measured by a duplex and colour Doppler technique with 5-min intervals during an entire MMC cycle. Total....... Conclusion: Blood flow in the portal vein varies with the characteristics of the MMC, a relationship which must be considered in future studies in health and disease....

  9. Massive hepatic necrosis with toxic liver syndrome following portal vein ligation

    Science.gov (United States)

    Dupré, Aurélien; Gagnière, Johan; Tixier, Lucie; Ines, David Da; Perbet, Sébastien; Pezet, Denis; Buc, Emmanuel

    2013-01-01

    Right portal vein ligation (PVL) is a safe and widespread procedure to induce controlateral liver hypertrophy for the treatment of bilobar colorectal liver metastases. We report a case of a 60-year-old man treated by both right PVL and ligation of the glissonian branches of segment 4 for colorectal liver metastases surrounding the right and median hepatic veins. After surgery, the patient developed massive hepatic necrosis with secondary pulmonary and renal insufficiency requiring transfer to the intensive care unit. This so-called toxic liver syndrome finally regressed after hemofiltration and positive oxygen therapy. Diagnosis of acute congestion of the ligated lobe was suspected. The mechanism suspected was an increase in arterial inflow secondary to portal vein ligation concomitant with a decrease in venous outflow due to liver metastases encircling the right and median hepatic vein. This is the first documented case of toxic liver syndrome in a non-cirrhotic patient with favorable issue, and a rare complication of PVL. PMID:23687421

  10. Relationship between Abnormal Characteristics of Sublingual Collateral and Portal Vein Hemodynamic Changes in Patients with Primary Hepatic Carcinoma

    Institute of Scientific and Technical Information of China (English)

    DENG Wei-zhe; LANG Qing-bo; LING Chang-quan

    2008-01-01

    Objective: To investigate the relationship between the abnormal characteristics of sublingual collateral (SC) and portal vein hemodynamic changes in patients with primary hepatic carcinoma (PHC). Methods: A total of 123 patients of PHC with abnormal SC were enrolled. The SC characteristics were classified and evaluated. The principal components (PC) of SC extracted from them by principal component analysis and the relationship between PC and the dynamic changes of portal vein flow were analyzed by correlation analysis. Results: Three groups of PC were extracted, namely PC-1 (length, width, presentation type of visualization), PC-2 (circuitous, vesicular change), and PC-3 (color, collateral hemostasis, petechiae, ecchymosis). Their total accumulative contribution degree reached 56.803%. Correlation analysis shows that PC-1 was significantly positively correlated with the hemodynamic parameters of the portal vein (P0.05). Conclusion= Length, width and presentation type of SC could be used for predicting the changes of portal venous pressure in PHC patients.

  11. Very Early Presentation of Extrahepatic Portal Vein Obstruction Causing Portal Hypertension in an Infant: Uncertainties in the Management and Therapeutic Limitations

    OpenAIRE

    Parisá Khodayar-Pardo; Andrés Peña Aldea; Ana Ramírez González; Adela Meseguer Carrascosa; Cristina Calabuig Bayo

    2016-01-01

    Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous ...

  12. Discrepant imaging findings of portal vein thrombosis with dynamic computed tomography and computed tomography during arterial portography in hepatocellular carcinoma: possible cause leading to inappropriate treatment selection.

    Science.gov (United States)

    Toyoda, Hidenori; Kumada, Takashi; Tada, Toshifumi; Mizuno, Kazuyuki; Kobayashi, Natsuko; Inukai, Yosuke; Takeda, Akira; Sone, Yasuhiro

    2017-04-01

    We encountered a patient with hepatocellular carcinoma who had discrepant imaging findings on portal vein thrombosis with portal phase dynamic computed tomography (CT) and CT during arterial portography (CTAP). CTAP, via the superior mesenteric artery and via the splenic artery, both showed a portal perfusion defect in the right hepatic lobe, indicating portal vein thrombosis in the main trunk of the right portal vein. Portal phase dynamic CT clearly depicted portal perfusion of the same hepatic area. Transarterial chemoembolization was successfully performed, but it was associated with severe liver injury. Clinicians should be cautious about this possible discrepancy based on imaging technique. The inaccurate evaluation of portal vein thrombosis may result in inappropriate treatment selection, which can worsen patient prognosis.

  13. A comparative study of 1D and 3D hemodynamics in patient-specific hepatic portal vein networks

    Directory of Open Access Journals (Sweden)

    Jonášová A.

    2014-12-01

    Full Text Available The development of software for use in clinical practice is often associated with many requirements and restrictions set not only by the medical doctors, but also by the hospital’s budget. To meet the requirement of reliable software, which is able to provide results within a short time period and with minimal computational demand, a certain measure of modelling simplification is usually inevitable. In case of blood flow simulations carried out in large vascular networks such as the one created by the hepatic portal vein, simplifications are made by necessity. The most often employed simplification includes the approach in the form of dimensional reduction, when the 3D model of a large vascular network is substituted with its 1D counterpart. In this context, a question naturally arises, how this reduction can affect the simulation accuracy and its outcome. In this paper, we try to answer this question by performing a quantitative comparison of 3D and 1D flow models in two patient-specific hepatic portal vein networks. The numerical simulations are carried out under average flow conditions and with the application of the three-element Windkessel model, which is able to approximate the downstream flow resistance of real hepatic tissue. The obtained results show that, although the 1D model can never truly substitute the 3D model, its easy implementation, time-saving model preparation and almost no demands on computer technology dominate as advantages over obvious but moderate modelling errors arising from the performed dimensional reduction.

  14. Giant cavernous hemangioma coexistent with diffuse hepatic hemangiomatosis presenting as portal vein thrombosis and hepatic lobar atrophy

    Directory of Open Access Journals (Sweden)

    Bo Reum Yoo

    2014-01-01

    Full Text Available

    A combination of giant hepatic hemangioma and diffuse hemangiomatosis is extremely rare in adults. Even when they are large, hemangiomas are soft and rarely compress adjacent structures. A 78-year-old man presented with abdominal pain and distension. Ultrasonography, computed tomography, and magnetic resonance imaging demonstrated a large expansile mass replacing the medial segment and caudate lobe with diffusely scattered nodules in the entire liver. The large hilar mass contained a central nonenhancing area and had a mass effect, leading to left portal vein occlusion. The image findings also revealed two unprecedented findings: left lateral segmental atrophy of the liver and recent portomesenteric vein thrombosis. The hepatic lesions were confirmed with hemangiomas by ultrasonography-guided biopsy. We diagnosed intrahepatic portal vein obstruction caused by a mass effect of giant hepatic hemangioma coexistent with diffuse hemangiomatosis, resulting in hepatic segmental atrophy and extrahepatic portal vein thrombosis.

  15. Giant cavernous hemangioma coexistent with diffuse hepatic hemangiomatosis presenting as portal vein thrombosis and hepatic lobar atrophy

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Bo Reum; Han, Hyun Young; Choi, So Young; Kim, Joo Heun [Eulji University Hospital, Daejeon(Korea, Republic of)

    2014-03-15

    A combination of giant hepatic hemangioma and diffuse hemangiomatosis is extremely rare in adults. Even when they are large, hemangiomas are soft and rarely compress adjacent structures. A 78-year-old man presented with abdominal pain and distension. Ultrasonography, computed tomography, and magnetic resonance imaging demonstrated a large expansile mass replacing the medial segment and caudate lobe with diffusely scattered nodules in the entire liver. The large hilar mass contained a central nonenhancing area and had a mass effect, leading to left portal vein occlusion. The image findings also revealed two unprecedented findings: left lateral segmental atrophy of the liver and recent portomesenteric vein thrombosis. The hepatic lesions were confirmed with hemangiomas by ultrasonography-guided biopsy. We diagnosed intrahepatic portal vein obstruction caused by a mass effect of giant hepatic hemangioma coexistent with diffuse hemangiomatosis, resulting in hepatic segmental atrophy and extrahepatic portal vein thrombosis.

  16. Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016

    Science.gov (United States)

    Chan, Stephen L; Chong, Charing C N; Chan, Anthony W H; Poon, Darren M C; Chok, Kenneth S H

    2016-01-01

    Portal vein tumor thrombosis (PVTT) is a common phenomenon in hepatocellular carcinoma (HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discuss the recent conceptual changes and summarize the data on the management of HCC with PVTT. PMID:27621575

  17. Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: A role for preoperative MRI?

    Energy Technology Data Exchange (ETDEWEB)

    Vermeulen, Mechteld A.R., E-mail: mar.vermeulen@vumc.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Ligthart-Melis, Gerdien C., E-mail: g.ligthart-melis@vumc.nl [Department of Internal Medicine, Dietetics and Nutritional Sciences, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Buijsman, René, E-mail: renebuysman@gmail.com [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Siroen, Michiel P.C., E-mail: m.siroen6@upcmail.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Poll, Marcel C.G. van de, E-mail: mcg.vandepoll@ah.unimaas.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Boelens, Petra G., E-mail: p.boelens@mumc.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Dejong, Cornelis H.C., E-mail: chc.dejong@mumc.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Schaik, Cors van, E-mail: c.vanschaik@vumc.nl [Department of Radiology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Hofman, Mark B.M., E-mail: mbm.hofman@vumc.nl [Department of Physics and Medical Technology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Leeuwen, Paul A.M. van, E-mail: pam.vleeuwen@vumc.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands)

    2012-09-15

    Background: Quantification of abdominal blood flow is essential for a variety of gastrointestinal and hepatic topics such as liver transplantation or metabolic flux measurement, but those need to be performed during surgery. It is not clear whether Duplex Doppler Ultrasound during surgery or MRI before surgery is the tool to choose. Objective: To examine whether preoperative evaluation of abdominal blood flow using MRI could prove to be a useful and reliable alternative for the perioperative sonographic approach. Methods: In this study portal and renal venous flow and hepatic arterial flow were sequentially quantified by preoperative MRI, preoperative and perioperative Duplex Doppler Ultrasound (DDUS). 55 Patients scheduled for major abdominal surgery were studied and methods and settings were compared. Additionally, average patient population values were compared. Results: Mean (±SD) plasmaflow measured by perioperative DDUS, preoperative DDUS and MRI, respectively was 433 ± 200/423 ± 162/507 ± 96 ml/min (portal vein); 96 ± 70/74 ± 41/108 ± 91 ml/min (hepatic artery); 248 ± 139/201 ± 118/219 ± 69 ml/min (renal vein). No differences between the different settings of DDUS measurement were detected. Equality of mean was observed for all measurements. Bland Altman Plots showed widespread margins. Hepatic arterial flow measurements correlated with each other, but portal and renal venous flow correlations were absent. Conclusions: Surgery and method (DDUS vs. MRI) do not affect mean flow values. Individual comparison is restricted due to wide range in measurements. Since MRI proves to be more reliable with respect to inter-observer variability, we recommend using mean MRI results in experimental setups.

  18. Rescue associating liver partition and portal vein ligation for staged hepatectomy after portal embolization: Our experience and literature review.

    Science.gov (United States)

    Maulat, Charlotte; Philis, Antoine; Charriere, Bérénice; Mokrane, Fatima-Zohra; Guimbaud, Rosine; Otal, Philippe; Suc, Bertrand; Muscari, Fabrice

    2017-08-10

    To report a single-center experience in rescue associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), after failure of previous portal embolization. We also performed a literature review. Between January 2014 and December 2015, every patient who underwent a rescue ALPPS procedure in Toulouse Rangueil University Hospital, France, was included. Every patient included had a project of major hepatectomy and a previous portal vein embolization (PVE) with insufficient future liver remnant to body weight ratio after the procedure. The ALPPS procedure was performed in two steps (ALPPS-1 and ALPPS-2), separated by an interval phase. ALPPS-2 was done within 7 to 9 d after ALPPS-1. To estimate the FLR, a computed tomography scan examination was performed 3 to 6 wk after the PVE procedure and 6 to 8 d after ALPPS-1. A transcystic stent was placed during ALPPS-1 and remained opened during the interval phase, in order to avoid biliary complications. Postoperative liver failure was defined using the 50-50 criteria. Postoperative complications were assessed according to the Dindo-Clavien Classification. From January 2014 to December 2015, 7 patients underwent a rescue ALPPS procedure. Median FLR before PVE, ALPPS-1 and ALPPS-2 were respectively 263 cc (221-380), 450 cc (372-506), and 660 cc (575-776). Median FLR/BWR before PVE, ALPPS-1 and ALPPS-2 were respectively 0.4% (0.3-0.5), 0.6% (0.5-0.8), and 1% (0.8-1.2). Median volume growth of FLR was 69% (18-92) after PVE, and 45% (36-82) after ALPPS-1. The combination of PVE and ALPPS induced a growth of median initial FLR of +408 cc (254-513), leading to an increase of +149% (68-199). After ALPPS-2, 4 patients had stage I-II complications. Three patients had more severe complications (one stage III, one stage IV and one death due to bowel perforation). Two patients suffered from postoperative liver failure according to the 50/50 criteria. None of our patients developed any biliary complication during the

  19. A case of extra hepatic portal vein obstruction in pregnancy with superimposed pre-eclampsia

    Directory of Open Access Journals (Sweden)

    Bindu Nambisan

    2016-09-01

    Full Text Available Extra hepatic portal vein obstruction in pregnancy poses a clinical challenge by itself. We present here a case of a 19 year old primigravida with EHPVO who developed superimposed preeclampsia. She had a successful maternal and fetal outcome in a tertiary care centre owing to the team effort involving specialists from medical gastroenterology, nephrology, anesthesiology, and neonatology apart from senior obstetrician. EHPVO is an important cause of non-cirrhotic portal hypertension in third world countries. In pregnancy, the increased blood volume and cardiac output and mesenteric vasodilatation will increase portal flow and aggravate portal hypertension in these patients. The resultant hematemesis in such patients, can compromise the perinatal outcome. Endoscopic variceal ligation (EVL reduces the risk of variceal bleeding, and can improve the pregnancy outcome in these women. Thrombocytopenia due to splenomegaly is one of the major complications in these patients and has to be corrected before pregnancy. Platelet transfusion is required intrapartum if the count is less than 50,000/mm3 caesarean delivery is reserved only for obstetric indications. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3213-3215

  20. Management of Anticoagulation for Portal Vein Thrombosis in Individuals with Cirrhosis: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Geneviève Huard

    2012-01-01

    Full Text Available Non-neoplastic portal vein thrombosis (PVT is an increasingly recognized complication of liver cirrhosis. It is often diagnosed fortuitously and can be either partial or complete. The clinical significance of PVT is not obvious except in some situations such as when patients are on the waiting list for liver transplantation. The only known therapy is anticoagulation which has been shown to permit the disappearance of thrombosis and to prevent further extension. Anticoagulation is a challenging therapy in individuals with liver cirrhosis because of the well-recognized coagulation abnormalities observed in that setting and because of the increased risk of bleeding, especially from gastrointestinal tract caused by portal hypertension. We herein review the current knowledge on that topic in order to highlight the advantages and disadvantages of the currently proposed therapeutic attitudes in face of the diagnosis of PVT in individuals with cirrhosis.

  1. Does Helicobacter pylori affect portal hypertensive gastropathy?

    Directory of Open Access Journals (Sweden)

    Al Mofleh Ibrahim

    2007-01-01

    Full Text Available Helicobacter pylori (H. pylori is a major etiological factor of peptic ulcer disease (PUD. It is supposed to be a risk factor for the more frequently encountered PUD in patients with liver cirrhosis. Several investigators have evaluated the effect of H. pylori on liver cirrhosis, portal hypertensive gastropathy (PHG and encephalopathy with controversial results. Some reports have shown a higher seroprevalence and suggested a synergistic effect of H. pylori on liver cirrhosis and PHG. However, this increased prevalence is associated with a negative histology and is not influenced by the cause of cirrhosis, PHG, Child class or gender. Most studies have not found any correlation between H. pylori and PHG. In contrast, other studies have reported a markedly lower prevalence of H. pylori in cirrhotics with duodenal ulcer compared to controls. The aim of this article is to review the relationship between H. pylori infection and portal hypertensive gastropathy and the role of H. pylori eradication in cirrhotic patients.

  2. Liver lobation and intraparenchymal distribution of the portal vein in Brazilian guinea pig (Galea spixii Wagler, 1831

    Directory of Open Access Journals (Sweden)

    Gleidson Benevides de Oliveira

    2011-09-01

    Full Text Available Liver lobation and intraparenchymal distribution of the portal vein was described according to studies performed in 10 specimens of Brazilian guinea pigs. The portal vein was cannulated and perfusedwith a vinyl acetate solution and the liver immersed in sulfuric acid solution to obtain vascular casts. The liver presented five lobes, which were named left lateral, left medial, square, right lateral, right medial, and caudate lobes with caudate and papillary processes. The portal vein, entering the portal fissure, divided into two branches, the right and left ones, as it entered the portal fissure. The right branch emitted isolated or common trunk branches to the right lateral lobe and to the caudate process of caudate lobe. On its turn, the left main branch of portal vein divided into two other branches. One of them formed a common trunk for the left lateral, left medial, and square lobes, being the two last ones in a common way. The second branch coursed towards to the right medial branch. Just after its formation, the common trunk of the left main branch emits small vascular branches to the papillary process of caudate lobe.

  3. Safety and efficacy of cryopreserved homologous veins for venous reconstruction in pancreatoduodenectomy.

    Science.gov (United States)

    Yamamoto, Masaki; Akamatsu, Nobuhisa; Aoki, Taku; Sakamoto, Yoshihiro; Tamura, Sumihito; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2017-02-01

    There are several techniques for reconstructing the portal vein-superior mesenteric vein during pancreatoduodenectomy. The aim of the present study was to present our results with portal vein-superior mesenteric vein reconstruction using cryopreserved homologous veins during pancreatoduodenectomy for patients with pancreatic head cancer. Patients who underwent pancreatoduodenectomy for pancreatic head cancer were reviewed retrospectively. In patients with portal vein-superior mesenteric vein resection, the detailed method of reconstruction and clinical outcomes were reviewed. Clinical characteristics, patient survival, and portal vein-superior mesenteric vein patency were compared between those with and without homologous vein grafts. Factors affecting the patency of reconstructed veins were assessed by univariate analysis. Among 144 patients undergoing pancreatoduodenectomy, portal vein-superior mesenteric vein resection was performed in 36 patients (25%); 18 (50%) underwent reconstruction with homologous veins, and the other 18 (50%) underwent reconstruction without homologous veins. The extent of portal vein-superior mesenteric vein involvement, operative time, duration of clamping of portal vein-superior mesenteric vein, intraoperative blood loss, and length of the venous resection were greater (P ≤ .013 each) in those with homologous vein grafts. There was no significant difference in postoperative morbidity/mortality, patient survival, or portal vein-superior mesenteric vein patency. The 1- and 2-year overall patency of portal vein-superior mesenteric vein was 76% and 71%, respectively, while the 2-year patencies were 67% and 67% in those with homologous veins and 87% and 73% in those without homologous veins without difference between the groups. Circumferential resection and pathologic portal vein-superior mesenteric vein involvement were associated with the patency of the reconstructed vein (P = .002 and P = .028, resp). Use of homologous venous

  4. Ultrasonography and 3D-CT Follow-Up of Extrahepatic Portal Vein Aneurysm: A Case Report

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    Norio Yukawa

    2010-01-01

    Full Text Available Extrahepatic portal vein aneurysm is a rare disorder. From 1956 to 2008, we found only 43 published English-language reports, including 67 cases, using Pub Med. We report a case of a 77-year-old woman who had complaints of lower abdominal fullness and residual urine. We performed ultrasonography (US, which demonstrated a congenital extrahepatic portal vein aneurysm. She had no obvious symptoms of the extrahepatic portal vein aneurysm. She had undergone gastrectomy without blood transfusion for gastric ulcer more than 20 years ago. Physical examination revealed no abnormal findings. US revealed a 2.2×1.8 cm, round shaped hypoechogenic lesion at the hepatic hilum. Color Doppler US showed bidirectional colors due to circular flow within this lesion. 3D-CT and CT angiography demonstrated that the saccular aneurysm at the hepatic hilum was 3.0 cm in diameter and was enhanced equal to that of portal vein.Twenty-six months after the diagnosis, the aneurysm had not grown in size. Since our patient had no serious complaints or liver disease, surgical procedures had not been employed. US and 3D-CT are noninvasive diagnostic techniques and are helpful in the diagnosis and follow-up of extrahepatic portal vein aneurysms.

  5. Treatment of surgical brain injury by immune tolerance induced by intrathymic and hepatic portal vein injection of brain antigens

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    Yang, Weijian; Liu, Yong; Liu, Baolong; Tan, Huajun; Lu, Hao; Wang, Hong; Yan, Hua

    2016-01-01

    Surgical brain injury (SBI) defines complications induced by intracranial surgery, such as cerebral edema and other secondary injuries. In our study, intrathymic and hepatic portal vein injection of allogeneic myelin basic protein (MBP) or autogeneic brain cell suspensions were administered to a standard SBI model. Serum pro-inflammatory IL-2, anti-inflammatory IL-4 concentrations and the CD4+T/CD8+T ratio were measured at 1, 3, 7, 14 and 21 d after surgery to verify the establishment of immune tolerance. Furthermore, we confirmed neuroprotective effects by evaluating neurological scores at 1, 3, 7, 14 and 21 d after SBI. Anti-Fas ligand (FasL) immunohistochemistry and TUNEL assays of brain sections were tested at 21 d after surgery. Intrathymic injections of MBP or autogeneic brain cell suspensions functioned by both suppressing secondary inflammatory reactions and improving prognoses, whereas hepatic portal vein injections of autogeneic brain cell suspensions exerted a better effect than MBP. Intrathymic and hepatic portal vein injections of MBP had equal effects on reducing secondary inflammation and improving prognoses. Otherwise, hepatic portal vein injections of autogeneic brain cell suspensions had better outcomes than intrathymic injections of autogeneic brain cell suspensions. Moreover, the benefit of injecting antigens into the thymus was outweighed by hepatic portal vein injections. PMID:27554621

  6. Complications of portal vein embolization evaluation on cross-sectional imaging

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    Yeom, Yoo Kyeong; Shin, Ji Hoon [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2015-10-15

    Portal vein embolization (PVE) is known as an effective and safe preoperative procedure that increases the future liver remnant (FLR) in patients with insufficient FLR. However, some possible major complications can lead to non-resectability or delayed elective surgery that results in increased morbidity and mortality. Although the majority of these complications are rare, knowledge of the radiologic findings of post-procedural complications facilitate an accurate diagnosis and ensure prompt management. We accordingly reviewed the CT findings of the complications of PVE.

  7. Portal Vein Thrombosis of a Newborn with Corrected Total Anomalous Pulmonary Venous Return

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    Ufuk Çakır

    2015-09-01

    Full Text Available Total anomalous pulmonary venous return (TAPVR is a rare and frequently isolated defect identified in 1% to 3% of all congenital heart diseases. To the best of our knowledge, portal vein thrombosis (PVT associated with TAPVR has not been reported in the literature. We report a successfully managed PVT in a newborn with infracardiac-type TAPVR and review the literature. Anticoagulation therapies were used during the neonatal period to prevent thrombus progression. PVT should be kept in mind in TAPVR patients who have open heart repair with total correction. The treatment in each neonate should be individualized with consideration of the risk/benefit ratio.

  8. Splenic Artery Aneurysm Presenting as Extrahepatic Portal Vein Obstruction: A Case Report

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    T. P. Elamurugan

    2011-01-01

    Full Text Available Splenic artery aneurysms are the most common visceral aneurysm occuring predominantly in females. They are usually asymptomatic, and the symptomatic presentation includes chronic abdominal pain of varied severity or an acute rupture with hypotension. Splenic artery aneurysm causing extrahepatic portal hypertension is very rare and is due to splenic vein thrombosis that develops secondary to compression by the aneurysm. We report one such rare presentation of splenic artery aneurysms in a pregnant female with the features of EHPVO (variceal bleed, hypersplenism treated by splenectomy along with excision of the aneurysm.

  9. Massive splenic infarction and portal vein thrombosis in children with chronic myeloid leukemia.

    Science.gov (United States)

    Aksu, Tekin; Erdem, Arzu Y; Fettah, Ali; Kaçar, Dilek; Avci, Zekai; Yarali, Nese; Tunc, Bahattin

    2014-10-01

    Massive splenic infarction and portal vein thrombosis (PVT) due to chronic myeloid leukemia (CML) is extremely rare. We describe 2 children who were presented with massive splenic infarction and PVT in the course of CML. Massive splenic infarction and PVT treated with splenectomy in one and with medical treatment in another in whom PVT resolved by cytoreductive treatment, led to downsizing of spleen or splenectomy. Splenic infarct and PVT should be considered in CML patients with long-lasting severe abdominal pain despite appropriate medical attempts. Splenectomy should be spared for persistent symptoms and complications.

  10. Stenting of the Portal Vein Combined with Different Numbers of Iodine-125 Seed Strands: Dosimetric Analyses

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    Li-Hong Yao

    2017-01-01

    Conclusions: A portal-vein stent combined with a single 125I seed strand could not meet dosimetry requirements. For a stent combined with two 125I seed strands, when the PD was 105 Gy and seed activity was 0.7 mCi, the dose distribution could satisfy dosimetry requirements. For a stent combined with three 125I seed strands, if the PD was 105, 125, or 145 Gy, the recommended seed activities were 0.5, 0.5, and 0.6 mCi, respectively.

  11. Acute partial Budd-Chiari syndrome and portal vein thrombosis in cytomegalovirus primary infection: a case report

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    Morard Isabelle

    2006-03-01

    Full Text Available Abstract Background Splanchnic vein thrombosis may complicate inherited thrombotic disorders. Acute cytomegalovirus infection is a rare cause of acquired venous thrombosis in the portal or mesenteric territory, but has never been described extending into a main hepatic vein. Case presentation A 36-year-old immunocompetent woman presented with acute primary cytomegalovirus infection in association with extensive thrombosis in the portal and splenic vein. In addition, a fresh thrombus was evident in the right hepatic vein. A thorough evaluation for a hypercoagulable state was negative. The clinical course, biological evolution, radiological and histological findings were consistent with cytomegalovirus hepatitis complicated by a partial acute Budd-Chiari syndrome and portal thrombosis. Therapeutic anticoagulation was associated with a slow clinical improvement and partial vascular recanalization. Conclusion We described in details a new association between cytomegalovirus infection and acute venous thrombosis both in the portal vein and in the right hepatic vein, realizing a partial Budd-Chiari syndrome. One should be aware that this rare thrombotic event may be complicated by partial venous outflow block.

  12. Heterotopic auxiliary rat liver transplantation with flow-regulated portal vein arterialization in acute hepatic failure.

    Science.gov (United States)

    Schleimer, Karina; Kalder, Johannes; Grommes, Jochen; Jalaie, Houman; Tawadros, Samir; Greiner, Andreas; Jacobs, Michael; Kokozidou, Maria

    2014-01-01

    In acute hepatic failure auxiliary liver transplantation is an interesting alternative approach. The aim is to provide a temporary support until the failing native liver has regenerated.(1-3) The APOLT-method, the orthotopic implantation of auxiliary segments- averts most of the technical problems. However this method necessitates extensive resections of both the native liver and the graft.(4) In 1998, Erhard developed the heterotopic auxiliary liver transplantation (HALT) utilizing portal vein arterialization (PVA) (Figure 1). This technique showed promising initial clinical results.(5-6) We developed a HALT-technique with flow-regulated PVA in the rat to examine the influence of flow-regulated PVA on graft morphology and function (Figure 2). A liver graft reduced to 30 % of its original size, was heterotopically implanted in the right renal region of the recipient after explantation of the right kidney.  The infra-hepatic caval vein of the graft was anastomosed with the infrahepatic caval vein of the recipient. The arterialization of the donor's portal vein was carried out via the recipient's right renal artery with the stent technique. The blood-flow regulation of the arterialized portal vein was achieved with the use of a stent with an internal diameter of 0.3 mm. The celiac trunk of the graft was end-to-side anastomosed with the recipient's aorta and the bile duct was implanted into the duodenum. A subtotal resection of the native liver was performed to induce acute hepatic failure. (7) In this manner 112 transplantations were performed. The perioperative survival rate was 90% and the 6-week survival rate was 80%. Six weeks after operation, the native liver regenerated, showing an increase in weight from 2.3±0.8 g to 9.8±1 g. At this time, the graft's weight decreased from 3.3±0.8 g to 2.3±0.8 g. We were able to obtain promising long-term results in terms of graft morphology and function. HALT with flow-regulated PVA reliably bridges acute hepatic failure

  13. Haemodynamic changes in the liver under balloon occlusion of a portal vein branch-evaluation with single-level dynamic computed tomography during hepatic arteriography

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    Komada, Y. [Department of Radiology/Center for Advanced Medical Technology, Sendagi, Bunkyo-ku, Tokyo (Japan)]. E-mail: brian-komada@msj.biglobe.ne.jp; Murata, S. [Department of Radiology/Center for Advanced Medical Technology, Sendagi, Bunkyo-ku, Tokyo (Japan); Tajima, H. [Department of Radiology/Center for Advanced Medical Technology, Sendagi, Bunkyo-ku, Tokyo (Japan); Kumita, S. [Department of Radiology/Center for Advanced Medical Technology, Sendagi, Bunkyo-ku, Tokyo (Japan); Kanazawa, H. [3rd Department of Internal Medicine, Sendagi, Bunkyo-ku, Tokyo (Japan); Tajiri, T. [1st Department of Surgery, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo (Japan)

    2007-06-15

    Aim: To assess haemodynamic changes in the liver under temporary occlusion of an intrahepatic portal vein. Materials and methods: Between February 2000 and October 2004, 16 patients with hepatobiliary disease underwent single-level dynamic computed tomography during hepatic arteriography (SLD-CTHA) under temporary balloon occlusion of an intrahepatic portal vein. All patients needed percutaneous transhepatic portography for therapy of their disease. SLD-CTHA was undertaken to clarify the time-attenuation curve influenced by portal vein occlusion, and it was performed continuously over a period of 30 s. The difference in absolute attenuation of the liver parenchyma in segments with occluded and non-occluded portal vein branches was determined by means of the CT number, and the difference in absolute attenuation of the occluded and non-occluded portal veins themselves was also evaluated. Results: SLD-CTHA demonstrated a demarcated hyperattenuation area in the corresponding distribution of the occluded portal vein branch. The attenuation of the liver parenchyma supplied by the occluded portal vein was significantly higher than that in the non-occluded area (p < 0.01). The balloon-occluded portal branch enhancement in 15 of 16 cases (94%) appears due to arterio-portal communications. Failure to evaluate a remaining case for portal branch enhancement was due to absence of a visualized portal branch in the section. Conclusion: Under temporary occlusion of an intrahepatic portal vein, hepatic angiography produced enhancement of the occluded portal branches and their corresponding parenchymal distribution; this finding is considered consistent with the presence of arterio-portal communications.

  14. Veias do sistema porta-hepático em gansos domésticos Veins from hepatic portal vein system in domestic geese

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    Tatiana C. Santos

    2009-04-01

    Full Text Available A distribuição intraparenquimal das veias porta-hepáticas foi estudada em 30 gansos domésticos. Latex Neoprene corado foi injetado pela veia isquiática e os animais forma fixados por imersão e injeção intramuscular com formol a 10% e dissecados. O fígado esteve composto por um grande lobo hepático direito e por um lobo hepático esquerdo menor, os quais estiveram conectados por uma ponte de parênquima. O lobo direito do fígado teve exclusivamente vasos do sistema porta-hepático formados pela distribuição intraparenquimal da veia porta-hepática direita, enquanto que no lobo esquerdo estes originaram-se da veia porta-hepática direita e de pequenas veias porta-hepáticas esquerdas. A veia porta-hepática direita emitiu o ramo caudal direito, que emitiu um pequeno ramo caudolateral direito e um grande ramo caudomedial direito. Cranialmente esta veia emitiu os ramos craniais direito e ramos lateral direito. A porção transversa da veia porta-hepática direita cruzou para o lobo hepático esquerdo, emitindo de 1 a 6 pequenos ramos craniais e caudais para a região média do fígado. No lobo esquerdo, o ramo esquerdo da veia porta-hepática direita emitiu o ramo cranial esquerdo, o ramo lateral esquerdo e o ramo medial. De 1 a 6 veias porta-hepáticas esquerdas foram identificadas desembocando ou no ramo esquerdo da veia porta-hepática direita ou em sua porção transversa, oriundos do ventrículo gástrico e do pró-ventrículo. Em 40% dos gansos uma veia porta-hepática própria oriunda da confluência de vasos venosos da face esquerda do ventrículo distribuiu-se na extremidade caudal do lobo esquerdo isoladamente.The intraparenchymal distribution of the hepatic portal veins in 30 domestic geese were studied. Stained Neoprene latex was injected into the isquiatic vessels, and the animals were fixed in 10% formaldehyde by immersion and intramuscular injection. The liver of geese was composed of a large right and a smaller left

  15. Portal vein omentin is increased in patients with liver cirrhosis but is not associated with complications of portal hypertension.

    Science.gov (United States)

    Eisinger, Kristina; Krautbauer, Sabrina; Wiest, Reiner; Karrasch, Thomas; Hader, Yvonne; Scherer, Marcus N; Farkas, Stefan; Aslanidis, Charalampos; Buechler, Christa

    2013-09-01

    Omentin is a visceral fat-derived adipokine associated with endothelium-dependent vasodilation. Impaired endothelial function is a major cause of portal hypertension in liver cirrhosis. The aim was to assess associations of omentin with systemic markers of endothelial function, namely arginine and asymmetric dimethylarginine (ADMA) and complications of portal hypertension in liver cirrhosis. Systemic omentin was measured by ELISA in portal venous serum (PVS), systemic venous serum (SVS) and hepatic venous serum (HVS) of 40 patients with liver cirrhosis and 10 liver-healthy controls. ADMA and arginine were determined in SVS of the patients by ELISA. Omentin is elevated in PVS and tends to be increased in SVS and HVS of patients with liver cirrhosis compared with controls. Omentin is principally expressed in visceral fat, and PVS omentin tends to be higher than SVS levels. Lower HVS than PVS omentin suggests that omentin may be partly removed from the circulation by the liver. Omentin in serum is not associated with stages of liver cirrhosis defined by CHILD-POUGH or MELD score and is not affected in patients with ascites. HVS omentin tends to be reduced in patients with large varices compared with patients without/with small varices. Arginine/ADMA ratio is reduced in patients with massive ascites but is not associated with variceal size. Further, Arginine/ADMA ratio does not correlate with omentin. Current data show that PVS omentin is increased in liver cirrhosis but is not associated with complications of portal hypertension. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

  16. Extracorporeal portal vein oxygenation improves outcome of acute liver failure in swine.

    Science.gov (United States)

    Nardo, B; Tsivian, M; Neri, F; Piras, G; Pariali, M; Bertelli, R; Cavallari, G

    2008-01-01

    Portal vein arterialization (PVA) has shown efficacy to treat acute liver failure (ALF) in preclinical studies. The next step is to perform large animal studies that propose a clinically acceptable method of PVA. In this study, we assessed the efficacy of PVA using an extracorporeal device to treat 2 ALF models in swine. The 2 ALF swine models were carbon tetrachloride toxic ALF and subtotal hepatectomy using 8 animals per group. PVA was performed with an extracorporeal device that may be suitable for future clinical studies. Arterial blood was drawn from the iliac artery and delivered into the portal vein for a 6-hour treatment. We analyzed biochemical, blood gas, and histological parameters as well as 1-week survival rates. In both models, ALF was successfully achieved. Control group animals deteriorated biochemically, dropping their prothrombin times and increasing the liver enzymes. In contrast, treated animals improved with a survival rate of 75% at 7 days compared with 0% for the former group. PVA using an extracorporeal device was feasible and effective to treat both toxic and resective ALF in swine.

  17. L-propionylcarnitine and synchronization of spontaneous activity in rat isolated portal vein.

    Science.gov (United States)

    Mancinelli, R

    1993-04-01

    The effects of L-propionylcarnitine (LPC) on spontaneous mechanical and electrical activity of rat portal vein have been studied "in vitro" by means of an isometric technique. Mechanical activity in normal Krebs solution consisted, in the majority of cases, in phasic contractions with variable amplitude, duration and frequency, while electrical activity showed both slow and fast spike potential components. By adding LPC to the medium at doses ranging from 10(-5) M to 10(-3) M, no effect has been observed while at concentrations from 2 x 10(-3) M to 8 x 10(-3) M, after an initial period of total inhibition, a dose-dependent increase in amplitude associated with a parallel decrease in frequency of contraction waves have been observed. The pattern of electrical activity was characterized by a regular slow wave component with the same frequency of the mechanical waves, and by an increase in number, amplitude and frequency of spike potentials. Experiments on synchronization of contractile activity showed that, in presence of LPC, hepatic and mesenteric regions of the vessel contract in close synchronism. These results suggest that LPC synchronizes spontaneous activity of rat portal vein by means of a mechanism which is at the present unknown.

  18. Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

    Institute of Scientific and Technical Information of China (English)

    Wei Lai; Shi-Chun Lu; Guan-Yin Li; Chuan-Yun Li; Ju-Shan Wu; Qing-Liang Guo; Meng-Long Wang; Ning Li

    2012-01-01

    AIM:To compare the incidence of early portal or splenic vein thrombosis (PSVT) in patients treated with irregular and regular anticoagulantion alter splenectomy with gastroesophageal devascularization.METHODS:We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010.Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation,respectively.Group A (153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin (LMWH) irregularly.Group B (148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery,followed by oral warfarin and aspirin for one month regularly.The target prothrombin time/international normalized ratio (PT/INR) was 1.25-1.50.Platelet and PT/INR were monitored.Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.RESULTS:The patients' data were collected and analyzed retrospectively.Among the patients,94 developed early postoperative mural PSVT,including 63patients in group A (63/153,41.17%) and 31 patients in group B (31/148,20.94%).There were 50 (32.67%)patients in group A and 27 (18.24%) in group B with mural PSVT in the main trunk of portal vein.After the administration of thrombolytic,anticoagulant and antiaggregation therapy,complete or partial thrombus dissolution achieved in 50 (79.37%) in group A and 26 (83.87%) in group B.CONCLUSION:Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization,and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy.Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.

  19. Effect of verapamil on nitric oxide synthase in a portal vein-ligated rat model: Role of prostaglandin

    Institute of Scientific and Technical Information of China (English)

    Chii-Shyan Lay; CMY May; Fa-Yauh Lee; Yang-Te Tsai; Shou-Dong Lee; Shu Chien; Shlomoh Sinchon

    2006-01-01

    AIM: To investigate the effects of verapamil on nitric oxide (NO) synthesis in a portal vein-ligated rat model.METHODS: Systemic and splanchnic hemodynamics were measured by radiolabeled microspheres in portal hypertensive rats after acute administration of verapamil (2 mg/kg) on chronic treatment with Nw-nitro-L-arginine (NNA)(80 mg/kg) and/or indomethacin (2 mg/kg) .RESULTS: Verapamil (2 mg/kg) caused a marked fall in both arterial pressure and cardiac output accompanied by an insignificant change in the portal pressure and no change in portal venous inflow. This result suggested that verapamil did not cause a reduction in portal vascular resistance of portal hypertensive rats, which was similar between Nw- nitro-L-arginine-treated and indomethacin-treated groups.CONCLUSION: In portal hypertensive rats.pretreated with NNA and/or indomethacin, acute verapamil administration can not reduce the portal pressure,suggesting that NO and prostaglandin play an important role in the pathogenesis of splanchnic arterial vasodilation in portal hypertension.

  20. Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Yoshimasa Maeda; Yumiko Ibata; Katsuhiko Higashi

    2006-01-01

    A 66-year-old woman underwent partial splenic embolization (PSE) for hypersplenism with idiopathic portal hypertension (IPH). One week later, contrastenhanced CT revealed extensive portal vein thrombosis (PVT) and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase.The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration (BRTO) technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt.Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

  1. Giant Splenorenal Shunt in a Young Patient with Autoimmune Hepatitis/Primary Biliary Cholangitis Overlap Syndrome and Portal Vein Thrombosis

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    F. Chegai

    2017-01-01

    Full Text Available We present a case of giant Splenorenal Shunt (SRS associated with portal vein thrombosis in a 37-year-old woman with a twelve-year history of autoimmune hepatitis/primary biliary cholangitis overlap syndrome. At the moment of the CT examination laboratory tests showed creatinine 1.5 mg/dl, bilirubin 1.5 mg/dl, INR 3, and Na 145 mmol/l and the Model End-Stage Liver Disease score was 24. Extensive calcified thrombosis causing complete occlusion of the portal vein lumen and partially occluding the origin of the superior mesenteric vein was present and a small calcified thrombus in the Splenic Vein lumen was also evident. SRS was located among the spleen hilum and the left kidney with a maximum diameter of 3.25 cm and was associated with dilatation of left renal vein and inferior vena cava. After a multidisciplinary evaluation the patient was put on the Regional Liver Transplant waiting list and liver transplantation was performed successfully. Although portal vein thrombosis and SRS are common occurrences in cirrhotic patients, the impact in the natural history of the disease is still unclear. Careful management and accurate imaging protocols are essential in the evaluation of those patients.

  2. Effect of wine polyphenol resveratrol on the contractions elicited electrically or by norepinephrine in the rat portal vein.

    Science.gov (United States)

    Protić, Dragana; Beleslin-Čokić, Bojana; Novaković, Radmila; Kanjuh, Vladimir; Heinle, Helmut; Sćepanović, Radisav; Gojković-Bukarica, Ljiljana

    2013-11-01

    We investigated the effects of resveratrol on rat portal vein (RPV) contractility without endothelium. Contractions were produced by electrical field stimulation of perivascular nerves (EFS), norepinephrine (NE), adenosine 5'-triphosphate (ATP), high K(+) solution and by calcium chloride (CaCl2 ) in Ca(2+) -free and high K(+) , Ca(2+) -free solution. The EFS-evoked contractions were more sensitive to resveratrol and to NS1619-selective openers of big calcium-sensitive (BKCa ) channels, than NE-evoked contractions. Effects of resveratrol on the ATP-evoked contractions were weak. Blockers of BKCa channels partly inhibited the effect of resveratrol only in EFS-contracted preparations. Western blotting showed that RPV expressed KCa 1.1 protein. Inhibitors of ATP- and voltage-sensitive K(+) channels did not modify the effects of resveratrol. None of the antagonists of K(+) channels affected the resveratrol inhibition of NE-evoked contractions and effect of high concentrations of resveratrol on the EFS-evoked contractions. Resveratrol more potently inhibited CaCl2 than potassium chloride contractions of RPV. Thus, BKCa channels partly mediate the inhibitory effect of resveratrol on the neurogenic contractions of RPV. The smooth muscle Ca(2+) channels and/or Ca(2+) mobilizing through cells might be involved in the effects of resveratrol on the contractility of RPV. Our results are important for better understanding the impact of resveratrol on the portal circulation.

  3. Liver transplant recipients with portal vein thrombosis:a single center retrospective study

    Institute of Scientific and Technical Information of China (English)

    Yi-Feng Tao; Fei Teng; Zheng-Xin Wang; Wen-Yuan Guo; Xiao-Min Shi; Gui-Hua Wang; Guo-Shan Ding; Zhi-Ren Fu

    2009-01-01

    BACKGROUND: Portal vein thrombosis (PVT) used to be a contraindication for liver transplantation (LT). This obstacle has been delt with following the improvement of LT-related techniques and therapeutic approaches to thrombosis. But the effect of PVT on LT outcomes is still controversial. We reviewed retrospectively the outcome of LT patients with PVT as well as risk factors and surgical management according to PVT grades. METHODS: A total of 465 adult LTs were performed from December 2002 through December 2006. Operative ifndings and the result of preoperative ultrasonography and imaging were reviewed for PVT grading (Yerdel grading). Comparison of risk factors, variables associated with perioperative period and prognosis between recipients with and without PVT is based on the grades. RESULTS: In the 465 LTs, 42 were operatively conifrmed to have PVT (9.0%) (19 recipients with grade 1, 14 with grade 2, 7 with grade 3, and 2 with grade 4). Increased age and treatment of portal hypertension were associated with PVT. Grade 1 or 2 PVT was treated by direct anastomosis or single thrombectomy. In grade 3 PVT patients, the donor PV was directly anastomosed to the dilated branch of the recipient portal venous system or to the distal open superior mesenteric vein through an interposition vein graft if needed. Grade 4 PVT was managed by our modiifed cavoportal hemitransposition technique. The comparison between PVT patients and controls showed no signiifcant difference in operative duration and blood transfusion (P>0.05). The lfow rate of the PV was lower in the PVT patients (48.881±12.788 cm/s) than in the controls (57.172±21.715 cm/s,P0.05); the 3-year survival rates were 58.8% and 56.4%respectively (P>0.05). CONCLUSIONS: PVT is not contraindicated for LT if it is graded. PVT recipients may have post-transplantation complications like renal failure and PV rethrombosis, and operative dififculty and patient survival are similar to those in recipients without PVT

  4. Portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula.

    Science.gov (United States)

    Ding, Pengxu; Li, Zhen; Han, Xin-Wei; Wang, Zhong-Gao; Zhang, Wen-Guang; Fu, Ming-Ti

    2014-07-01

    We present an unusual case of portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula. The thromboses were successfully treated with anticoagulation therapy. The patient was a 37-year-old woman who presented with portal hypertension manifested by gastrointestinal bleeding with no evidence of liver disease. Splenic arteriography confirmed the presence of a high-flow arteriovenous fistulous communication from the splenic artery directly into the splenic vein. The arteriovenous fistula was successfully treated with percutaneous transarterial embolization by embolization coils and the patient achieved effective hemostasis. Low-molecular-weight heparin and warfarin were administrated to prevent thrombosis in the portal venous system after the procedure. Although anticoagulants were immediately administered, thromboses of the portal, mesenteric, and splenic veins were diagnosed by contrast-enhanced computed tomography after 10 days. Complete recanalization of the portal venous system confirmed by contrast-enhanced computed tomography was achieved by administering warfarin orally for 3 months.

  5. Oxygenation of the portal vein by intraperitoneal administration of oxygenated perfluorochemical improves the engraftment and function of intraportally transplanted islets.

    Science.gov (United States)

    Sakai, Tetsuya; Li, Shiri; Kuroda, Yoshikazu; Tanioka, Yasuki; Fujino, Yasuhiro; Suzuki, Yasuyuki

    2011-04-01

    One of the major obstacles for successful intraportal islet transplantation (IPIT) is early graft loss due to hypoxia. We therefore examined the effect of intraperitoneal oxygenated perfluorochemical (PFC) on oxygenation of the portal vein with respect to islet engraftment and function after IPIT in a rat model. First, we measured the oxygen tension and saturation in the portal vein of Lewis rats before and after intraperitoneal injection of oxygenated PFC. Second, blood glucose levels, glucose tolerance, and the number of surviving islets were measured after IPIT with oxygenated PFC (group 1), with PFC saturated by nitrogen (group 2), and without any PFC (control). Both oxygen tension and saturation in the portal vein significantly increased after injection of oxygenated PFC. In IPIT, the functional success rate in group 1 was 83.3%, compared with 16.7% in group 2 and 16.7% in the control. On the 28th posttransplantation day, the number of engrafted islets in the liver in group 1 (12.8 [SD, 3.3]) was significantly higher than that in group 2 (4.7 [SD, 3.0]) and in the control group (6.5 [SD, 3.3]). We clearly demonstrated the effect of intraperitoneal oxygenated PFC on oxygenation of the portal vein, resulting in better IPIT outcomes.

  6. Successful pregnancy outcome in decompensated chronic liver disease with portal vein thrombosis: case report and review of literature.

    Science.gov (United States)

    Kumar, Mukesh; Kamani, Lubna; Hussain, Riaz; Siddique, Shoaib

    2011-07-01

    Pregnancy is rare in women with decompensated chronic liver disease. In this case report, we describe a case of a young woman who presented with hepatitis B-related decompensated chronic liver disease with portal vein thrombosis having successful full-term uneventful pregnancy.

  7. Treatment of gastric varices with partial splenic embolization in a patient with portal vein thrombosis and a myeloproliferative disorder.

    Science.gov (United States)

    Gianotti, Robert; Charles, Hearns; Hymes, Kenneth; Chandarana, Hersh; Sigal, Samuel

    2014-10-21

    Therapeutic options for gastric variceal bleeding in the presence of extensive portal vein thrombosis associated with a myeloproliferative disorder are limited. We report a case of a young woman who presented with gastric variceal bleeding secondary to extensive splanchnic venous thrombosis due to a Janus kinase 2 mutation associated myeloproliferative disorder that was managed effectively with partial splenic embolization.

  8. Transhepatic fibrinolysis of mesenteric and portal vein thrombosis in a patient with ulcerative colitis: A case report

    Institute of Scientific and Technical Information of China (English)

    Alfredo Guglielmi; Francesca Fior; Orsolya Halmos; Gian Franco Veraldi; Lorenzo Rossaro; Andrea Ruzzenente; Claudio Cordiano

    2005-01-01

    AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesenteric-portal system. Treatment of acute portal vein thrombosis has ranged from conservative treatment with thrombolysis and anticoagulation therapy to surgical treatment with thrombectomy and/or intestinal resection.METHODS: We treated our patient with intraportal infusion of plasminogen activator and then heparin through a percutaneous transhepatic catheter.RESULTS: Thrombus resolved despite premature interruption of the thrombolytic treatment for neurological complications, which subsequently resolved.CONCLUSION: Conservative management with plasminogen activator, could be considered as a good treatment for patients with acute porto-mesenteric thrombosis.

  9. Huge inflammatory pseudotumor of the spleen with postoperative portal vein thrombosis: report of a case.

    Science.gov (United States)

    Tsutsumi, Norifumi; Kawanaka, Hirofumi; Yamaguchi, Shohei; Sakai, Masahiro; Momosaki, Seiya; Endo, Kazuya; Ikejiri, Koji

    2012-04-01

    We report the rare case of a splenic inflammatory pseudotumor associated with massive splenomegaly, diagnosed after surgery. A 51-year-old woman was admitted to our hospital for investigation of anemia. Physical examination revealed a palpable left upper quadrant mass. Computed tomography and magnetic resonance imaging showed a splenic mass, 20 cm in diameter. We performed splenectomy for both diagnosis and treatment. The spleen weighed 2400 g, and histologic examination of the mass confirmed an inflammatory pseudotumor. Portal vein thrombosis (PVT) developed the day after surgery, but resolved with anticoagulation therapy. This case highlights that there is a risk of PVT after splenectomy in patients with massive splenomegaly, and that anticoagulant therapy should be initiated promptly.

  10. Cavernous Transformation of the Portal Vein Might Increase the Risk of Liver Abscess

    Directory of Open Access Journals (Sweden)

    Xin-Bo Ai

    2010-09-01

    Full Text Available Cavernous transformation of the portal vein (CTPV is not quite common in adults, and cases with CTPV and acute liver abscess are lacking. We report a patient with CTPV inducing extrahepatic and intrahepatic obstruction, finally leading to acute liver abscess due to bile duct infection. We aim to find out the possible relationship between CTPV and acute liver abscess. A 45-year-old female patient was admitted to our hospital for recurrent upper abdominal pain and distension for one year, aggravated with fever for three years. A diagnosis of CTPV and liver abscess was made by 16-slice computed tomography. Effective antibiotics and drainage were used for this patients, and she was eventually cured. When treating patients with CTPV, extrahepatic and intrahepatic obstruction, one should be aware of the presence of acute liver abscess, and empirical antibiotics might be valuable.

  11. Pharmacokinetic analysis of cyclosporine in a renal transplant recipient with congenital absence of the portal vein.

    Science.gov (United States)

    Nakazawa, Ryuto; Sato, Yuichi; Sasaki, Hideo; Shibagaki, Yugo; Kimura, Kenjiro; Chikaraishi, Tatsuya

    2015-08-01

    Here we report therapeutic drug monitoring of cyclosporine in a kidney transplant recipient lacking enterohepatic circulation. The patient developed steroid-resistant nephrotic syndrome at age 14 years, and was medicated with an oral cyclosporine microemulsion. However, her cyclosporine trough level was unexpectedly elevated, and subsequent investigations showed that she was deficient in drug metabolism as a result of the congenital absence of the portal vein. Her renal function gradually decreased and she became dialysis-dependent at the age of 21 years, and kidney transplantation was planned. Based on pretransplant therapeutic drug monitoring, we started cyclosporine microemulsion at half of the conventional dosage. After transplantation, the dosage was successfully adjusted to achieve a target trough level. The post-transplant course was stable with no symptoms of rejection or cyclosporine-associated nephrotoxicity. © 2015 The Japanese Urological Association.

  12. Diffusion-Weighted MRI of Malignant versus Benign Portal Vein Thrombosis

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    Ahn, Jhii-Hyun; Yu, Jeong-Sik; Cho, Eun-Suk; Chung, Jae-Joon; Kim, Joo Hee; Kim, Ki Whang [Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273 (Korea, Republic of)

    2016-11-01

    To validate the diffusion-weighted MRI (DWI) for differentiation of benign from malignant portal vein thrombosis. The Institutional Review Board approved this retrospective study and waived informed consent. A total of 59 consecutive patients (52 men and 7 women, aged 40–85 years) with grossly defined portal vein thrombus (PVT) on hepatic MRI were retrospectively analyzed. Among them, liver cirrhosis was found in 45 patients, and hepatocellular carcinoma in 47 patients. DWI was performed using b values of 50 and 800 sec/mm{sup 2} at 1.5-T unit. A thrombus was considered malignant if it enhanced on dynamic CT or MRI; otherwise, it was considered bland. There were 18 bland thrombi and 49 malignant thrombi in 59 patients, including 8 patients with simultaneous benign and malignant PVT. Mean apparent diffusion coefficients (ADCs) of benign and malignant PVTs were compared by using Mann-Whitney U test. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis. The mean ADC ± standard deviation of bland and malignant PVT were 1.00 ± 0.39 × 10{sup -3} mm{sup 2}/sec and 0.92 ± 0.25 × 10{sup -3} mm{sup 2}/sec, respectively; without significant difference (p = 0.799). The area under ROC curve for ADC was 0.520. An ADC value of > 1.35 × 10{sup -3} mm{sup 2}/sec predicted bland PVT with a specificity of 94.6% (95% confidence interval [CI]: 84.9–98.9%) and a sensitivity of 22.2% (95% CI: 6.4–47.6%), respectively. Due to the wide range and considerable overlap of the ADCs, DWI cannot differentiate the benign from malignant thrombi efficiently.

  13. Diffusion-weighted MRI of malignant versus benign portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Jhii Hyun; Yu, Jeong Sik; Cho, Eun Suk; Chung, Jae Joon; Kim, Joo Hee; Kim, Ki Whang [Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul(Korea, Republic of)

    2016-07-15

    To validate the diffusion-weighted MRI (DWI) for differentiation of benign from malignant portal vein thrombosis. The Institutional Review Board approved this retrospective study and waived informed consent. A total of 59 consecutive patients (52 men and 7 women, aged 40-85 years) with grossly defined portal vein thrombus (PVT) on hepatic MRI were retrospectively analyzed. Among them, liver cirrhosis was found in 45 patients, and hepatocellular carcinoma in 47 patients. DWI was performed using b values of 50 and 800 sec/mm2 at 1.5-T unit. A thrombus was considered malignant if it enhanced on dynamic CT or MRI; otherwise, it was considered bland. There were 18 bland thrombi and 49 malignant thrombi in 59 patients, including 8 patients with simultaneous benign and malignant PVT. Mean apparent diffusion coefficients (ADCs) of benign and malignant PVTs were compared by using Mann-Whitney U test. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis. The mean ADC ± standard deviation of bland and malignant PVT were 1.00 ± 0.39 × 10(-3) mm{sup 2}/sec and 0.92 ± 0.25 × 10(-3) mm{sup 2}/sec, respectively; without significant difference (p = 0.799). The area under ROC curve for ADC was 0.520. An ADC value of > 1.35 × 10(-3) mm{sup 2}/sec predicted bland PVT with a specificity of 94.6% (95% confidence interval [CI]: 84.9-98.9%) and a sensitivity of 22.2% (95% CI: 6.4-47.6%), respectively. Due to the wide range and considerable overlap of the ADCs, DWI cannot differentiate the benign from malignant thrombi efficiently.

  14. What we should know about portal vein thrombosis in cirrhotic patients: A changing perspective

    Institute of Scientific and Technical Information of China (English)

    Francesca Romana Ponziani; Maria Assunta Zocco; Matteo Garcovich; Francesca D'Aversa; Davide Roccarina; Antonio Gasbarrini

    2012-01-01

    Portal vein thrombosis (PVT) is one of the most common complications occurring during the natural course of liver cirrhosis.Even though PVT is often asymptomatic,the worsening of liver function,an unexpected episode of gastrointestinal bleeding or ascitic decompensation may be landmarks of PVT development.Beyond these clinical manifestations,it is debated whether PVT really has an impact on liver cirrhosis natural history or rather represents only one of its consequences.Probably PVT development should not only be considered as a matter of impaired blood flow or pro-coagulation tendency.On one hand,PVT seems a consequence of the worsening in portal vein outflow due to the increased hepatic resistance in cirrhotic livers.On the other hand,vascular microthrombosis secondary to necroinflammation may cause liver ischemia and infarction,with loss of hepatic tissue (parenchymal extinction) which is replaced by fibrotic tissue.Therefore,PVT might also be considered as the overt manifestation of the liver fibrosing process evolution and anticoagulant therapy may thus have microscopic indirect effects also on the progression of liver disease.At present,a connection between PVT development and the progression of liver fibrosis/cirrhosis has not yet been demonstrated.Nevertheless,it is not clear if PVT development may worsen cirrhotic patients' outcome by itself.Some authors tried to assess liver transplant benefit in PVT cirrhotic patients but data are contrasting.In this review,we will try to answer these questions,providing a critical analysis of data reported in literature.

  15. Role of preoperative selective portal vein embolization in two-step curative hepatectomy for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Wu Ji; Jie-Shou Li; Ling-Tang Li; Wu-Hong Liu; Kuan-Sheng Ma; Xiang-Tian Wang; Zhen-Ping He; Jia-Hong Dong

    2003-01-01

    AIM: To determine the feasibility and role of ultrasoundguided preoperative selective portal vein embolization (POSPVE) in the two-step hepatectomy of patients with advanced primary hepatocellular carcinoma (HCC).METHODS: Fifty patients with advanced HCC who were not suitable for curative hepatectomy were treated by ultrasound-guided percutaneous transhepatic POSPVE with fine needles. The successful rate, side effects and complications of POSPVE, changes of hepatic lobe volume and two-step curative hepatectomy rate after POSPVE were observed.RESULTS: POSPVE was successfully performed in 47(94.0 %) patients. In patients whose right portal vein branches were embolized, their right hepatic volume decreased and left hepatic volume increased gradually. The ratio of right hepatic volume to total hepatic volume decreased from 62.4 % before POSPVE to 60.5 %, 57.2 %and 52.8 % after 1, 2 and 3 weeks respectively. The side effects included different degree of pain in liver area (38cases), slight fever (27 cases), nausea and vomiting (9cases). The level of aspartate alanine transaminase (AST),alanine transaminase (ALT) and total bilirubin (TBIL)increased after POSPVE, but returned to preoperative level in 1 week. After 2-4 weeks, two-step curative hepatectomy for HCC was successfully performed on 23 (52.3 %) patients.There were no such severe complications as ectopic embolization, local hemorrhage and bile leakage.CONCLUSION: Ultrasound-guided percutaneous transhepatic POSPVE with fine needles is feasible and safe. It can extend the indications of curative hepatectomy of HCC, and increase the safety of hepatectomy.

  16. Prognostic factors for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma complicated by portal vein tumor thrombus

    Directory of Open Access Journals (Sweden)

    ZHANG Cheng

    2016-01-01

    Full Text Available ObjectiveTo investigate the therapeutic effect of transcatheter arterial chemoembolization (TACE in patients with hepatocellular carcinoma (HCC complicated by portal vein tumor thrombus, and to identify related prognostic factors. MethodsThe clinical data of 152 HCC patients with portal vein tumor thrombus who were admitted to Xijing Hospital of Fourth Military Medical University and received TACE from January 2006 to December 2010 were analyzed retrospectively. The occurrence of post-TACE liver failure, upper gastrointestinal bleeding, and post-embolization syndrome was observed, and survival data and prognostic factors were analyzed. The Kaplan-Meier method was used to calculate cumulative survival rate, the log-rank test was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis. ResultsThe median survival time was 5.0 months, and the 6-, 12-, and 18-month cumulative survival rates were 37%, 18%, and 9%, respectively. Univariate analysis showed that tumor size, tumor type, involvement of both liver lobes, distant metastasis, and Child-Pugh class were the prognostic factors for TACE in HCC patients with portal vein tumor thrombus (χ2=5.108, 11.542, 6.036, 12.319, and 22.574, respectively, all P<0.05; multivariate analysis showed that tumor size, tumor type, distant metastasis, and Child-Pugh class were the independent prognostic factors (Wald values=11.243, 5.021, 7.651, and 25876, respectively, all P<0.05; Child-Pugh class was the only influencing factor for liver failure in HCC patients with portal vein tumor thrombus (P=0.015. ConclusionTACE is safe and effective in HCC patients with portal vein thrombus and good liver function. Tumor size, tumor type, distant metastasis, and Child-Pugh class are the main factors influencing survival, which provides a basis for clinicians to select appropriate interventional therapies.

  17. Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans.

    Science.gov (United States)

    Boas, F Edward; Kamaya, Aya; Do, Bao; Desser, Terry S; Beaulieu, Christopher F; Vasanawala, Shreyas S; Hwang, Gloria L; Sze, Daniel Y

    2015-04-01

    Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

  18. Native portal vein embolization for persistent hyperoxaluria following kidney and auxiliary partial liver transplantation.

    Science.gov (United States)

    Elias, N; Kawai, T; Ko, D S C; Saidi, R; Tolkoff-Rubin, N; Wicky, S; Cosimi, A B; Hertl, M

    2013-10-01

    Type 1 primary hyperoxaluria (PH1) causes renal failure, for which isolated kidney transplantation (KT) is usually unsuccessful treatment due to early oxalate stone recurrence. Although hepatectomy and liver transplantation (LT) corrects PH1 enzymatic defect, simultaneous auxiliary partial liver transplantation (APLT) and KT have been suggested as an alternative approach. APLT advantages include preservation of the donor pool and retention of native liver function in the event of liver graft loss. However, APLT relative mass may be inadequate to correct the defect. We here report the first case of native portal vein embolization (PVE) to increase APLT to native liver mass ratio (APLT/NLM-R). Following initial combined APLT-KT, both allografts functioned well, but oxalate plasma levels did not normalize. We postulated the inadequate APLT/NLM-R could be corrected by trans-hepatic native PVE. The resulting increased APLT/NLM-R decreased serum oxalate to normal levels within 1 month following PVE. We conclude that persistently elevated oxalate levels after combined APLT-KT for PH1 treatment, results from inadequate relative functional capacity. This can be reversed by partial native PVE to decrease portal flow to the native liver. This approach might be applicable to other scenarios where partial grafts have been transplanted to replace native liver function.

  19. Assessment of contrast-enhanced ultrasonography of the hepatic vein for detection of hemodynamic changes associated with experimentally induced portal hypertension in dogs.

    Science.gov (United States)

    Morishita, Keitaro; Hiramoto, Akira; Michishita, Asuka; Takagi, Satoshi; Hoshino, Yuki; Itami, Takaharu; Lim, Sue Yee; Osuga, Tatsuyuki; Nakamura, Sayuri; Ochiai, Kenji; Nakamura, Kensuke; Ohta, Hiroshi; Yamasaki, Masahiro; Takiguchi, Mitsuyoshi

    2017-04-01

    OBJECTIVE To assess the use of contrast-enhanced ultrasonography (CEUS) of the hepatic vein for the detection of hemodynamic changes associated with experimentally induced portal hypertension in dogs. ANIMALS 6 healthy Beagles. PROCEDURES A prospective study was conducted. A catheter was surgically placed in the portal vein of each dog. Hypertension was induced by intraportal injection of microspheres (10 to 15 mg/kg) at 5-day intervals via the catheter. Microsphere injections were continued until multiple acquired portosystemic shunts were created. Portal vein pressure (PVP) was measured through the catheter. Contrast-enhanced ultrasonography was performed before and after establishment of hypertension. Time-intensity curves were generated from the region of interest in the hepatic vein. Perfusion variables measured for statistical analysis were hepatic vein arrival time, time to peak, time to peak phase (TTPP), and washout ratio. The correlation between CEUS variables and PVP was assessed by use of simple regression analysis. RESULTS Time to peak and TTPP were significantly less after induction of portal hypertension. Simple regression analysis revealed a significant negative correlation between TTPP and PVP. CONCLUSIONS AND CLINICAL RELEVANCE CEUS was useful for detecting hemodynamic changes associated with experimentally induced portal hypertension in dogs, which was characterized by a rapid increase in the intensity of the hepatic vein. Furthermore, TTPP, a time-dependent variable, provided useful complementary information for predicting portal hypertension. IMPACT FOR HUMAN MEDICINE Because the method described here induced presinusoidal portal hypertension, these results can be applied to idiopathic portal hypertension in humans.

  20. Left Aberrant Gastric Vein Causing Isolated Left Hepatic Portal Venous Gas Secondary to an Incarcerated Diaphragmatic Hernia

    Science.gov (United States)

    Mittal, Kartik; Anandpara, Karan; Dey, Amit K.; Kedar, Pradnya; Hira, Priya; Kale, Sunita

    2015-01-01

    Summary Background Hepatic portal venous gas (HPVG) is an ominous radiological sign suggestive of underlying intestinal sepsis, infection or trauma. Portal pneumatosis secondary to gastric pathologies is rare. Case Report We report a rare case of a 34-year-old man who presented with acute epigastric pain and vomiting, diagnosed to have an incarcerated diaphragmatic hernia causing gastric pneumatosis and resultant portal venous gas. Conclusions Our case highlights an unusual presentation of gastric pneumatosis secondary to an incarcerated hiatal hernia with resultant portal venous gas involving only the left lobe of the liver. An aberrant left gastric vein was responsible for this phenomenon in our case. A sound understanding of anatomical variants is thus crucial to radiological diagnosis. PMID:26251676

  1. 3-dimensional resin casting and imaging of mouse portal vein or intrahepatic bile duct system.

    Science.gov (United States)

    Walter, Teagan J; Sparks, Erin E; Huppert, Stacey S

    2012-10-25

    In organs, the correct architecture of vascular and ductal structures is indispensable for proper physiological function, and the formation and maintenance of these structures is a highly regulated process. The analysis of these complex, 3-dimensional structures has greatly depended on either 2-dimensional examination in section or on dye injection studies. These techniques, however, are not able to provide a complete and quantifiable representation of the ductal or vascular structures they are intended to elucidate. Alternatively, the nature of 3-dimensional plastic resin casts generates a permanent snapshot of the system and is a novel and widely useful technique for visualizing and quantifying 3-dimensional structures and networks. A crucial advantage of the resin casting system is the ability to determine the intact and connected, or communicating, structure of a blood vessel or duct. The structure of vascular and ductal networks are crucial for organ function, and this technique has the potential to aid study of vascular and ductal networks in several ways. Resin casting may be used to analyze normal morphology and functional architecture of a luminal structure, identify developmental morphogenetic changes, and uncover morphological differences in tissue architecture between normal and disease states. Previous work has utilized resin casting to study, for example, architectural and functional defects within the mouse intrahepatic bile duct system that were not reflected in 2-dimensional analysis of the structure(1,2), alterations in brain vasculature of a Alzheimer's disease mouse model(3), portal vein abnormalities in portal hypertensive and cirrhotic mice(4), developmental steps in rat lymphatic maturation between immature and adult lungs(5), immediate microvascular changes in the rat liver, pancreas, and kidney in response in to chemical injury(6). Here we present a method of generating a 3-dimensional resin cast of a mouse vascular or ductal network

  2. [Hyperhomocysteinemia complicated by myocardial infarction and portal vein thrombosis--case report].

    Science.gov (United States)

    Dworakowska, Dorota; Kazimierska, Ewa; Weyer-Hepka, Jolanta; Dworakowski, Rafał; Jakóbiewicz-Banecka, Joanna; Suwała, Wojciech; Czestochowska, Eugenia

    2006-03-01

    Hyperhomocysteinemia (HHcy) can be associated with deficiency of group B vitamins and folic acid. HHcy might also results from renal insufficiency, diabetes, hypothyreosis or malignant diseases. In same cases HHcy is connected with mutations of genes involved in its metabolism. HHcy causes the increased risk of arterial and vein thrombosis. In this paper we show case report of woman with HHcy, who developed several complications, probably because of HHcy. This patient in the age of 38 and 44 years developed twice myocardial infarction, whereas in the age of 48 she suffered from portal vein thrombosis. According to documentation, the level of cholesterol has never been elevated, however HHcy was observed. During diagnostic process, the primary and secondary causes of HHcy were assessed. Mutations of genes involved in Hcy metabolism were also assessed. We did not find any mutation in protein products of methylenotetrahydrofolate reductase (MTHFR) or cystationine beta-synthase (CBS). The patient was treated with the use of folic acid, vitamin B12 and B6 supplementation, and normalization of Hcy level was received. This case report underline, how important role in the case of HHcy play vitamin supplementation. The early treatment of HHcy might limit thromboembolic complication.

  3. GI ischemia in patients with portal vein thrombosis: a prospective cohort study.

    Science.gov (United States)

    Harki, Jihan; Plompen, Elisabeth P C; van Noord, Désirée; Hoekstra, Jildou; Kuipers, Ernst J; Janssen, Harry L A; Tjwa, Eric T T L

    2016-03-01

    GI ischemia is a concerning adverse event of portal vein thrombosis (PVT). Minimally invasive techniques, such as visible light spectroscopy (VLS), have greatly improved the ability to diagnose GI ischemia. The aim of this study was to assess the clinical presentation and characteristics of GI ischemia in patients with PVT. Patients with noncirrhotic, nonmalignant PVT were included in this prospective cohort study. Clinical symptoms of GI ischemia were assessed by a structured questionnaire, VLS, and radiologic evaluation of the mesenteric vasculature. VLS measurements were compared with those in patients with cirrhosis and with a reference population. We included 15 patients with chronic PVT and 1 patient with acute PVT (median age 46.1 years [interquartile range [IQR], 30.9-53.7]; 44% male). Decreased mucosal oxygenation in at least 1 location of the GI tract was found in 12 patients (75%). Compared with the reference population (median 60.0 [IQR, 56.2-61.7]), VLS measurements were mostly decreased in the descending duodenum in patients with PVT (median 55.5 [IQR, 52.3-58.8]; P = .02) and patients with cirrhosis (median 52.0 [IQR, 46.5-54.0], P = .003). Symptoms typical for GI ischemia, such as postprandial pain and exercise-induced pain, were reported in 10 patients (63%) with PVT. In patients with extension of thrombosis into the superior mesenteric vein and splenic vein and/or presence of hypercoagulability, decreased VLS measurements were observed compared with historical control subjects. In patients with chronic PVT, GI ischemia is frequent. VLS enables objective and quantitative determination of GI mucosal ischemia. Onset of abdominal symptoms such as postprandial pain should prompt the physician to re-evaluate extent, cause, and treatment of PVT. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  4. Prognosis of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus:Assessment Based on Clinical and Computer Tomography Characteristics

    Directory of Open Access Journals (Sweden)

    Jia,Lizhong

    2012-04-01

    Full Text Available Patients with hepatocellular carcinoma (HCC complicated by portal vein tumor thrombus (PVTT have an extremely poor prognosis. It is important to select adequate therapeutic options based on reliable prognostic factors using imaging studies and clinical data. Prognostic factors were analyzed in patients with HCC with PVTT in the first branch or main trunk of the portal vein. From 2000 to 2007, 107 consecutive patients with HCC with PVTT in the major portal vein were reviewed, and diagnostic images and clinical characteristics were retrospectively observed. Thirty-eight possible prognostic factors for survival were analyzed by the log-rank test and multivariate analysis using Coxʼs proportional hazards model. Median overall survival was 14 months following PVTT diagnosis. Survival rates at 6 months, 1, 2, and 3 years were 72.1%, 52.6%, 32.6%, and 29.6%, respectively. Independent prognostic factors for longer survival included:patient age <65 years, Child-Pugh classification A/B, PVTT treatment, accumulation of Lipiodol in the PVTT after TACE, initial radical treatment for HCC, HCC located in a single lobe of the liver, and no invasion of HCC to the hepatic vein or bile duct. Survival was associated with liver function, tumor extension, and treatment for HCC and PVTT.

  5. Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft.

    Science.gov (United States)

    Moreno, Carlos; Sabaté, Antoni; Figueras, Joan; Camprubí, Imma; Dalmau, Antonia; Fabregat, Joan; Koo, Maylin; Ramos, Emilio; Lladó, Laura; Rafecas, Antoni

    2006-11-01

    We performed a prospective, randomized study of adult patients undergoing orthotopic liver transplantation, comparing hemodynamic and tissular oxygenation during reperfusion of the graft. In 30 patients, revascularization was started through the hepatic artery (i.e., initial arterial revascularization) and 10 minutes later the portal vein was unclamped; in 30 others, revascularization was started through the portal vein (i.e., initial portal revascularization) and 10 minutes later the hepatic artery was unclamped. The primary endpoints of the study were mean systemic arterial pressure and the gastric-end-tidal carbon dioxide partial pressure (PCO(2)) difference. The secondary endpoints were other hemodynamic and metabolic data. The pattern of the hemodynamic parameters and tissue oxygenation values during the dissection and anhepatic stages were similar in both groups At the first unclamping, initial portal revascularization produced higher values of mean pulmonary pressure (25 +/- 7 mm of Hg vs. 17 +/- 4 mm of Hg; P portal revascularization produced higher values of cardiac output and mean arterial pressure (87 +/- 15 mm of Hg vs. 79 +/- 15 mm of Hg; P portal group. During revascularization, the values of gastric and arterial pH decreased in both groups and recovered at the end of the procedure, but were more accentuated in the initial arterial revascularization group. In conclusion, we found that initial arterial revascularization of the graft increases pulmonary pressure less markedly, so it may be indicated for those patients with poor pulmonary and cardiac reserve. Nevertheless, for the remaining patients, initial portal revascularization offers more favorable hemodynamic and metabolic behavior, less inotropic drug use, and earlier normalization of lactate and pH values. (c) 2006 AASLD

  6. Comparison of the Treatment Efficiency of Bone Marrow-Derived Mesenchymal Stem Cell Transplantation via Tail and Portal Veins in CCl4-Induced Mouse Liver Fibrosis

    National Research Council Canada - National Science Library

    Truong, Nhung Hai; Nguyen, Nam Hai; Le, Trinh Van; Vu, Ngoc Bich; Huynh, Nghia; Nguyen, Thanh Van; Le, Huy Minh; Phan, Ngoc Kim; Pham, Phuc Van

    2016-01-01

    ...) on mouse liver cirrhosis induced by carbon tetrachloride. Portal and tail vein transplantations were examined to evaluate the effects of different injection routes on the liver cirrhosis model at 21 days after transplantation...

  7. The Role of Portal Vein Thrombosis in the Clinical Course of Inflammatory Bowel Diseases: Report on Three Cases and Review of the Literature

    OpenAIRE

    Emanuele Sinagra; Emma Aragona; Claudia Romano; Simonetta Maisano; Ambrogio Orlando; Roberto Virdone; Lorenzo Tesè; Irene Modesto; Valeria Criscuoli; Mario Cottone

    2012-01-01

    Inflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic ab...

  8. Spleno-adrenal shunt: a novel alternative for portosystemic decompression in children with portal vein cavernous transformation.

    Science.gov (United States)

    Gu, Song; Chang, Shirong; Chu, Jun; Xu, Min; Yan, Zhilong; Liu, Donald C; Chen, Qimin

    2012-12-01

    Children with portal vein cavernous transformation (PVCT) can develop life-threatening variceal hemorrhage from progressive portal hypertension. While spleno-renal shunt ± splenectomy is the most common portosystemic decompression surgery performed in children, we have adopted a modified spleno-adrenal (SA) shunt for complicated PVCT. We describe our 10 year experience focusing on technique evolution and treatment efficacy. Between 2001 and 2011, 15 children (9 girls and 6 boys, ages 3-11 years, median: 6 years) with PVCT, portal hypertension, and hypersplenism were treated with SA shunt with splenectomy in Shanghai Children's Medical Center. All children in the study had endoscopy proven active esophageal variceal bleeding requiring multiple transfusions (mean: 4.2 units) with failed sclerotherapy (mean: 2.6 times). Greater omental vein pressure (GVP) approximating portal venous pressure was measured pre- and post-SA shunt. Pre- and post-operative ammonia levels were obtained. Follow-up ranged from 6 months to 10 years (mean: 4.2 ± 2 years). Intra-operative adrenal vein diameter and length ranged from 0.7 to 1.8 cm and 2 to 3 cm, respectively. Intra-operative GVPs pre-and post-SA shunt were (30 ± 11) and (22 ± 7) mmHg, respectively (pappropriate neurodevelopment (Bayley's assessment). Barium swallow and/or upper endoscopy showed interval resolution of esophageal varices in all children, and vascular ultrasound showed patent shunt anastomosis without stricture in 14 (93%). The left adrenal vein is a viable conduit for effective selective portosystemic decompression. Similar to the more traditional spleno-renal shunt, SA appears also to have the advantage of preventing hepatic encephalopathy preserving neurodevelopment, although the rise in post-operative ammonia levels was unexpected. Longer follow-up is needed to look for late signs of encephalopathy assessing neurodevelopment long term. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the predictive value of D-dimer as a predictive indicator of portal vein thrombosis (PVT) after portal hypertension surgery in hepatitis B virus-related cirrhosis.METHODS: A prospective study was carried out in 52 patients who had undergone surgery for portal hypertension in hepatitis B virus-related cirrhosis.Changes in perioperative dynamic D-dimer were observed. The sensitivity, specificity, positive predictive values and negative predictive values of D-dimer were calculated, and ROC curves were analyzed.RESULTS: The D-dimer levels in the group developing postoperative PVT was significantly higher than those in the group not developing PVT (P = 0.001), and the ROC semi-quantitative and qualitative analysis of D-dimer showed a moderate predictive value in PVT (semiquantitative value Az = 0.794, P = 0.000; qualitative analysis: Az = 0.739, P = 0.001).CONCLUSION: Dynamic monitoring of D-dimer levels in patients with portal hypertension after surgery can help early diagnosis of PVT, as in cases where the D-dimer levels steadily increase and exceed 16 μg/mL, the possibility of PVT is very high.

  10. Significant cohort of non-alcoholic fatty liver disease with portal vein thrombosis in transplant waiting list

    Institute of Scientific and Technical Information of China (English)

    Metin; Basaranoglu; Sonia; M; Najjar; Ali; Ebag; Demirbag; Hakan; Senturk

    2016-01-01

    AIM: To characterize non-alcoholic fatty liver disease(NAFLD) presentation with esophageal varices. METHODS: We carried out a retrospective cohort study on 258 patients with esophageal varices at a single tertiary referral center. These patients underwent diagnosis of several liver diseases, including: NAFLDassociated cirrhosis, hepatitis B, hepatitis C, Wilson disease, autoimune liver diseases, and others. RESULTS: Of the 258 patients, 39% of patients exhibited esophageal varices due to NAFLD-associated cirrhosis. Of the 38(14.7%) patients developed hepatocellular carcinoma during follow-up, 52% were due to hepatitis B, 26% due to hepatitis C and 13.2% due to NAFLD. Of the 258 patients, 50.0% with NAFLD, 33.3% with hepatitis B, 26.3% with hepatitis C, and 58.3% with other diseases were alive at the end of the 5-year period with a significant difference according to the Kaplan-Meier log Rank test(P = 0.040). Portal vein thrombosis was detected in 47.5% of patients with NAFLD, in 29% of patients with hepatitis B, in 17% of patients with hepatitis C, and in 62% of patients with other related diseases(P < 0.0001). CONCLUSION: Our study showed a proportionally greater elevation in liver transplant candidacy in patients with NAFLD and portal vein thrombosis. Older patients were more prone to developing cirrhosis, hepatocellular carcinoma and a high mortality rate. However, younger patients exhibited more portal vein thrombosis and gastric varices.

  11. Duodenal stenosis resulting from a preduodenal portal vein and an operation for scoliosis

    Institute of Scientific and Technical Information of China (English)

    Kouji Masumoto; Risa Teshiba; Genshiro Esumi; Kouji Nagata; Takanori Nakatsuji; Yuko Nishimoto; Sadako Yamaguchi; Kenzo Sumitomo; Tomoaki Taguchi

    2009-01-01

    A preduodenal portal vein (PDPV) is known to be a rare cause of duodenal stenosis. We treated a 22-yearold male patient with malnutrition as a result of PDPV and a previously performed operation for scoliosis,who showed an improvement in quality of life after being treated with a combination of nutritional support and surgery. The patient with PDPV had been admitted to our department with duodenal stenosis, ranging from the first to third portions. He had suffered from vomiting since 1 year of age, and he developed malnutrition during the last 6-mo period after orthopedic surgery for scoliosis. The stenosis was related to both the PDPV and the previously performed operation for scoliosis. After receiving nutritional support for 6 mo, a gastrojejunostomy with Braun's anastomosis for the first portion and a duodenojejunostomy for the second and third portions were performed. The postoperative course was almost uneventful. Three months later, he was discharged and able to attend university. In patients with widespread duodenal stenosis, there may be a complicated cause,such as PDPV and duodenal stretching induced by previous spinal surgery.

  12. Associating Liver Partition and Portal Vein Occlusion, Including Venous Congestion, Induction in Rats.

    Science.gov (United States)

    Kawaguchi, Daisuke; Hiroshima, Yukihiko; Kikuchi, Yutaro; Matsuo, Kenichi; Tanaka, Kuniya

    2017-06-01

    Associating liver partition with portal vein occlusion for staged hepatectomy (ALPPS) is a recently developed strategy for inducing rapid hypertrophy of the future liver remnant (FLR). To explore possible mechanisms, we designed the first model of ALPPS with venous congestion (ALPPS+C) in rats. Rats were assigned randomly to 3 experimental groups: ALPPS, ALPPS+C and sham. Hepatic regeneration rate, Ki-67 and histopathology were assessed at 24 h, 48 h, and 7 days postoperatively. Hepatic regeneration rate was much higher for ALPPS+C than for ALPPS at 48 h and 7 days postoperatively (pliver showed greater hepatocyte density and smaller hepatocyte size in ALPPS+C than in ALPPS (p<0.01 for each). Greater hepatic regeneration in ALPPS+C than in ALPPS confirmed that we established a rat model of ALPPS with benefit from venous congestion. Producing a congested area may contribute importantly to rapid FLR hypertrophy during ALPPS. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  13. Liver transplantation in adults with portal vein thrombosis: Data from the China Liver Transplant Registry.

    Science.gov (United States)

    Gao, Peng Ji; Gao, Jie; Li, Zhao; Hu, Zhi Ping; Leng, Xi Sheng; Zhu, Ji Ye

    2016-06-01

    Portal vein thrombosis (PVT) is a common complication in patients with liver cirrhosis. During liver transplantation (LT), PVT may complicate the procedure and lead to a poor prognosis. The aim of this study is to evaluate patients enrolled in the China Liver Transplant Registry, to understand the influence of PVT to the LT recipients. We collected data from patients who underwent LT and were entered into the China Liver Transplant Registry. All data of medical records and follow-up were retrospectively reviewed. The preoperative condition, duration of surgery, intraoperative blood loss, postoperative early and late PVT, and survival rates were compared between patients with PVT and those without PVT. Multivariate Cox analysis and survival analysis were used to determine the influence of PVT. A total of 20,524 cases were recruited into the study. In all, 1810 (8.82%) patients were diagnosed with preoperative PVT of various severities. All patients were followed up for an average of 30.25±33.25months (up to a maximum of 171.68months). Patients with PVT had a significantly longer operating time, more intraoperative blood loss and a higher rate of post-LT PVT (Ptransplantation centers. Copyright © 2016. Published by Elsevier Masson SAS.

  14. Incidence and clinical presentation of portal vein thrombosis in cirrhotic patients

    Institute of Scientific and Technical Information of China (English)

    Yasir Furkan Cagin; Yahya Atayan; Mehmet Ali Erdogan; Firat Dagtekin; Cemil Colak

    2016-01-01

    BACKGROUND: Portal vein thrombosis (PVT) is due to many risk factors, but its pathogenesis is still not clearly understood. To identify the risk factors for PVT, we analyzed the clinical characteristics and complications associated with PVT in cir-rhotic patients. METHODS: We studied patients with liver cirrhosis who were admitted to our unit from April 2009 to December 2014. The patients were divided into the PVT and non-PVT groups, and were compared by variables including gender, age, the etiology of cirrhosis, stage of cirrhosis, complications, imaging, and treatment. RESULTS: PVT was found in 45 (9.8%) of 461 cirrhotic pa-tients admitted to our hospital. Most patients (45.9%) had hepatitis B virus (HBV)-related cirrhosis, with a similar dis-tribution of etiologies between the groups. However, there was no positive relationship between PVT and etiologies of cirrhosis. Most patients (71.5%) were in the stage of hepatic decompensation. No statistically signiifcant differences were found in complications including esophageal varices, ascites, and hepatic encephalopathy between the groups. However, there was a signiifcant positive correlation between hepatocel-lular carcinoma (HCC) and PVT (P CONCLUSIONS: The incidence of PVT was 9.8%, mainly in patients with HBV-related cirrhosis. The development of PVT was associated with the severity of liver disease and HCC.

  15. Comparison of CT and MRI artefacts from coils and vascular plugs used for portal vein embolization

    Energy Technology Data Exchange (ETDEWEB)

    Geisel, Dominik, E-mail: dominik.geisel@charite.de [Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); Gebauer, Bernhard [Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); Malinowski, Maciej; Stockmann, Martin [Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); Denecke, Timm [Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany)

    2014-04-15

    Purpose: To retrospectively analyze the degree of artefacts in CT and MRI scans caused by coils and vascular plugs used for portal vein embolization (PVE). Materials and methods: All patients who underwent PVE between July 2011 and December 2012 and received either plug or coil embolization additional to particle embolization were retrospectively analyzed. Artefacts causes by embolization materials were measured in CT and MRI scans following PVE. Results: The sum of the artefact diameters caused from coils was significantly higher in CT (188.3 ± 26.1 mm) than in MRI T1 (50.5 ± 6.5 mm) or T2 imaging (39.5 ± 9.7 mm) (P < 0.05). In MRI, the diameter in T1 and T2 sequences did not differ significantly (P = 0.977). The sum of the artefact diameters from vascular plugs in MRI T1 sequences (62.5 ± 8.7 mm) was significantly higher than in CT (46.6 ± 4.8 mm; P < 0.05) and MRI T2 sequences (52.8 ± 3.8 mm; P < 0.05). Conclusion: PVE with particles and vascular plug causes significantly fewer artefacts than PVE with particles and coils on CT scans following embolization, which can be important in the event of vascular complications or in follow-up scans, should the patient become unresectable.

  16. Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis.

    Science.gov (United States)

    Yu, Jeong Il; Park, Hee Chul

    2016-08-14

    Although the current standard treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is sorafenib, many previous studies have established the need for a reliable local modality for PVTT control, which is a major cause of liver function deterioration and metastasis. Additionally, there is growing evidence for the prognostic significance of PVTT classification according to the location of tumor thrombosis. Favorable outcomes can be obtained by applying local modalities, including surgery or transarterial chemoembolization, especially in second-order or distal branch PVTT. Rapid control of PVTT could maintain or improve liver function and reduce intrahepatic as well as distant metastasis. Radiotherapy (RT) is one of the main locoregional treatment modalities in oncologic fields, but has rarely been used in HCC because of concerns regarding hepatic toxicity. However, with the development of advanced techniques, RT has been increasingly applied in HCC management. Randomized studies have yet to definitively prove the benefit of RT, but several comparative studies have justified the application of RT in HCC. The value of RT is especially noticeable in HCC with PVTT; several prospective and retrospective studies have reported favorable outcomes, including a 40% to 60% objective response rate and median overall survival of 15 mo to 20 mo in responders. In this review, we evaluate the role of RT as an alternative local modality in HCC with PVTT.

  17. Tolerability and efficacy of gamma knife radiosurgery on hepatocellular carcinoma with portal vein tumor thrombosis

    Science.gov (United States)

    Lu, Xiao-Jie; Dong, Jing; Ji, Li-Juan; Xiao, Li-Xin; Ling, Chang-Quan; Zhou, Jun

    2016-01-01

    This is a retrospective study on the safety and efficacy of gamma knife radiosurgery (GKR) in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Patients with confirmed HCC and PVTT were allocated into two groups based on the treatments they received (palliative or GKR). A total of 138 patients were included (74 in the palliative group, 64 in GKR group). No significant differences in baseline characteristics existed between the two groups. Treatment-related adverse events (AEs) were recorded and compared between groups. The majority of AEs were mild to moderate and subsided naturally or after medication. There was no AE-induced death. The influences of baseline characteristics and treatment options on patients' OS were analyzed. The median OS of patients in the palliative and GKR group were 3.0 months (95% CI: 2.719-3.281) and 6.1 months (95% CI: 4.706-7.494) respectively (p = 0.003). Multivariate analysis revealed that GKR treatment, performance status 0-1, Child A, smaller tumor diameter and monolobar distribution were significant favorable prognosticators. Subgroup analyses showed OS benefit of GKR regardless of PVTT location (main or branch of PVTT). In conclusion, GKR is well tolerated in selected HCC-PVTT patients and can confer OS benefit, which needs validation in future prospective studies. PMID:26473291

  18. Adipose derived mesenchymal stem cells transplantation via portal vein improves microcirculation and ameliorates liver fibrosis induced by CCl4 in rats

    Directory of Open Access Journals (Sweden)

    Wang Yu

    2012-06-01

    Full Text Available Abstract Introduction Adipose derived mesenchymal stem cells (ADMSCs, carrying the similar characteristics to bone marrow mesenchymal stem cells, only much more abundant and easier to obtain, may be a promising treatment for liver fibrosis. We aim to investigate the therapeutic potential of ADMSCs transplantation in liver fibrosis caused by carbon tetrachloride (CCl4 in rats as well as its underlying mechanism, and to further explore the appropriate infusion pathway. Methods ADMSCs were isolated, cultured and identified. Placebo and ADMSCs were transplanted via portal vein and tail vein respectively into carbon tetrachloride (CCl4-induced liver fibrosis rats. Computed tomography (CT perfusion scan and microvessel counts were performed to measure the alteration of liver microcirculation after therapy. Liver function tests and histological findings were estimated. Results CT perfusion scan shown significant decrease of hepatic arterial perfusion index, significant increased portal vein perfusion, total liver perfusion in rats receiving ADMSCs from portal vein, and Factor VIII (FVIII immunohistochemical staining shown significant decrease of microvessels in rats receiving ADMSCs from portal vein, indicating microcirculation improvement in portal vein group. Vascular endothelial growth Factor (VEGF was significantly up-regulated in fibrosis models, and decreased after ADMSCs intraportal transplantation. A significant improvement of liver functional test and histological findings in portal vein group were observed. No significance was found in rats receiving ADMSCs from tail vein. Conclusions ADMSCs have a therapeutic effect against CCl4-mediated liver fibrosis. ADMSCs may benefit the fibrotic liver through alteration of microcirculation, evidenced by CT perfusion scan and down-regulation of VEGF. Intraportal transplantation is a better pathway than tail vein transplantation.

  19. Conjoined unification venoplasty for triple portal vein branches of right liver graft: a case report and technical refinement.

    Science.gov (United States)

    Kwon, Jae Hyun; Hwang, Shin; Song, Gi-Won; Moon, Deok-Bog; Park, Gil-Chun; Kim, Seok-Hwan; Lee, Sung-Gyu

    2016-05-01

    Anomalous portal vein (PV) branching of the donor liver is uncommon and usually makes two, or rarely, more separate PV branches at the right liver graft. Autologous PV Y-graft interposition has long been regarded as the standard procedure, but is currently replaced with the newly developed technique of conjoined unification venoplasty (CUV) due to its superior results. Herein, we presented a case of CUV application to three PV openings of a right liver graft. The recipient was a 32-year-old male patient with hepatitis B virus-associated liver cirrhosis. The living liver donor was his 33-year-old sister who had a type III PV anomaly, but the right posterior PV branch was bifurcated early into separate branches of the segments VI and VII, thus three right liver PV branches were cut separately. We used the CUV technique consisting of placement of a small vein unification patch between three PV orifices, followed by overlying coverage with a crotch-opened autologous portal Y-graft. The portal Y-graft was excised and its crotches were incised to make a wide common orifice. Three bidirectional running sutures were required to attach the crotch-opened autologous portal Y-graft. After portal reperfusion, the conjoined PV portion bulged like a tennis ball, providing a wide range of alignment tolerance. The patient recovered uneventfully from the liver transplantation operation. The CUV technique enabled uneventful reconstruction of triple donor PV orifices. Thus, CUV can be a useful and effective technical option for reconstruction of right liver grafts with various anomalous PVs.

  20. Is Post-TIPS Anticoagulation Therapy Necessary in Patients with Cirrhosis and Portal Vein Thrombosis? A Randomized Controlled Trial.

    Science.gov (United States)

    Wang, Zhu; Jiang, Ming-Shan; Zhang, Hai-Long; Weng, Ning-Na; Luo, Xue-Feng; Li, Xiao; Yang, Li

    2016-06-01

    Purpose To determine whether posttransjugular intrahepatic portosystemic shunt (TIPS) placement anticoagulation therapy could benefit patients with cirrhosis and portal vein thrombosis (PVT) from the perspective of a change in portal vein patency status and clinical outcomes. Materials and Methods The study was approved by the institutional review board, and informed consent was obtained from each patient. From October 2012 to February 2014, patients with cirrhosis and PVT who underwent TIPS placement were randomly assigned to the anticoagulation therapy or control group. All patients were followed at 1, 3, 6, and 12 months after the TIPS procedure. Outcome measures were a change of portal vein patency status and clinical measures including gastrointestinal rebleeding, shunt dysfunction, hepatic encephalopathy, and survival. Student t test, χ(2) test, Fisher exact test, Mann-Whitney U test, and logistical regression were applied where appropriate. Results A total of 64 patients were enrolled in the study, with 31 allocated to the anticoagulation group and 33 allocated to the control group. Overall, thrombi were improved in 61 patients (96.8%) after the procedure. PVT recanalization (ie, complete disappearance; reconstruction of cavernous transformation) was achieved in 26 patients (83.9%) in the anticoagulation therapy group and in 23 (71.8%) patients in tthe control group (P = .252). The presence of a superior mesenteric vein thrombus may help predict recanalization failure (unadjusted relative risk = 0.243; 95% confidence interval: 0.070, 0.843; P = .026). Clinical outcomes were also similar between the two groups. Conclusion Anticoagulation therapy may not be necessary in certain patients with PVT because TIPS placement alone can achieve a high persistent recanalization rate. (©) RSNA, 2015.

  1. Selective internal radiation therapy compared with sorafenib for hepatocellular carcinoma with portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Edeline, Julien [Centre Eugene Marquis, Medical Oncology Department, Rennes (France); Inserm UMR991, Rennes (France); Crouzet, Laurence; Pracht, Marc; Boucher, Eveline [Centre Eugene Marquis, Medical Oncology Department, Rennes (France); Campillo-Gimenez, Boris [Centre Eugene Marquis, Clinical Research Department, Rennes (France); Rolland, Yan; Rohou, Tanguy [Centre Eugene Marquis, Imaging Department, Rennes (France); Guillygomarc' h, Anne [CHU Pontchaillou, Hepatology Department, Rennes (France); Boudjema, Karim [CHU Pontchaillou, Hepatobiliary Surgery, Rennes (France); Lenoir, Laurence [Centre Eugene Marquis, Nuclear Medicine Department, Rennes (France); Adhoute, Xavier [Hopital Saint-Joseph, Hepato-Gastroenterology Department, Marseille (France); Clement, Bruno [Inserm UMR991, Rennes (France); Blanc, Jean-Frederic [Hopital Saint-Andre, Hepato-Gastroenterology Department, Bordeaux (France); Garin, Etienne [Inserm UMR991, Rennes (France); Centre Eugene Marquis, Nuclear Medicine Department, Rennes (France)

    2016-04-15

    Tumoural portal vein thrombosis (PVT) is a major prognostic factor in hepatocellular carcinoma (HCC). The efficacy of sorafenib, the only treatment approved at an advanced stage, is limited. Based on previous data, selective internal radiation therapy (SIRT), or {sup 90}Y radioembolization, seems an interesting option. We aimed to compare both treatments in this population. We retrospectively compared patients treated in two centres for HCC with tumoural PVT. We compared overall survival (OS) between patients treated with SIRT and patients treated with sorafenib. Analyses were performed before and after 1:1 matching with a propensity score for controlling indication bias, using a Cox proportional hazards model. A total of 151 patients were analysed, 34 patients treated with SIRT and 117 patients treated with sorafenib only. In the whole population, SIRT was associated with a higher median OS as compared with sorafenib: 18.8 vs 6.5 months (log-rank p < 0.001). There was an imbalance of baseline characteristics between patients treated by SIRT and sorafenib, which justified patient matching with use of a propensity score: 24 patients treated with SIRT could be matched with 24 patients treated with sorafenib. OS was estimated with a median of 26.2 vs 8.7 months in patients treated with SIRT vs sorafenib, respectively (log-rank p = 0.054). Before and after patient matching, the adjusted hazard ratio related to treatment by SIRT was estimated at 0.62 [95 % confidence interval (CI) 0.39-0.97] (p = 0.037) and 0.40 (95 % CI 0.19-0.82) (p = 0.013), respectively. SIRT seems more effective than sorafenib in patients presenting with HCC and tumoural PVT. This hypothesis is being tested in prospective randomized trials. (orig.)

  2. Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis

    Institute of Scientific and Technical Information of China (English)

    Jia Fan; Jian Zhou; Zhi-Quan Wu; Shuang-Jian Qiu; Xiao-Ying Wang; Ying-Hong Shi; Zhao-You Tang

    2005-01-01

    AIM: To evaluate the efficacy of different treatment strategies for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and investigate factors influencing prognosis.METHODS: One hundred and seventy-nine HCC patients with macroscopic PVTT were enrolled in this study. They were divided into four groups and underwent different treatments: conservative treatment group (n = 18),chemotherapy group (n = 53), surgical resection group (n = 24) and surgical resection with postoperative chemotherapy group (n = 84). Survival rates of the patients were analyzed by the Kaplan-Meier method. A log-rank analysis was performed to identify group differences. Cox's proportional hazards model was used to analyze variables associated with survival.RESULTS: The mean survival periods of the patients in four groups were 3.6, 7.3, 10.1, and 15.1 mo respectively.There were significant differences in the survival rates among the groups. The survival rates at 0.5-, 1-, 2-, and 3-year in surgical resection with postoperative chemotherapy group were 55.8%, 39.3%, 30.4%, and 15.6% respectively, which were significantly higher than those of other groups (P<0.001). Multivariate analysis revealed that the strategy of treatment (P<0.001) and the number of chemotherapy cycles (P = 0.012) were independent survival predictors for patients with HCC and PVTT.CONCLUSION: Surgical resection of HCC and PVTT combined with postoperative chemotherapy or chemoembolization is the most effective therapeutic strategy for the patients who can tolerate operation.Multiple chemotherapeutic courses should be given postoperatively to the patients with good hepatic function reserve.

  3. Three-dimensional conformal radiotherapy for portal vein tumor thrombosis alone in advanced hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ju Hye Kim Dong Hyun; Ki, Yong Kan; Kim, Dong Won; Kim, Won Taek; Heo, Jeong; Woo, Hyun Young [Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Nam, Ji Ho [Dept.of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2014-09-15

    We sought to evaluate the clinical outcomes of 3-dimensional conformal radiation therapy (3D-CRT) for portal vein tumor thrombosis (PVTT) alone in patients with advanced hepatocellular carcinoma. We retrospectively analyzed data on 46 patients who received 3D-CRT for PVTT alone between June 2002 and December 2011. Response was evaluated following the Response Evaluation Criteria in Solid Tumors. Prognostic factors and 1-year survival rates were compared between responders and non-responders. Thirty-seven patients (80.4%) had category B Child-Pugh scores. The Eastern Cooperative Oncology Group performance status score was 2 in 20 patients. Thirty patients (65.2%) had main or bilateral PVTT. The median irradiation dose was 50 Gy (range, 35 to 60 Gy) and the daily median dose was 2 Gy (range, 2.0 to 2.5 Gy). PVTT response was classified as complete response in 3 patients (6.5%), partial response in 12 (26.1%), stable disease in 19 (41.3%), and progressive disease in 12 (26.1%). There were 2 cases of grade 3 toxicities during or 3 months after radiotherapy. Twelve patients in the responder group (15 patients) received at least 50 Gy irradiation, but about 84% of patients in the non-responder group received less than 50 Gy. The 1-year survival rate was 66.8% in responders and 27.4% in non-responders constituting a statistically significant difference (p = 0.008). Conformal radiotherapy for PVTT alone could be chosen as a palliative treatment modality in patients with unfavorable conditions (liver, patient, or tumor factors). However, more than 50 Gy of radiation may be required.

  4. Clinical outcome comparison between TIPS and EBL in patients with cirrhosis and portal vein thrombosis.

    Science.gov (United States)

    Wang, Zhu; Zhao, He; Wang, Xiaoze; Zhang, Hailong; Jiang, Mingshan; Tsauo, Jiaywei; Luo, Xuefeng; Yang, Li; Li, Xiao

    2015-08-01

    The aim of this study is to compare the clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic band ligation (EBL) in patients with cirrhosis and portal vein thrombosis (PVT). We retrospectively reviewed the January to September 2010 data from our database and included 25 patients with cirrhosis and PVT who underwent successful TIPS creation. We selected another 25 patients who underwent EBL matching for age, sex, and Child-Pugh-Turcotte class. The outcome measures included changes in the PVT status before and after the treatments, the rebleeding rate, and the overall survival. The mean follow-up was 25.1 ± 8.7 months in the EBL group and 25.6 ± 8.5 months in the TIPS group (P = 0.85). After treatments, the PVT severity improved in 40% and worsened in 25% of patients who did not undergo TIPS, compared with 87% and none of the patients who underwent TIPS (P EBL group, and 12.5% and 25.2% in the TIPS group (P = 0.002). The 1- and 2-year survival rates were, respectively, 95.7% and 85.2% in the EBL group, and 96% and 78.7% in the TIPS group (P = 0.203). The MELD score was the only independent predictive factor for survival (HR 1.73, 95% CI 1.27-2.37, P = 0.001). Compared with EBL, TIPS contributed to PVT improvement and reduced the risk of rebleeding without providing a survival benefit for patients with PVT.

  5. Portal vein thrombosis in a patient with HCV cirrhosis and combined hemophilia A and thrombophilia V Leiden

    Directory of Open Access Journals (Sweden)

    Nikos Eleftheriadis

    2010-10-01

    Full Text Available Nikos Eleftheriadis, Pantelis MakrisHemostatic Unit of The First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotles University of Thessaloniki, GreeceAbstract: The relation of hemophilia A with thrombophilia V Leiden is extremely rare in the literature. Furthermore, hemophiliac patients have an increased risk of severe life-threatening hemorrhage, blood transfusions, and therefore hepatitis transmission, mainly hepatitis C (HCV.Aims and methods: We present a 54-year-old male with a 5-year history of decompensated liver cirrhosis on the grounds of HCV hepatitis, hemophilia A, and thrombophilia V Leiden. He was admitted to our department because of severe abdominal distension, resembling ‘tense ascites’ despite the use of diuretics. Clinical examination showed shifting dullness and a protuberant abdomen, while hematological and blood chemistry results revealed thrombopenia (platelets: 77000/mL and hypoalbuminemia. Repeated abdominal paracentesis (under factor VIII administration failed to remove ascitic fluid, while abdominal echosonography and computed tomography revealed severe edema of mesenterium and intraabdominal viscus and the absence of free ascitic fluid, atrophic cirrhotic liver, and splenomegaly. Moreover, abdominal doppler echosonography revealed signs of portal hypertension, previous portal vein thrombosis, and revascularization of the portal vein. Gastroscopy showed esophageal varices grade II, without signs of bleeding. A-FP and all other laboratory examinations were normal.Results: Our patient was intravenously treated with albumine and diuretics (furosemide with mild improvement of his abdominal distension. During his hospitalization he presented an episode of spontaneous bacterial peritonitis and hepatic encephalopathy, which were successfully treated with lactulose clysmas and ciprofloxacine. He was discharged in a good general condition.Conclusion: According to our case we consider the false clinical

  6. 肝门静脉高压症猪肝门静脉的结构重建%Structure remodeling of swine portal vein in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    贺细菊; 余明华; 李静; 黄铁柱

    2011-01-01

    目的:建立猪肝门静脉高压症模型,探讨肝门静脉高压症时肝门静脉的结构重建.方法:猪以四氯化碳、苯巴比妥、乙醇配合高脂、低蛋白、低胆碱饮食进行混合饲养.通过脾静脉插管测压,取门静脉常规石蜡包埋、切片,用H-E 染色法、Weigert法、Aniline blue法、Organge G法分别染组织结构、弹性纤维、胶原纤维和平滑肌,用计算机图像分析系统定量分析肝门静脉的几何形态及显微成分.结果:实验组肝门静脉压为(4.17±1.03)kPa,而正常组为(1.51±0.79)kPa,实验组门静脉的内膜与中膜增厚,管壁增厚,管径增粗,平滑肌、胶原纤维的百分含量增加,平滑肌细胞核的数密度和面密度也在增加,C/E值增加.结论:肝门静脉高压症时,与血液动力学改变相适应,肝门静脉的几何形态与显微结构成分均发生了改变.%Objective: To establish reliable swine portal hypertension model and explore the morphological properties of hepatic portal vein.Methods: Liver cirrhosis and portal hypertension was induced by carbon tetrachloride and fenobarbital (n = 8), 4 pigs served as the control, and the hepatic arteries were collected and serially sectioned.The tissue structure, elastic fiber, collagen fiber and smooth muscle were stained by H-E, Weigert, Aniline blue and Orange G respectively.The morphological data of hepatic arteries were obtained by the computer image analysis system.Results: The portal vein pressure of the experimental group was (4.17 ± 1.03) kpa, and that of normal group was (1.51 ± 0.79) kPa.The thickness of intima and media wall, diameter of the experimental group were significantly larger than those of the normal group (P <0.01).The relative content of collagenic fiber and smooth muscle, and C/E of the experimental group were also significantly larger than that of the normal group.Conclusion: In portal hypertension, the structure remodeling of the portal vein was significantly changed, and

  7. Complete Metabolic Response with Recanalization of Portal Vein Tumor Thrombosis after Sunitinib in a Patient with Advanced Hepatocellular Carcinoma

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    Michele Basso

    2010-11-01

    Full Text Available The prognosis of patients with advanced hepatocellular carcinoma (HCC is very poor. The outcome of these patients is particularly bleak when the disease is complicated by portal vein tumor thrombosis (PVTT, since the increased portal pressure often causes serious gastrointestinal bleedings. Before the introduction of sorafenib (SOR, a tyrosine kinase inhibitor, no effective treatment was available for patients with advanced disease. SOR is now considered the standard treatment even for patients with tumor thrombosis, although the well-known interference between tyrosine kinase inhibitors and the coagulation pathway calls for caution against their use in this setting. Here, we report the case of a 74-year-old male patient with advanced HCC and PVTT treated with sunitinib (SUN, another multikinase inhibitor. During the third cycle, our patient experienced a life-threatening hematemesis with hemorrhagic shock that required intensive care treatment and SUN discontinuation. However, he completely recovered, and the PET/CT scan performed 1 year after the adverse effect demonstrated no evidence of the tumor together with portal vein recanalization. The short course of SUN causing both tumor response and gastrointestinal bleeding warrants further studies on the effectiveness of SUN in this setting as well as on the duration of treatment with multikinase inhibitors in patients with tumor thrombosis.

  8. Aspectos ultra-sonográficos da trombose da veia porta Ultrasonographic features of portal vein thrombosis

    Directory of Open Access Journals (Sweden)

    Márcio Martins Machado

    2006-04-01

    Full Text Available A trombose da veia porta pode estar associada a várias alterações, como a presença de tumores (por exemplo: hepatocarcinoma, doença metastática hepática e carcinoma do pâncreas, pancreatite, hepatite, septicemia, trauma, esplenectomia, derivações porto-cava, estados de hipercoagulabilidade (por exemplo: gravidez, em neonatos (por exemplo: onfalite e cateterização da veia umbilical e desidratação aguda. Os autores discutem, neste artigo, os aspectos ultra-sonográficos da trombose de veia porta e alguns aspectos de relevância clínica.Portal vein thrombosis may be associated with many alterations, such as the presence of tumors (for example, hepatocellular carcinoma, metastatic liver disease and carcinoma of the pancreas as well as pancreatitis, hepatitis, septicemia, trauma, splenectomy, portacaval shunts, hypercoagulable conditions (for example, pregnancy, in neonates (for example, omphalitis and umbilical vein catheterization and in acute dehydration. The authors discuss herein the sonographic features of portal vein thrombosis as well as some aspects of clinical relevance.

  9. Differentiation of neoplastic from bland macroscopic portal vein thrombi using dual-energy spectral CT imaging: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Qian, Li Jun; Zhu, Jiong; Zhuang, Zhi Guo; Xu, Jian Rong [Shanghai Jiaotong University School of Medicine, Department of Radiology, Renji Hospital, Shanghai (China); Xia, Qiang [Shanghai Jiaotong University School of Medicine, Department of Hepatic Surgery, Renji Hospital, Shanghai (China); Cheng, Yu.Fan [Chang Gung University College of Medicine, Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung (China); Li, Jian Ying [GE Healthcare China, CT Imaging Research Center, Beijing (China)

    2012-10-15

    To assess the feasibility and value of dual-energy spectral computed tomography (DESCT) imaging for differentiating neoplastic from bland macroscopic portal vein (PV) thrombi. Computed tomography (CT) images of 44 patients with macroscopic PV thrombus (bland group, n = 16; neoplastic group, n = 28) were reviewed. Iodine-based material decomposition images in the portal venous phase were reconstructed to compare the iodine indices between groups, including thrombus iodine density (I{sub T}), thrombus-aorta iodine density ratio (I{sub T}/I{sub A}), and thrombus-PV iodine density ratio (I{sub T}/I{sub P}). Differential diagnostic performances of DESCT were calculated in the subgroup of 21 patients with histopathological evidence (bland group, n = 12; neoplastic group, n = 9). The iodine indices of the neoplastic group were significantly higher than those in the bland group (P < 0.001). A threshold I{sub T} of 1.14 mg/mL, I{sub T}/I{sub A} of 0.17, and I{sub T}/I{sub P} of 0.17 in the portal venous phase yielded 100 %, 88.9 %, and 100 % sensitivity, and 91.7 %, 91.7 %, and 83.3 % specificity, respectively, in differentiating neoplastic from bland PV thrombi. DESCT imaging with quantification of thrombus iodine density in the portal venous phase appears to be a promising new method for distinguishing neoplastic from bland macroscopic PV thrombi. (orig.)

  10. The effect of rectal ozone on the portal vein oxygenation and pharmacokinetics of propranolol in liver cirrhosis (a preliminary human study).

    Science.gov (United States)

    Zaky, Saad; Fouad, Ehab Ahmad; Kotb, Hassan Ibrahim Mohamad

    2011-03-01

    The aim of this study was to investigate the effect of rectal ozone on portal vein oxygenation and the pharmacokinetic changes of propranolol in patients with liver cirrhosis. Fifteen patients with liver cirrhosis were included They were given a fixed oral dose of propranolol 80mg on the morning of day 1 after overnight fasting. Blood samples were collected at fixed time intervals for 24h. Patients were given 12 sessions of rectal ozone of 300ml of 40% ozone/oxygen mixture. On day 14 another oral dose of 80mg propranolol was given and blood samples were collected as on day 1. Plasma concentrations of propranolol were measured by HPLC. Portal vein oxygen tension and saturation were measured before and after rectal ozone. Plasma concentrations of propranolol were reduced after ozone therapy with pronounced decreases in the maximum plasma concentration and the area under the plasma concentration-time curve. The changes were consistent with a decrease in propranolol bioavailability. There was a decrease in the elimination half-life and mean residence time. Portal vein oxygenation significantly increased after rectal ozone. The changes in the pharmacokinetics of propranolol probably reflect an increase in the rate and extent of its metabolism resulting from improved portal vein oxygenation attributable to the ozone therapy. The present work highlights that ozone can be an alternative medical measure to improve portal vein oxygenation in liver cirrhosis. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

  11. Sectional localization of a small hepatocellular carcinoma in the right hepatic lobe by computed tomography: Comparison between the conventional and portal vein tracing methods

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Chun-Gao [Seoul National University Hospital, Department of Radiology, Jongro-gu, Seoul (Korea, Republic of); The First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology, Nanjing (China); Chung, Jin Wook; Hur, Saebeom; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun; Yin, Yong-Hu; Kim, Young Il [Seoul National University Hospital, Department of Radiology, Jongro-gu, Seoul (Korea, Republic of); Ahn, Sang-bu [Dongnam Institution of Radiological and Medical Sciences, Department of Radiology, Busan (Korea, Republic of); Cho, Baik Hwan [Chonbuk National University Hospital, Department of Radiology, Jeonju (Korea, Republic of)

    2016-12-15

    To compare the accuracy of the conventional and portal vein tracing methods in the right hepatic lobe in multidetector computed tomography (MDCT). This retrospective study included patients with hepatocellular carcinoma (HCC) lesions in the right hepatic lobe who underwent multiphasic MDCT and C-arm CT hepatic arteriography (C-arm CTHA) for chemoembolization. The accuracies of the conventional and portal vein tracing methods were evaluated using C-arm CTHA as the gold standard. A total of 147 patients with 205 HCC nodules were included. The C-arm CTHA could identify all the tumour-feeding arteries and consequently demonstrated that 120 lesions were located in the anterior section, 78 in the posterior section, and 7 in the border zone. The accuracy rates of conventional vs. portal vein tracing methods were 71.7 % vs. 98.3 % for the anterior section lesions, 67.9 % vs. 96.2 % for the posterior section, and 28.6 % vs. 57.1 % for the border zone. The portal vein tracing method was more accurate than the conventional method (P<0.001). The portal vein tracing method should be used for sectional localization of HCCs in the right lobe, because it predicts the location more accurately than the conventional method. (orig.)

  12. A long-surviving case of gastric cancer with main portal vein tumor thrombus after surgical resection and postoperative S-1 therapy.

    Science.gov (United States)

    Sato, Shinsuke; Nagai, Erina; Taki, Yusuke; Watanabe, Masaya; Takahashi, Michiro; Kyoden, Yusuke; Ohata, Ko; Kanemoto, Hideyuki; Oba, Noriyuki; Taku, Keisei; Suzuki, Makoto; Takagi, Masakazu

    2016-08-01

    Gastric cancer patients with main portal vein tumor thrombus usually have a short survival time, owing to its aggressive behavior. Herein, we report a long-surviving case of gastric cancer with main portal vein tumor thrombus. A 78-year-old man presenting with anorexia and body weight loss was diagnosed with gastric cancer. The patient was referred to our hospital for further examination and treatment. Endoscopy revealed a type 3 tumor (8.0 cm in length) in the body of the stomach. Biopsy led to the diagnosis of moderately differentiated adenocarcinoma. Enhanced computed tomography revealed a large tumor thrombus extending from the gastric coronary vein to the portal trunk. A total gastrectomy with lymphadenectomy, splenectomy, and thrombectomy was performed. Postoperative chemotherapy with S-1 was administered for 18 months. The patient died a natural death without recurrence at 49 postoperative months. To the best of our knowledge, the patient was the oldest to be diagnosed with gastric cancer with main portal vein tumor thrombus at diagnosis, who survived >36 months. Although gastric cancer with main portal vein tumor thrombus is a rare occurrence, its prognosis is extremely poor. Intensive surgery and long-term chemotherapy may be effective at improving survival time in these patients.

  13. Interobserver Variability in Target Definition for Hepatocellular Carcinoma With and Without Portal Vein Thrombus: Radiation Therapy Oncology Group Consensus Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S., E-mail: tshong1@mgh.harvard.edu [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Bosch, Walter R. [Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri (United States); Krishnan, Sunil [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kim, Tae K. [Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women' s College Hospital, University of Toronto, Toronto, Ontario (Canada); Mamon, Harvey J. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Shyn, Paul [Department of Radiology, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ben-Josef, Edgar [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Seong, Jinsil [Department of Radiation Oncology, Yonsei University Medical College, Seoul (Korea, Republic of); Haddock, Michael G. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Cheng, Jason C. [Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (China); Feng, Mary U. [Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan (United States); Stephans, Kevin L. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Roberge, David [Department of Radiation Oncology, Montreal General Hospital/McGill University Health Centre, Montreal, Quebec (Canada); Crane, Christopher [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); and others

    2014-07-15

    Purpose: Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. Methods and Materials: Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. Results: Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). Conclusions: In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment

  14. Associating liver partition and portal vein ligation for staged hepatectomy:From technical evolution to oncological benefit

    Institute of Scientific and Technical Information of China (English)

    Jun Li; Florian Ewald; Amit Gulati; Bj?rn Nashan

    2016-01-01

    Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is a novel approach in liver surgery that allows for extensive resection of liver parenchyma by inducing a rapid hypertrophy of the future remnant liver. However,recent reports indicate that not all patients eligible for ALPPS will benefit from this procedure. Therefore,careful patient selection will be necessary to fully exploit possible benefits of ALPPS. Here,we provide a comprehensive overview of the technical evolution of ALPPS with a special emphasis on safety and oncologic efficacy. Furthermore,we review the contemporary literature regarding indication and benefits,but also limitations of ALPPS.

  15. [A Case of Portal Vein Thrombosis Occurring during CapeOX and Bevacizumab Combination Therapy for Liver Metastasis].

    Science.gov (United States)

    Uno, Yasuo; Tsuboi, Kenji; Shimizu, Mitsuya; Tomosugi, Toshihide; Shoka, Michita; Hibino, Soki; Matsushita, Hidenobu; Takahashi, Takuji; Okochi, Osamu; Kawase, Yoshihisa

    2016-07-01

    A73 -year-old man underwent a sigmoidectomy for sigmoid colon cancer with liver metastasis. After the operation, he received CapeOX combined with bevacizumab therapy. After 6 courses, the liver metastasis was undetectable on computed tomography scans. After 15 courses, computed tomography revealed ascites, and chemotherapy was discontinued. Two months later, computed tomography revealed portal vein thrombosis. Owing to the chronic nature of the thrombosis, thrombolytic therapy was not initiated. However, preservation therapy using antiplatelet drugs for 1 month resolved the ascites and the thrombosis. The risk of serious thrombosis must be considered when using bevacizumab.

  16. Relationship between the histological appearance of the portal vein and development of ischemic-type biliary lesions after liver transplantation.

    Science.gov (United States)

    Farid, Waqar R R; de Jonge, Jeroen; Zondervan, Pieter E; Demirkiran, Ahmet; Metselaar, Herold J; Tilanus, Hugo W; de Bruin, Ron W F; van der Laan, Luc J W; Kazemier, Geert

    2013-10-01

    Ischemic-type biliary lesions (ITBLs) are a major cause of morbidity after liver transplantation (LT). Their assumed underlying pathophysiological mechanism is ischemia/reperfusion injury of the biliary tree, in which the portal circulation has been proposed recently to have a role. The aim of this study was to investigate whether early histological changes, particularly in the portal vein, predispose patients to ITBLs. A case-control study of 22 LT recipients was performed through a retrospective assessment of more than 30 histological parameters in 44 intraoperative liver biopsy samples taken after cold ischemia (time 0) and portal reperfusion (time 1). Eleven grafts developed ITBLs requiring retransplantation (the ITBL group), and 11 matched controls had normally functioning grafts 11 years after LT on average (the non-ITBL group). Additionally, 11 liver biopsy samples from hemihepatectomies performed for metastases of colorectal cancer (CRC) were assessed similarly. Analyses showed no significant histological differences at time 0 between the ITBL and non-ITBL groups. However, the time 1 biopsy samples from the ITBL group showed smaller portal vein branches (PVBs) significantly more often than the samples from the non-ITBL group, which also showed persisting paraportal collateral vessels. Larger PVBs and paraportal collateral vessels were also found in the CRC group. A morphometric analysis confirmed these findings and showed that PVB measurements were significantly lower for the ITBL group at time 1 versus the ITBL group at time 0 and the non-ITBL and CRC groups (they were largest in the CRC group). Thus, the PVB dimensions decreased in the ITBL group in comparison with the time 0 biopsy samples, and they were significantly smaller at time 1 in comparison with the dimensions for the non-ITBL and CRC groups. In conclusion, a smaller PVB lumen size in postreperfusion biopsy samples from liver grafts, suggesting a relatively decreased portal blood flow, is

  17. Impact of Portal Vein Involvement from Pancreatic Cancer on Metastatic Pattern After Surgical Resection.

    Science.gov (United States)

    Mierke, Franz; Hempel, Sebastian; Distler, Marius; Aust, Daniela E; Saeger, Hans-Detlev; Weitz, Jürgen; Welsch, Thilo

    2016-12-01

    The present study aims to evaluate the long-term outcome and metastatic pattern of patients who underwent resection of a pancreatic ductal adenocarcinoma (PDAC) with portal or superior mesenteric vein (PV/SMV) resection. Patients who underwent a partial pancreatoduodenectomy or total pancreatectomy for PDAC between 2005 and 2015 were retrospectively analyzed. Three subgroups were generated, depending on PV/SMV resection (P(+)) and pathohistological PV/SMV tumor infiltration (I(+)): P(+)I(+), P(+)I(-), and P(-)I(-). Statistical analysis was performed using the R software package. The study cohort included 179 patients, 113 of whom underwent simultaneous PV/SMV resection. Thirty-six patients (31.9 %) had pathohistological tumor infiltration of the PV/SMV (P(+)I(+)), and were matched with 66 cases without PV/SMV infiltration (P(-)I(-)). The study revealed differences in overall median survival (11.9 [P(+)I(+)] vs. 16.1 [P(+)I(-)] vs. 20.1 [P(-)I(-)] months; p = 0.01). Multivariate survival analysis identified true invasion of the PV/SMV as the only significant, negative prognostic factor (p = 0.01). Whereas the incidence of local recurrence was comparable (p = 0.96), the proportion of patients with distant metastasis showed significant differences (75 % [P(+)I(+)] vs. 45.8 % [P(+)I(-)] vs. 54.7 % [P(-)I(-)], p = 0.01). Furthermore, the median time to progression was significantly shorter if the PV/SMV was involved (7.4 months [P(+)I(+)] vs. 10.9 months [P(+)I(-)] vs. 11.6 months [P(-)I(-)]). Initial liver metastases occurred in 33 % of the patients. True invasion of the PV/SMV is an independent risk factor for overall survival, and is associated with a higher incidence of distant metastasis and shorter progressive-free survival. Radical vascular resection cannot compensate for aggressive tumor biology.

  18. Bleed caused by varicose veins rupture in a rare site in portal hypertension. Differential diagnosis with causes of acute hypovolemic shock in emergency.

    Directory of Open Access Journals (Sweden)

    Rosarino Procopio

    2011-09-01

    Full Text Available Portal hypertension is the increase in the pressure of the venous portal system, which receives around 1,500 mL/m of blood from the intestinum tenue, colon, spleen, and pancreas. A blocking of the flux or an increase in the resistance at any level of the portal tree results in an increase in the pressure in the system and the appearance of lateral circles between the portal vein and the inferior and superior, thus allowing for varicose veins to spread in the whole system. The present paper reports the case of a woman with liver cirrhosis, great ascites and bleeding out of varicose veins’ rupture at the spleen axis level, which presented the problem of differential diagnosis with other causes of hypovolemic shock. This cases resulted in the patient’s exitus.

  19. An assessment of the antagonistic activity of reactive blue 2 at P1- and P2-purinoceptors: supporting evidence for purinergic innervation of the rabbit portal vein.

    Science.gov (United States)

    Reilly, W M; Saville, V L; Burnstock, G

    1987-08-04

    A comparison of the effect of the putative adenosine 5'-triphosphate (ATP) antagonist, reactive blue 2, was made on the inhibitory responses to exogenous purines and non-adrenergic, non-cholinergic nerve stimulation in the rabbit portal vein, a preparation possessing both P1- and P2Y-purinoceptors, and on the excitatory responses to alpha, beta-methylene ATP in the rat portal vein where P2X-purinoceptors are present. In the ergotamine-contracted rabbit portal vein, ATP, adenosine and isoprenaline induced concentration-dependent relaxations. Reactive blue 2 (10-50 microM) produced a 2-9-fold shift to the right of the concentration-response curve to ATP, while the responses to adenosine and isoprenaline were not significantly altered. The inhibition of ATP assessed in the concentration-response curves appeared to be non-competitive. Electrical field stimulation of the ergotamine-contracted rabbit portal vein produced frequency-dependent relaxations that were abolished following incubation with tetrodotoxin (1 microM) and were inhibited by reactive blue 2 (30-50 microM), in a concentration-dependent manner. The rat portal vein contracted in response to the application of exogenous noradrenaline and alpha, beta-methylene ATP. Responses to both alpha, beta-methylene ATP (a P2X-purinoceptor agonist) and noradrenaline were not significantly inhibited by concentrations of reactive blue 2 that produced inhibition of the P2Y-mediated responses of the rabbit portal vein. In conclusion, it is suggested that reactive blue 2 is a non-competitive P2Y-purinoceptor antagonist, although the drug has a narrow range of activity and non-specific side effects become apparent at high concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Son, Rak Chae; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jong Woo; Ko, Gi Young [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

  1. Portal vein embolization for induction of selective hepatic hypertrophy prior to major hepatectomy: rationale, techniques, outcomes and future directions

    Science.gov (United States)

    Li, David; Madoff, David C.

    2016-01-01

    The ability to modulate the future liver remnant (FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable to survive liver resection. Multiple techniques have been developed to augment the FLR including portal vein embolization (PVE), associating liver partition and portal vein ligation (ALPPS), and the recently reported transhepatic liver venous deprivation (LVD). PVE is a well-established means to improve the safety of liver resection by redirecting blood flow to the FLR in an effort to selectively hypertrophy and ultimately improve functional reserve of the FLR. This article discusses the current practice of PVE with focus on summarizing the large number of published reports from which outcomes based practices have been developed. Both technical aspects of PVE including volumetry, approaches, and embolization agents; and clinical aspects of PVE including data supporting indications, and its role in conjunction with chemotherapy and transarterial embolization will be highlighted. PVE remains an important aspect of oncologic care; in large part due to the substantial foundation of information available demonstrating its clear clinical benefit for hepatic resection candidates with small anticipated FLRs. PMID:28154774

  2. Lobar Hepatocellular Carcinoma with Ipsilateral Portal Vein Tumor Thrombosis Treated with Yttrium-90 Glass Microsphere Radioembolization: Preliminary Results

    Directory of Open Access Journals (Sweden)

    M. Pracht

    2013-01-01

    Full Text Available Portal vein tumor thrombosis (PVTT is a common complication of hepatocellular carcinoma (HCC and has a negative impact on prognosis. This characteristic feature led to the rationale of the present trial designed to assess the efficacy and the safety of yttrium-90 glass-microsphere treatment for advanced-stage lobar HCC with ipsilateral PVTT. 18 patients with unresectable lobar HCC and ipsilateral PVTT were treated in our institution with 90Y-microS radioembolization. Patients were evaluated every 3 to 6 months for response, survival, and toxicity. Mean follow-up was 13.0 months (2.2–50.6. Outcomes were: complete response (n=2, partial response (n=13, stable disease (n=1, and progressive disease (n=2 giving a disease control rate of 88.9%. Four patients were downstaged. Treating lobar hepatocellular carcinoma with ipsilateral portal vein thrombosis with yttrium-90 glass-microsphere radioembolization is safe and efficacious. Further clinical trials are warranted to confirm these results and to compare 90Y-microS with sorafenib, taking into account not only survival but also the possibility of secondary surgery for putative curative intention after downstaging.

  3. [Enzyme levels and morphological picture of normal and cirrhotic rat livers following portal vein ligation and subcutaneous transposition of the spleen].

    Science.gov (United States)

    Zelder, O; Dorn, R; Bürcklein, H H; Bode, Ch; Bode, J C; Jerusalem, C R

    1975-01-01

    The effect of portal vein ligation after subcutaneous transposition of the spleen is investigated on enzyme-activities. and morphological pattern of the normal and cirrhotic rat-liver. The increase of glycolytic enzyme-activities and the decrease of enzyme-activities of oxidative metabolic pathways can be explained by adaptation on throttled blood supply of the liver. Significant decrease of arginase-activity (urea-cycle) can not be explained by reduced protein content of food (pair-fed-animals). Diminished substrate (ammonia)-level (NH3/t/hepatocytes) may be an explanation. Histological pattern of normal and cirrhotic rat liver is nearly unchanged after portal vein ligation.

  4. Different survival of Barcelona clinic liver cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread.

    Science.gov (United States)

    Sinn, Dong Hyun; Cho, Ju-Yeon; Gwak, Geum-Youn; Paik, Yong-Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon; Yoo, Byung Chul

    2015-01-01

    Portal vein invasion (PVI) and extrahepatic spread (ES) are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC) staging system (BCLC stage C), and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%), hepatitis B virus (458, 78.7%)], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES), C2 (PVI-II/III without distant ES), C3 (PVI-0/I with distant ES), and C4 (PVI-II/III with distant ES), respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

  5. Different survival of Barcelona clinic liver cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread.

    Directory of Open Access Journals (Sweden)

    Dong Hyun Sinn

    Full Text Available Portal vein invasion (PVI and extrahepatic spread (ES are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC staging system (BCLC stage C, and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%, hepatitis B virus (458, 78.7%], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES, C2 (PVI-II/III without distant ES, C3 (PVI-0/I with distant ES, and C4 (PVI-II/III with distant ES, respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

  6. Non-Hodgkin lymphoma as a cause of obstructive jaundice with simultaneous extrahepatic portal vein obstruction: A case report

    Institute of Scientific and Technical Information of China (English)

    Masao Hashimoto; Nobutaka Umekita; Kazumasa Noda

    2008-01-01

    Non-Hodgkin lymphoma is a rare cause of biliary obstruction. To the best of our knowledge, non-Hodgkin lymphoma in the peripancreatic region causing obstructive jaundice with simultaneous portal vein (PV) invasion has not yet been reported. We present a 50-year-old patient with obstructive jaundice whose extrahepatic portal vein was obstructed by the invasion of a peripancreatic non-Hodgkin lymphoma. The patient denied any other symptoms such as recurrent fever, night sweat and loss of body weight. Computed tomography (CT) revealed a 10cm mass in the retroperitoneal space behind the head of the pancreas causing obstruction of the distal bile duct and the PV. A pylorus-preserving pancreaticoduodenectomy combined with a PV resection was performed. The PV was reconstructed using an autologous right internal jugular vein graft. The resected specimen showed endoluminal invasion of both the bile duct and the PV. Histological examination showed the mass consisting of diffuse sheets of large malignant lymphoid cells. These cells were positive for CD20 and CD79a, partially positive for CD10, and negative for CD3, CD4, CD5, CD8 and CD30. The pathologic diagnosis was diffuse large B-cell type non-Hodgkin lymphoma and the patient was transferred to the Department of Hematology and Oncology for chemotherapy. He received four cycles of combined chemotherapy including cyclophosphamide, doxorubicin, vincristine and prednisone plus rituximab, and three cycles of intrathecal chemoprophylaxis including methotorexate, cytosine arbinoside and prednisone. The patient is alive with no evidence of the disease for 7 mo after operation and will receive additional courses of chemotherapy.

  7. Establishing models of portal vein occlusion and evaluating value of multi-slice CT in hepatic VX2 tumor in rabbits

    Institute of Scientific and Technical Information of China (English)

    Yue-Yong Qi; Li-Guang Zou; Ping Liang; Dong Zhang

    2007-01-01

    AIM: To establish models of portal vein occlusion of hepatic VX2 tumor in rabbits and to evaluate the value of multi-slice CT.METHODS: Forty New Zealand rabbits were divided into 4 groups according to digital table: Immediate group (group A; transplantation of tumor immediately after the portal vein occlusion), 3-wk group (group B;transplantation of tumor at 3 wk after the portal vein occlusion), negative control group (group C) and positive control group (group D), 10 rabbits in each group.Hepatic VX2 tumor was transplanted with abdominal-embedding innoculation immediately after the portal vein occlusion and at 3 wk after the portal vein occlusion.Meanwhile, they were divided into negative control group (Left external branch of portal vein was occluded by sham-operation, and left exite was embedded and inoculated pseudoly) and positive control group (Transplanted tumor did not suffer from the portal vein occlusion). All rabbits were scanned with multi-slice CT.RESULTS: All 40 animals were employed in the final analysis without death. Tumor did not grow in both immediate group and 3-wk group. In 3-wk group, left endite was atrophied and growth of tumor was inhibited.The maximal diameter of tumor was significantly smaller than that in positive control group (2.55 ± 0.46 vs3.59 ± 0.37 cm, t = 5.57, P < 0.001). Incidences of metastasis in the liver and lung were lower in 3-wk group than those in positive control group (10% vs 40%, and 90% vs 100%, respectively). The expression intensities of the vascular endothelium growth factor (VEGF) in groups A, B, C and D were 0.10 ± 0.06, 0.66 ± 0.21, 0.28± 0.09 and 1.48 ± 0.32, respectively. VEGF expression level in the test group A was significantly lower than that in the negative control group C (t = 5.07; P < 0.001).In addition, VEGF expression in the test group B was significantly lower than that in the positive control group D (t = 6.38; P < 0.001). Scanning with multi-slice CT showed that displaying rate of

  8. Effectiveness and safety of proton beam therapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Uk; Park, Joong-Won; Kim, Tae Hyun; Kim, Yeon-Joo; Woo, Sang Myung; Koh, Young-Hwan; Lee, Woo Jin; Park, Sang-Jae; Kim, Dae Yong; Kim, Chang-Min [National Cancer Center, Center for Liver Cancer, Research Institute and Hospital, Goyang-si, Gyeonggi-do (Korea, Republic of)

    2014-09-15

    To evaluate the clinical effectiveness and safety of proton beam therapy (PBT) in advanced hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). Twenty-seven HCC patients with PVTT underwent PBT, including 22 patients with modified International Union Against Cancer (mUICC) stage IVA,five patients with stage IVB primary tumors, and 16 with main PVTT. A median dose of 55 GyE (range, 50-66 GyE) in 20-22 fractions was delivered to a target volume encompassing both the PVTT and primary tumor. Overall, treatment was well tolerated, with no toxicity of grade ≥ 3. Median overall survival (OS) times in all patients and in stage IVA patients were 13.2 months and 16 months, respectively. Assessments of PVTT response showed complete response in 0 of 27 (0 %) patients, partial response in 15 (55.6 %), stable disease in 10 (37 %), and progressive disease in 2 (7.4 %) patients, with an objective response rate of 55.6 %. PVTT responders showed significantly higher actuarial 1-year local progression-free survival (LPFS; 85.6 % vs. 51.3 %), relapse-free survival (RFS; 20 % vs. 0 %) and OS (80 % vs. 25 %) rates than nonresponders (p < 0.05 each). Multivariate analysis showed that PVTT response and mUICC stage were independent prognostic factors for OS. Our data suggest that PBT could improve LPFS, RFS, and OS in advanced HCC patients with PVTT and it is feasible and safe for these patients. (orig.) [German] In der vorliegenden Arbeit wurde versucht, die klinische Wirksamkeit und Sicherheit der Protonenstrahltherapie (PBT) fuer Patienten mit fortgeschrittenem Leberzellkarzinom (HCC) in Verbindung mit Portadertumorthrombosen (PVTT) zu bewerten. Ausgefuehrt wurde die PBT fuer 27 HCC-Patienten mit PVTT, einschliesslich 22 Patienten im mUICC-Stadium (''International Union Against Cancer'') IVA sowie 5 Patienten mit Primaertumor im Stadium IVB und 16 Patienten mit PVTT im primaeren Stadium nach der geaenderten UICC-Klassifikation. Eine

  9. Clinical characteristics of portal vein thrombosis in patients with liver cirrhosis%肝硬化后门静脉血栓形成的临床特点研究

    Institute of Scientific and Technical Information of China (English)

    吴勤; 楚金东; 金波; 刘博; 吴立兵; 熊小青; 马雪梅; 孟繁平; 陈劲频

    2013-01-01

    patients in the control group,with significant difference between the two groups (P<0.05).Conclusion PVT affects the clinical outcome of LC patients.%目的 研究肝硬化(liver cirrhosis,LC)后门静脉血栓(portal vein thrombosis,PVT)形成的临床特点.方法 对9678例LC患者进行回顾性分析,采用腹部B超/腹部增强CT及腹部增强MRI检查门脉主干或左右分支,筛选出LC伴PVT形成者(PVT组),同时将LC后无PVT患者纳为对照组,比较2组的Child-Pugh分级、门静脉及脾静脉宽度、脾脏面积及厚度、腹水、上消化道出血、肝性脑病和肝肾综合征等并发症.结果 LC患者中有396例(4.09%)PVT形成.PVT组中LC的病因主要有乙型肝炎、酒精性及丙型肝炎LC,PVT主要分布在门静脉主干、门静脉右支、肠系膜上静脉、门静脉左支和脾静脉.按Child-Pugh进行分级,PVT组与对照组比较,肝损伤较重(P<0.01).PVT组合并腹水、上消化道出血、肝性脑病及肝肾综合征等并发症的发病率均较对照组高(P<0.01).PVT组门静脉和脾静脉宽度分别为(1.50±0.23) cm和(1.25±0.34) cm,对照组为(1.38±0.23) cm和(1.06±0.29) cm.PVT组脾脏面积为(97.48±32.90) cm2,脾脏厚度为(6.09±1.21) cm;对照组分别为(81.19±29.10) cm2和(5.26±0.99) cm.PVT组门静脉及脾静脉宽度和脾脏厚度均大于对照组,差异有统计学意义(P<0.05).PVT组有侧支循环开放的患者占96.21%,对照组为78.25%,2组比较差异有统计学意义(P<0.05).结论 LC后PVT形成对LC患者的临床转归有重要影响.

  10. The effect of some α-adrenoceptor antagonists on spontaneous myogenic activity in the rat portal vein and the putative involvement of ATP-sensitive K+channels

    NARCIS (Netherlands)

    Schwietert, R.; Wilhelm, D.; Wilffert, B.; Van Zwieten, P.A.

    1992-01-01

    In the present study we showed that the α-adrenoceptor antagonists phentolamine, yohimbine, prazosin, corynanthine and idazoxan, when cumulatively applied in high concentrations (1-100 μmol/l), can increase spontaneous myogenic activity in the rat portal vein. 5-Methyl-urapidil and rauwolscine were

  11. THE EFFECT OF SOME ALPHA-ADRENOCEPTOR ANTAGONISTS ON SPONTANEOUS MYOGENIC ACTIVITY IN THE RAT PORTAL-VEIN AND THE PUTATIVE INVOLVEMENT OF ATP-SENSITIVE K+ CHANNELS

    NARCIS (Netherlands)

    SCHWIETERT, R; WILHELM, D; WILFFERT, B; VANZWIETEN, PA

    1992-01-01

    In the present study we showed that the alpha-adrenoceptor antagonists phentolamine, yohimbine, prazosin, corynanthine and idazoxan, when cumulatively applied in high concentrations (1-100-mu-mol/l), can increase spontaneous myogenic activity in the rat portal vein. 5-Methyl-urapidil and rauwolscine

  12. F-18-fluorodeoxyglucose positron emission tomography leading to a diagnosis of septic thrombophlebitis of the portal vein: description of a case history and review of the literature.

    NARCIS (Netherlands)

    Bleeker-Rovers, C.P.; Jager, G.J.; Tack, C.J.J.; Meer, J.W.M. van der; Oyen, W.J.G.

    2004-01-01

    Pylephlebitis or septic thrombophlebitis of the portal vein is a serious infectious disorder. Early diagnosis is difficult, due to nonspecific symptoms and signs, limitations of diagnostic modalities and the lack of familiarity of physicians with this entity. We report the history of a 73-year-old

  13. Differences between full and partial α-adrenoceptor agonists in eliciting phasic and tonic types of responses in the longitudinal smooth muscle of the rat portal vein

    NARCIS (Netherlands)

    Schwietert, H.R.; Wilhelm, D.; Wilffert, B.; Van Zwieten, P.A.

    1991-01-01

    The aim of the present investigation was to study, taking into account both quantitative and qualitative differences, the influence of full and partial α-adrenoceptor agonists on spontaneous myogenic activity in the rat portal vein. We found that the α-adrenoceptor agonists cirazoline, adrenaline, n

  14. Sustained prejunctional facilitation of noradrenergic neurotransmission by adrenaline as a co-transmitter in the portal vein of freely moving rats

    NARCIS (Netherlands)

    COPPES, RP; Freie, I.; SMIT, J; ZAAGSMA, J

    1994-01-01

    1 The duration of the facilitatory effect of adrenaline on the electrically evoked overflow of noradrenaline was studied in the portal vein of permanently adreno-demedullated freely moving rats. 2 Rats were infused with adrenaline (20 or 100 ng min(-1)) for 2 h. After an interval of 1 h, when plasma

  15. A newborn liver mass that never existed: a somber reminder of embryonic ties between umbilical vein and portal venous system

    Directory of Open Access Journals (Sweden)

    Haafiz A

    2011-12-01

    Full Text Available Allah Haafiz1, Jonathan L Williams2, Joel M Andres1, Don A Novak11Pediatric Gastroenterology, Hepatology; 2Department of Pediatric Radiology, University of Florida College of Medicine, Gainesville, FL, USAAbstract: A 6-day-old, known to have transposition of the great vessels, received care in the neonatal intensive care unit at a tertiary care center. A computed tomography scan was performed for abdominal distention and upper gastrointestinal bleeding, which revealed a “mass lesion” in the left liver lobe. Analysis of antecedent events and the clinical and laboratory course uncovered an iatrogenic etiology and pathogenesis of the lesion. As the nature of the lesion was clarified, no specific therapy was required. This case is presented to show a serious yet preventable complication of a commonly performed procedure.Keywords: portal vein thrombosis, liver mass, umbilical venous catheter

  16. Associating liver partition with portal vein ligation and staged hepatectomy (ALPPS) for the treatment of liver tumors in children.

    Science.gov (United States)

    Wiederkehr, Julio Cesar; Avilla, Sylvio Gilberto; Mattos, Elisângela; Coelho, Izabel Meister; Ledesma, Jorge Alberto; Conceição, Alexandra Fernandes; Wiederkehr, Henrique Aguiar; Wiederkehr, Barbara Aguiar

    2015-07-01

    Resection is the only curative treatment option for primary and secondary malignant tumors of the liver. Although curative resection is associated with long-term survival rates, it can only be performed in 10% of patients with primary tumors and 25% of patients with liver metastases. Liver insufficiency is one of the most serious postoperative complications of patients undergoing extensive liver resections. When total liver resection is necessary liver transplant is mandatory, with the burden of long-term immunosuppression and its complications. Among several different strategies to increase the resectability of liver tumors, portal vein occlusion (embolization or ligature), bilateral tumor resection in two stages, and resection combined with loco regional therapy are the most popular. A new strategy for patients with marginally resectable liver tumors previously considered to be unresectable was formally reported by Baumgart et al. in 2011, originally developed by Hans Schlitt in 2007. This technique consists of a two-staged hepatectomy with initial portal vein ligation and in situ splitting of the liver parenchyma, and it is known as ALPPS (associating liver partition with portal vein ligation for staged hepatectomy). The aim of this study is to present the first series of pediatric patients with marginally resectable liver tumors previously considered to be unresectable treated with two-stage hepatectomy with initial portal vein ligation and in situ splitting of the liver parenchyma. Two patients were diagnosed with hepatoblastoma, and one each with rhabdomyosarcoma, hepatocellular carcinoma, and nodular focal hyperplasia. ALPPS technique was considered whenever the future liver remnant (FLR) was 40% or less of the total liver volume (TLV) determined by CT or MRI scans. The ratio of FLR to TLV before the first procedure ranged from 0.15 to 0.38, with a mean±sd of 0.253±0.07. In all patients, a rapid growth of the FLR was observed. Estimates of the FRL volume

  17. Pure 3D laparoscopic living donor right hemihepatectomy in a donor with separate right posterior and right anterior hepatic ducts and portal veins.

    Science.gov (United States)

    Hong, Suk Kyun; Suh, Kyung-Suk; Kim, Hyo-Sin; Yoon, Kyung Chul; Ahn, Sung-Woo; Oh, Dongkyu; Kim, Hyeyoung; Yi, Nam-Joon; Lee, Kwang-Woong

    2017-04-14

    Despite increases in the performance of pure laparoscopic living donor hepatectomy, variations in the bile duct or portal vein have been regarded as relative contraindications to this technique [1-3]. This report describes a donor with separate right posterior and right anterior hepatic ducts and portal veins who underwent pure laparoscopic living donor right hemihepatectomy, integrated with 3D laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography [1, 4, 5]. A 50-year-old man offered to donate part of his liver to his older brother, who required a transplant for hepatitis B-associated liver cirrhosis and hepatocellular carcinoma. Donor height was 178.0 cm, body weight was 82.7 kg, and body mass index was 26.1 kg/m(2). Preoperative computed tomography and magnetic resonance cholangiopancreatography showed that the donor had separate right posterior and right anterior hepatic ducts and portal veins. The entire procedure was performed under 3D laparoscopic view. Following intravenous injections of 0.05 mg/kg ICG, ICG near-infrared fluorescence camera was used to demarcate the exact transection line and determine the optimal bile duct division point. The total operation time was 443 min; the donor required no transfusions and experienced no intraoperative complications. The graft weighed 1146 g with a graft-to-recipient weight ratio of 1.88%. The optimal bile duct division point was identified using ICG fluorescence cholangiography, and the bile duct was divided with good patency without any stricture. The right anterior and posterior portal veins were transected with endostaplers without any torsion. The patient was discharged on postoperative day 8, with no complications. Using a 3D view and ICG fluorescence cholangiography, pure 3D laparoscopic living donor right hemihepatectomy is feasible in a donor with separate right posterior and right anterior hepatic ducts and portal veins.

  18. Portal vein thrombosis: Prevalence, patient characteristics and lifetime risk: A population study based on 23796 consecutive autopsies

    Institute of Scientific and Technical Information of China (English)

    Mats (O)gren; David Bergqvist; Martin Bj(o)rck; Stefan Acosta; Henry Eriksson; Nils H Sternby

    2006-01-01

    AIM: To assess the lifetime cumulative incidence of porGl venous thrombosis (PVT) in the general population.METHODS: Between 1970 and 1982, 23 796 autopsies,representing 84% of all in-hospital deaths in the Malmo city population, were performed, using a standardised protocol including examination of the portal vein. PVT patients were characterised and the PVT prevalence at autopsy, an expression of life-time cumulative incidence,assessed in high-risk disease categories and expressed in terms of odds ratios and 95% CI.RESULTS: The population prevalence of PVT was 1.0%.Of the 254 patients with PVT 28% had cirrhosis, 23%primary and 44% secondary hepatobiliary malignancy,10% major abdominal infectious or inflammatory disease and 3% had a myeloproliferative disorder. Patients with both cirrhosis and hepatic carcinoma had the highest PVT risk, OR 17.1 (95% CI 11.1-26.4). In 14% no cause was found; only a minority of them had developed portal-hypertension-related complications.CONCLUSION: In this population-based study, PVT was found to be more common than indicated by previous clinical series. The markedly excess risk in cirrhosis and hepatic carcinoma should warrant an increased awareness in these patients for whom prospective studies of directed intervention might be considered.

  19. Bile acid flux through portal but not peripheral veins inhibits CYP7A1 expression without involvement of ileal FGF19 in rabbits.

    Science.gov (United States)

    Shang, Quan; Guo, Grace L; Honda, Akira; Shi, Daniel; Saumoy, Monica; Salen, Gerald; Xu, Guorong

    2014-08-15

    It was proposed that CYP7A1 expression is suppressed through the gut-hepatic signaling pathway fibroblast growth factor (FGF) 15/19-fibroblast growth factor receptor 4, which is initiated by activation of farnesoid X receptor in the intestine rather than in the liver. The present study tested whether portal bile acid flux alone without ileal FGF19 could downregulate CYP7A1 expression in rabbits. A rabbit model was developed by infusing glycodeoxycholic acid (GDCA) through the splenic vein to bypass ileal FGF19. Study was conducted in four groups of rabbits: control; bile fistula + bovine serum albumin solution perfusion (BF); BF + GDCA (by portal perfusion); and BF + GDCA-f (by femoral perfusion). Compared with only BF, BF + GDCA (6 h portal perfusion) suppressed CYP7A1 mRNA, whereas BF + GDCA-f (via femoral vein) with the same perfusion rate of GDCA did not show inhibitory effects. Meanwhile, there was a decrease in ileal FGF19 expression and portal FGF19 protein levels, but an equivalent increase in biliary bile acid outputs in both GDCA perfusion groups. This study demonstrated that portal bile acid flux alone downregulated CYP7A1 expression with diminished FGF19 expression and protein levels, whereas the same bile acid flux reaching the liver through the hepatic artery via femoral vein had no inhibitory effect on CYP7A1. We propose that bile acid flux through the portal venous system may be a kind of "intestinal factor" that suppresses CYP7A1 expression.

  20. Comparison of the Treatment Efficiency of Bone Marrow-Derived Mesenchymal Stem Cell Transplantation via Tail and Portal Veins in CCl4-Induced Mouse Liver Fibrosis.

    Science.gov (United States)

    Truong, Nhung Hai; Nguyen, Nam Hai; Le, Trinh Van; Vu, Ngoc Bich; Huynh, Nghia; Nguyen, Thanh Van; Le, Huy Minh; Phan, Ngoc Kim; Pham, Phuc Van

    2016-01-01

    Because of self-renewal, strong proliferation in vitro, abundant sources for isolation, and a high differentiation capacity, mesenchymal stem cells are suggested to be potentially therapeutic for liver fibrosis/cirrhosis. In this study, we evaluated the treatment effects of mouse bone marrow-derived mesenchymal stem cells (BM-MSCs) on mouse liver cirrhosis induced by carbon tetrachloride. Portal and tail vein transplantations were examined to evaluate the effects of different injection routes on the liver cirrhosis model at 21 days after transplantation. BM-MSCs transplantation reduced aspartate aminotransferase/alanine aminotransferase levels at 21 days after injection. Furthermore, BM-MSCs induced positive changes in serum bilirubin and albumin and downregulated expression of integrins (600- to 7000-fold), transforming growth factor, and procollagen-α1 compared with the control group. Interestingly, both injection routes ameliorated inflammation and liver cirrhosis scores. All mice in treatment groups had reduced inflammation scores and no cirrhosis. In conclusion, transplantation of BM-MSCs via tail or portal veins ameliorates liver cirrhosis in mice. Notably, there were no differences in treatment effects between tail and portal vein administrations. In consideration of safety, we suggest transfusion of bone marrow-derived mesenchymal stem cells via a peripheral vein as a potential method for liver fibrosis treatment.

  1. Highly metabolic thrombus of the portal vein: 18F fluorodeoxyglucose positron emission tomography/computer tomography demonstration and clinical significance in hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM: To assess the ability of 18F-fluorodeoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) to differentiate between benign and malignant portal vein thrombosis in hepatocellular carcinoma (HCC) patients. METHODS: Five consecutive patients who had HBV cirrhosis, biopsy-proven HCC, and thrombosis of the main portal vein and/or left/right portal vein on ultrasound (US), computer tomography (CT) or magnetic resonance imaging (MRI) were studied with 18F-FDG PET/CT. The presence or absence of a highly metabolic thrombus on 18F-FDG PET/CT was considered diagnostic for malignant or benign portal vein thrombosis, respectively. All patients were followed-up monthly with US, CT or MRI. Shrinkage of the thrombus or recanalization of the vessels on US, CT or MRI during follow-up was considered to be definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered to be consistent with malignancy 18F-FDG PET/CT, and US, CT or MRI results were compared. RESULTS: Follow-up (1 to 10 mo) showed signs of malignant thrombosis in 4 of the 5 patients. US, CT or MRI produced a true-positive result for malignancy in 4of the patients, and a false-positive result in 1.18F-FDG PET/CT showed a highly metabolic thrombus in 4 of the 5 patients.18F-FDG PET/CT achieved a true-positive result in all 4 of these patients, and a true-negative result in the other patient. No false-positive result was observed using 18F-FDG PET/CT.CONCLUSION: 18F-FDG PET/CT may be helpful in discriminating between benign and malignant portal vein thrombi. Patients may benefit from 18F-FDG PET/OT when portal vein thrombi can not be diagnosed exactly by US, CT or MRI.

  2. Insulin secretion-independent effects of GLP-1 on canine liver glucose metabolism do not involve portal vein GLP-1 receptors

    OpenAIRE

    Dardevet, Dominique; Courtney Moore, Mary; DiCostanzo, Catherine; Farmer, Ben; Neal, Doss; Snead, Wanda; Lautz, Margaret; Cherrington, Alan

    2005-01-01

    Whether glucagon-like peptide (GLP)-1 requires the hepatic portal vein to elicit its insulin secretion-independent effects on glucose disposal in vivo was assessed in conscious dogs using tracer and arteriovenous difference techniques. In study 1, six conscious overnight-fasted dogs underwent oral glucose tolerance testing (OGTT) to determine target GLP-1 concentrations during clamp studies. Peak arterial and portal values during OGTT ranged from 23 to 65 pM and from 46 to 113 pM, respectivel...

  3. MRI B-TFE Vein Imaging in the Application of Portal Vein Imaging%MRI B-TFE静脉成像在门静脉造影中的应用

    Institute of Scientific and Technical Information of China (English)

    郑力强; 柏沙美; 江新青; 徐向东

    2012-01-01

    目的 探讨MRI B-TFE静脉成像在门静脉造影中的应用价值.方法 选择17例临床疑似门静脉高压病人,行B-TFE和DCE MRP.B-TFE组 敏感性编码因子取值为1、2.B-TFE和DCEMRP组在冠状位MIP图测量门静脉主干径线及SNR、门静脉与周围组织的CNR. 两位不知病情的影像医师对门静脉三维图像质量、门脉主干径线、MPV、RPV、LPV、SPV、SMV的显影质量评分.测量数据和图像评分进行统计学处理.结果 B-TFE组缩减因子为1,SNR为118.0±25.1;CNR为103.7±33.5.B-TFE组缩减因子为2,SNR为93.5±23.1; CNR为83.1±34.5. DCEMRP组门静脉的SNR为103.8±31.5,CNR为92.7±30.1.组内和组间门静脉三维图像质量主干径线及分支差异均无统计学意义.结论 B-TFE可以结合临床诊断门静脉高压,避免不必要的对比剂增强检查,使用非对比剂的方法多角度直观的显示门静脉系统,是值得推荐的好方法.%Objective To explore the MRI B-TFE vein imaging in the application of portal vein imaging value. Methods Select of 17 cases clinical suspected patients with portal hypertension, line B-TFE and DCE MRP. B-TFE group sensitivity encoding factor value for 1,2. B-TFE and DCE MRP group in the coronary a MIP figure measuring diameter line and the portal vein and SNR, portal vein and the surrounding tissue CNR, the two never know the condition of portal vein image doctor 3 d image quality, Portal backbone diameter line, MPV, RPV, LPV, SPV, SMV enhancement quality score. The measurement data and image processing the statistical rating. Results B-TFE group reduced factors for 1, SNR is 118.0 ± 25.1; For 103.7 ± 33.5 CNR. B-TFE group reduced factors for 2, SNR is 93.5 ± 23.1; For 83.1 ± 34.5 CNR. DCE MRP group of portal vein for 103.8 ± 31.5 CNR SNR is 92.7 ± 30.1. In the group and group 3 d image quality between Portal backbone diameter line and branch were no statistically significant differences. Conclusion B-TFE can combine clinical diagnosis of

  4. 肝硬化门静脉高压症不同手术方式与血栓形成%Different operative patterns for cirrhotic portal hypertensive patients and development of portal vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    吴婷婷; 吴志勇; 罗蒙

    2014-01-01

    relationship between different operation patterns for patients with portal hypertension caused by hepatic cirrhosis and examine the incidence,position and risk fac-tors of portal vein thrombosis (PVT).Methods From January 201 1 to December 2012,72 patients with portal hypertension in liver cirrhosis were analyzed.There were devascularization (n =25 ),se-lective devascularization (n = 1 5 )and splenorenal shunt associated with devascularization (n = 32). Platelet,prothrombin time,hemodynamics of portal vein and the incidence of PVT were analyzed be-fore and after operation.Results Pre-operative blood velocity of portal vein decreased remarkably in patients with PVT while both groups showed no difference in factors of coagulation function.No re-markable inter-group difference existed in platelet levels,but D-dimer levels were higher than nor-mal though the inter-group difference was insignificant.At 2 weeks and 2 months post-devascular-ization,splenic vein thrombosis extended to trunk and branch(es)of portal vein in 12(48%)patients. After selective devascularization,some of them had thrombosis extended to trunk of portal vein or branch(es)and blocked gastric coronary vein and paraesophageal vein.While another few patients on-ly showed superior mesenteric vein,gastric coronary vein and paraesophageal vein,with splenic vein and portal vein completely blocked.After splenorenal shunt associated with devascularization,the rate of PVT was 75% at 2 months post-operation and decreased to 41 % at 6 months.And it was the lowest among 3 groups.Most patients suffered partial thrombosis in portal trunk and(or)branches while only 1 case had the partially blocked shunt.Conclusion Occurring at different sites in trunk or branch(es)of portal vein after splenorenal shunt associated with devascularization,PVT may be cor-related with the changes of portal hemodynamics.

  5. Multimodality Treatment for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Large-Scale, Multicenter, Propensity Mathching Score Analysis.

    Science.gov (United States)

    Wang, Kang; Guo, Wei Xing; Chen, Min Shan; Mao, Yi Lei; Sun, Bei Cheng; Shi, Jie; Zhang, Yao Jun; Meng, Yan; Yang, Ye Fa; Cong, Wen Ming; Wu, Meng Chao; Lau, Wan Yee; Cheng, Shu Qun

    2016-03-01

    The optimal treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains controversial. We aimed to investigate the best treatment for patients with HCC with PVTT. From January 2002 to January 2014, the data from all consecutive patients with HCC with PVTT who underwent surgical treatment (ST),TACE,TACE combined with sorafenib (TACE-Sor), or TACE combined with radiotherapy (TACE-RT) in the 4 largest tertiary hospitals in China were analyzed retrospectively. The patients were divided into 3 subtypes according to the extent of PVTT in the portal vein (type I-III). The primary endpoint was overall survival (OS). A total of 1580 patients with HCC with PVTT were included in the study. The median survival times (MST) for ST (n = 745) for type I, II, and III patients (95% CI) were 15.9 (13.3-18.5), 12.5 (10.7-14.3), and 6.0 (4.3-7.7) months, respectively. The corresponding figures for patients after TACE (n = 604) were 9.3 (5.6-12.9), 4.9 (4.1-5.7), and 4.0 (3.1-4.9), respectively; for patients after TACE-Sor (n = 113) 12.0 (6.6-17.4), 8.9 (6.7-11.1), and 7.0 (3.0-10.9), respectively; and for patients after TACE-RT (n = 118) 12.2 (0-24.7), 10.6 (6.8-14.5), and 8.9 (5.2-12.6), respectively. Comparison among the different treatments for the 3 subtypes of PVTT patients after propensity score (PS) matching showed the effectiveness of ST to be the best for type I and type II PVTT patients, and TACE-RT was most beneficial for type III patients. Treatment was an independent risk factor of OS. ST was the best treatment for type I and II PVTT patients with Child-Pugh A and selected B liver function. TACE-RT should be given to type III PVTT patients.

  6. The effect of external divalent cations on spontaneous non-selective cation channel currents in rabbit portal vein myocytes.

    Science.gov (United States)

    Albert, A P; Large, W A

    2001-10-15

    1. The effects of external divalent cations on spontaneous single non-selective cation channel currents were studied in outside-out patches from rabbit portal vein smooth muscle cells in K+-free conditions. 2. In an external medium containing 1.5 mM Ca2+ (Ca2+o) the majority of spontaneous channel currents had a unitary conductance of 23 pS, reversal potential (Vr) of +10 mV and a low open probability (Po) at negative patch potentials. Some channels opened to a lower conductance state of about 13 pS suggesting that the cation channels have two conductance states. Open time and burst duration distributions could both be described by two exponentials with time constants of about of 1 ms and 7 ms for open times and 3 ms and 16 ms for burst durations. 3. In 0 Ca2+o the majority of spontaneous cation channels had a unitary conductance of 13 pS and Vr was shifted to +4 mV. Moreover the longer open time and longer burst duration time constants were both reduced to approximately half the values in 1.5 mM Ca2+o. 4. Compared to 0 Ca2+o the single channel currents in 3 microM and 100 microM Ca2+o had a 5- to 6-fold increase in Po which was accompanied by increases in both open times and burst durations. In 3 microM and 100 microM Ca2+o the unitary conductance of the single channel currents was between 22 and 26 pS. 5. At positive membrane potentials the single channel currents had an increased Po compared to negative potentials which was associated with increased open times and burst durations but these values were similar in 3 microM, 100 microM and 1.5 mM Ca2+o. 6. In 1.5 mM Sr2+o and 1.5 mM Ba2+o channels opened to the higher conductance state of about 22-25 pS and had a 3- to 7-fold greater Po than in 0 Ca2+o. 7. In conclusion, external divalent cations have marked effects on the unitary conductance and kinetic behaviour of non-selective cation channels in rabbit portal vein smooth muscle cells.

  7. Safety and efficacy of transhepatic and transsplenic access for endovascular management of portal vein complications after liver transplantation.

    Science.gov (United States)

    Ohm, Joon-Young; Ko, Gi-Young; Sung, Kyu-Bo; Gwon, Dong-Il; Ko, Heung Kyu

    2017-09-01

    The purpose of this article is to evaluate and compare the safety and efficacy of endovascular management of the portal vein (PV) via percutaneous transsplenic access versus percutaneous transhepatic access in liver transplantation (LT) recipients. A total of 18 patients who underwent endovascular management of PV via percutaneous transhepatic (n = 8) and transsplenic (n = 10) access were enrolled. Transsplenic access was chosen if the spleen was located in a normal position, the splenic vein (SpV) was preserved, and the target lesion did not involve confluence of the superior mesenteric and SpVs. Accessibility of the percutaneous transsplenic puncture was confirmed via ultrasound (US) in the angiography suite. All procedures were performed under local anesthesia. Percutaneous transhepatic or transsplenic access was performed using a 21-gauge Chiba needle under US and fluoroscopic guidance, followed by balloon angioplasty, stent placement, or variceal embolization. The access tract was embolized using coils and a mixture (1:2) of glue and ethiodized oil. Transhepatic or transsplenic access was successfully achieved in all patients. A total of 12 patients underwent stent placement; 3 had balloon angioplasty only; 2 had variceal embolization only; and 1 had variceal embolization followed by successful stent placement. Regarding major complications, 1 patient experienced a SpV tear with extravasation during transsplenic balloon angioplasty, which was successfully managed using temporary balloon inflation, followed by transfusion. Clinical success was achieved in 9 of 11 (82%) patients who exhibited clinical manifestations. The remaining 7 patients who underwent prophylactic endovascular management were healthy. In conclusion, endovascular management of PV via percutaneous transsplenic access is a relatively safe and effective alternative that does not damage the liver grafts of LT recipients. Liver Transplantation 23 1133-1142 2017 AASLD. © 2017 by the American

  8. Comparison of intra-arterial chemoembolization with and without radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Zhao Q

    2016-12-01

    Full Text Available Qianqian Zhao,1,2 Kunli Zhu,2 Jinbo Yue,2 Zhonghua Qi,1,2 Shumei Jiang,2 Xiaoqing Xu,2 Rui Feng,2 Renben Wang2 1School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, 2Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People’s Republic of China Purpose: Numerous studies have tried to combine transarterial chemoembolization (TACE or hepatic arterial infusion chemotherapy (HAIC with radiotherapy (RT for the treatment of hepatocellular carcinoma (HCC patients with portal vein tumor thrombus (PVTT. However, the efficacy of TACE or HAIC combined with RT versus TACE or HAIC alone remains controversial. Thus, we performed a meta-analysis to compare the efficacy and safety of intra-arterial chemoembolization combined with RT versus intra-arterial chemoembolization alone for the treatment of HCC patients with PVTT.Methods: PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies. Two authors independently reviewed the abstracts, extracted relevant data and rated the quality of studies. The major end points were objective response rate (ORR, overall survival (OS, and adverse events.Results: Eight studies with a total of 1,760 patients were included in this meta-analysis. The pooled results showed that intra-arterial chemoembolization combined with RT significantly improved ORR of PVTT (OR, 4.22; 95% CI, 3.07–5.80; P<0.001 and OS (HR, 0.69; 95% CI, 0.57–0.83; P=0.001, but did not affect ORR of primary liver tumor (OR, 1.37; 95% CI, 0.67–2.79; P=0.390. The incidence of grade 3 or 4 leukopenia (OR, 5.80; 95% CI, 2.478–13.56; P<0.001 and thrombocytopenia (OR, 3.77; 95% CI, 1.06–13.43; P=0.041 was higher in the intra-arterial chemoembolization plus RT group than in the intra-arterial chemoembolization group.Conclusion: Combination therapy of intra-arterial chemoembolization and RT for HCC patients with PVTT could

  9. Congenital short pancreas, polysplenia, and portal vein thrombosis: an association or a chance finding?; Pancreas curto congenito, poliesplenia e trombose da veia porta: associacao ou achado casual?

    Energy Technology Data Exchange (ETDEWEB)

    Baldisserotto, Matteo; Peletti, Adriana Barcellos; Araujo, Manoel Angelo de; Pertence, Ana Paula Cardoso; Dora, Marcelo Dourado [Hospital da Crianca Conceicao, Porto Alegre, RS (Brazil)]. E-mail: peletti@hotmail.com

    2006-10-15

    Polysplenia syndrome with short pancreas is a rare congenital anomaly usually associated with cardiovascular and abdominal malformations. We describe a patient with this syndrome associated with portal vein thrombosis and cavernous transformation, an association that has not been reported before. This patient also had intestinal mal rotation and interruption of the inferior vena cava with azygous continuation. Special attention is drawn to the role of imaging studies - bowel transit, computed tomography and color Doppler sonography - in the diagnosis of these anomalies. (author)

  10. Clinical Outcome of Autologous Hematopoietic Stem Cell Infusion via Hepatic Artery or Portal Vein in Patients with End-stage Liver Diseases

    Institute of Scientific and Technical Information of China (English)

    Xiao-lun Huang; Tian Zhang; Ping Xie; Mao-zhu Yang; Shao-ping Deng; Le Luo; Lan-yun Luo; Hua Xue; Ling-ling Wei; Yu-tong Yao; Hai-bo Zou; Xiao-bing Huang; Yi-fan Zhu

    2014-01-01

    Objective To investigate the efficacy of hematopoietic stem cell (HSC) transplantation via the hepatic artery vs. the portal vein for end-stage liver disease (ESLD). Methods Patients with hepatic decompensation were prospectively recruited from September 2010 to September 2012 to receive HSC transplantation via the hepatic artery or the portal vein. Liver function was examined at 3, 6, and 12 months after transplantation. Liver biopsy results were analyzed using the Knodell score. Results Eighty patients (58 males and 22 females) were enrolled in the study. The Child-Pugh score was grade B in 69 cases, and grade C in the remaining 11 cases. HSC transplantation was performed via the portal vein in 36 patients and via the hepatic artery in 44 patients. ALT levels decreased while serum albumin levels increased significantly in both groups at 6 and 12 months after HSC transplantation (P Conclusions Autologous HSC transplantation improves liver function and histology in ESLD patients. The administration route of HSC has no significant impact on the efficacy of transplantation.

  11. Role of a preoperative distal and proximal embolization of the right branch of the portal vein at surgical treatment of a liver malignant tumors

    Directory of Open Access Journals (Sweden)

    Popov M.V.

    2016-12-01

    Full Text Available Objective: assessment of safety and efficiency of application of the method of the distal and proximal embolization of the right branch of a portal vein using an occluder for preventive increase of the small future remaining liver amount in case of the planned resection. Material and methods. In the Burnazyan Federal Medical Biophysical Center that method was used in two cases: metastasises of bladder cancer in one case and of colorectal cancer in second case. Patients were males aged 57 and 64. Measuring the amount of future remaining liver volume was carried out with the CT-volumetry. Portal vein embolization of the right branch was carried out by transhepatic ipsilateral access using polyvinyl alcohol particles and occluder AVP II. Results. As a result in both cases the gain (9 and 24%, sufficient for performance of a resection, of the remaining liver volume was noted; the progression of the tumor process and periop-erative complications were not observed. Conclusion. Distal and proximal preoperative portal vein embolization is an effective and promising method, allowing surgeons to increase the number of operable patients and reduce the risk of postoperative liver failure.

  12. Is portal vein thrombosis still a contraindication for liver transplantation? A single-institute’s 5-year experience and literature review

    Directory of Open Access Journals (Sweden)

    Ghazwani S

    2016-11-01

    Full Text Available S Ghazwani, F Panaro, F Navarro Department of Transplant Unit, Saint Eloi University Hospital, University of Montpellier, Montpellier, France Background/purpose: Portal vein thrombosis (PVT is a common problem in candidates for liver transplantation (LT. PVT is a well-recognized complication of patients with end-stage liver disease and its incidence ranges from 2% to 26%. The total PVT still represents an absolute contraindication for an LT. Various techniques of PV revascularization have been proposed; however, the results are far from optimal. Objective: The aim of this article is to report our experience in LT with PVT and to analyze the latest literature in this field. Materials and methods: In the past 5 years, 317 LTs were performed in 317 patients. Twenty-one (6.6% of them had a PVT (19 partial and two total.Results: During transplantation, a total thrombectomy was performed in 13 cases and a partial thrombectomy in the remaining six patients. In case of total thrombectomy, a left renovascular revascularization was performed in one case and a left gastric vein revascularization in the other. No cases of PVT recurrence were reported in the early follow-up. Conclusion: PVT no longer represent an absolute contraindication for an LT. Keywords: reno-portal anastomosis, portal vein thrombosis, nonanatomical revascularization

  13. Noncirrotisk intrahepatisk portal hypertension

    DEFF Research Database (Denmark)

    Dam Fialla, Annette; Havelund, Troels

    2007-01-01

    Non-cirrhotic intrahepatic portal hypertension is characterized by portal hypertension in the absence of liver cirrhosis or portal vein thrombosis. The disease is common in the East and rarely seen in the West. Two cases with oesophageal varices are described. The histopathology is heterogeneous...... but includes vascular lesions and portal fibrosis. Patient management follows the current recommendations for variceal bleeding....

  14. Undifferentiated embryonal sarcoma of the liver in a young female: treatment with portal vein embolization and liver trisectonectomy.

    Science.gov (United States)

    Giakoustidis, Dimitrios E; Gargavanis, Athanasios A; Katsiki, Evangelia D; Salveridis, Nikolaos T; Antoniadis, Nikolaos A; Papanikolaou, Vasileios

    2016-08-01

    Undifferentiated Embryonal Sarcoma of the Liver (UESL) is a tumor highly malignant, of mesenchymal origin. It is a rare finding in adults, though less rare in children. The strategy to be followed and the therapeutic targets to be reached for this tumor, in adult cases, remain ambiguous and controversial. Herein we report the case of a 29 year old female patient with a massive UESL and we describe our therapeutic approach. A 29 year-old female patient was referred to our center with severe intermittent epigastric pain and fever due to a voluminous liver tumor: Needle biopsy was of no specific findings and surgical excision was decided. Right portal vein embolization and selective embolization of the segment's IV branch was performed in order to achieve adequate future liver remnant (FLR). Right trisectonectomy was then performed, with uneventful post operative period and the patient was discharged at the 11(th) post operative day. UESL is a rare tumor that needs aggressive surgical approach and multidisciplinary team management is of paramount importance.

  15. Acute Portal Vein Thrombosis and Massive Necrosis of the Liver. An Unusual Complication After Stenting for Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Velayutham Vimalraj

    2006-11-01

    Full Text Available Context ERCP can provide information which is invaluable in managing chronic pancreatitis but it is associated withinfrequent, although significant, complications and rare mortality. The complications uniquely associated withdiagnostic ERCP include pancreatitis and sepsis (primary cholangitis. Case report A 32-year-old man presented with severe upper abdominal pain radiating to the back, associated with vomiting and abdominal distension. The patient was diagnosed as having had chronic calcific pancreatitis recently and had undergone ERCP with pancreatic duct stenting elsewhere. Two days after the procedure, the patient developed severe abdominal pain, vomiting and abdominal distention, and patient was referred to our hospital 7 days after the procedure. Investigation revealed massive liver necrosis and portal vein thrombosis. This patient had a life-threatening complication following pancreatic duct stenting for chronic pancreatitis and was managed medically.Conclusion Therapeutic pancreatic endoscopy procedures are technically demanding and should be restricted to highvolume centers. There is a continuing need for evaluation and comparison with alternative strategies. In a good surgical candidate, it is better to avoid stenting.

  16. Effect of He-Ne laser irradiation on spontaneous contractive activity and basal tone level of rat portal vein

    Science.gov (United States)

    Petrishchev, Nikolai N.; Barabanova, Valeria V.; Mikhailova, Irina A.; Chephu, Svetlana G.

    2000-11-01

    To study the effect of He-Ne irradiation (632.8 nm, 15 mW/cm2) on spontaneous contractive activity the fragments of rat portal vein weremounted isometrically in Krebs buffer. Irradiation of vessel fragments by He-Ne laser during 3,5 and 10 min caused the decrease of ton up to 50%, which lasted in postirradiation period (the observation time - 10 min). The frequency of phasic and tonic contractions did not change, but the amplitude increased up to 40% as compared to the initial level. The decreased basal tone level and the increased amplitude of phasic oscillations lasted in postirradiation period. Adding NO synthasa blocator (N - nitro-L-arginine) to Krebs solution before irradiation caused no significant changes mentioned above parameters. Irradiation and coputing of the same parameters of spontaneous contractive activity of vena porta caused no effects, mentioned in the absence of the blocator. From the results it is concluded that the decrease of tone is evoked by the increase of EDRF production and cGMP. The increase of amplitude of phasic and tonic contractions is connected with increase of Ca++ entry in every contraction cycle as a result of membrane Ca++ pool increase.

  17. Effectiveness of stereotactic body radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombosis.

    Directory of Open Access Journals (Sweden)

    Mian Xi

    Full Text Available BACKGROUND: To report the feasibility, efficacy, and toxicity of stereotactic body radiotherapy (SBRT for the treatment of portal vein tumor thrombosis (PVTT and/or inferior vena cava tumor thrombosis (IVCTT in patients with advanced hepatocellular carcinoma (HCC. MATERIALS AND METHODS: Forty-one patients treated with SBRT using volumetric modulated arc therapy (VMAT for HCC with PVTT/IVCTT between July 2010 and May 2012 were analyzed. Of these, 33 had PVTT and 8 had IVCTT. SBRT was designed to target the tumor thrombosis and deliver a median total dose of 36 Gy (range, 30-48 Gy in six fractions during two weeks. RESULTS: The median follow-up was 10.0 months. At the time of analysis, 15 (36.6% achieved complete response, 16 (39.0% achieved partial response, 7 (17.1% patients were stable, and three (7.3% patients showed progressive disease. No treatment-related Grade 4/5 toxicity was seen within three months after SBRT. One patient had Grade 3 elevation of bilirubin. The one-year overall survival rate was 50.3%, with a median survival of 13.0 months. The only independent predictive factor associated with better survival was response to radiotherapy. CONCLUSIONS: VMAT-based SBRT is a safe and effective treatment option for PVTT/IVCTT in HCC. Prospective randomized controlled trials are warranted to validate the role of SBRT in these patients.

  18. In Vitro-In Vivo Extrapolation of Intestinal Availability for Carboxylesterase Substrates Using Portal Vein-Cannulated Monkey.

    Science.gov (United States)

    Trapa, Patrick E; Beaumont, Kevin; Atkinson, Karen; Eng, Heather; King-Ahmad, Amanda; Scott, Dennis O; Maurer, Tristan S; Di, Li

    2017-03-01

    Prediction of intestinal availability (FaFg) of carboxylesterase (CES) substrates is of critical importance in designing oral prodrugs with optimal properties, projecting human pharmacokinetics and dose, and estimating drug-drug interaction potentials. A set of ester prodrugs were evaluated using in vitro permeability (parallel artificial membrane permeability assay and Madin-Darby canine kidney cell line-low efflux) and intestinal stability (intestine S9) assays, as well as in vivo portal vein-cannulated cynomolgus monkey. In vitro-in vivo extrapolation (IVIVE) of FaFg was developed with a number of modeling approaches, including a full physiologically based pharmacokinetic (PBPK) model as well as a simplified competitive-rate analytical solution. Both methods converged as in the PBPK simulations enterocyte blood flow behaved as a sink, a key assumption in the competitive-rate analysis. For this specific compound set, the straightforward analytical solution therefore can be used to generate in vivo predictions. Strong IVIVE of FaFg was observed for cynomolgus monkey with R(2) of 0.71-0.93. The results suggested in vitro assays can be used to predict in vivo FaFg for CES substrates with high confidence. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  19. Arterial ischemia in the deportalized liver following associating liver partition and portal vein ligation for staged hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Srinivas; Sanjeevi; Ernesto; Sparrelid; Stefan; Gilg; Eduard; Jonas; Bengt; Isaksson

    2015-01-01

    Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is a novel 2-stage technique intended to induce rapid growth of the future liver remnant(FLR). Initial reports of a 12% mortality rate have sparked debate regarding the safety of the procedure. A 64 years old male was planned for a rightsided hemi-hepatectomy due to colorectal cancer liver metastases. Intra-operatively it was decided to convert to an ALPPS due to unexpectedly small segments 2-4. Post-operative serum laboratory tests indicated an acute liver failure and radiological imaging showed no sign of arterial blood flow to the right hemi-liver. A computed tomography examination on post-operative day 3 revealed that the FLR had increased from 290 to 690 m L in 3 d(138% growth). In the following days serum values gradually improved and stage 2 was carried out on post-operative day 7. The rest of the hospital stay was uneventful and the patient made a full recovery. ALPPS is a fascinating advancement in liver surgery. Despite severe post-operative complications, in properly selected cases it provides successful outcomes that other modalities of treatment cannot offer.

  20. Comparison of the effectiveness of preoperative portal vein embolization in patients with chronic liver disease: Gelfoam versus gelfoam coil

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Sung Wook; Chang, Il Soo; Do, Young Soo; Park, Hong Suk; Park, Kwang Bo; Cho, Sung Ki; Choo, In Wook [Dept. of Radiology, and Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Choo, Sung Wook [Dept. of Radiology, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2015-05-15

    To compare the effectiveness of portal vein embolization (PVE) performed using gelfoam or a gelfoam-coil combination before major hepatic resection in patients with chronic liver disease. PVE using gelfoam or a gelfoam-coil combination was performed in 37 patients. From April 2003 to September 2007, PVE was performed using gelfoam (n = 17) and a gelfoam-coil combination (n = 20) to induce hypertrophy. Computed tomography volumetry was performed 2-4 weeks after PVE to assess the changes in liver volume. The mean percentage increase in future liver remnant volume was 23.7 +/- 23.7% in the gelfoam group and 36.7 +/- 18.5% in the gelfoam-coil group (p = 0.02). Recanalization was found in 15 gelfoam group patients and 8 gelfoam-coil group patients (p = 0.003). The mean tumor size increased from 4.5 +/- 2.9 cm before PVE to 5.0 +/- 3.5 cm after PVE in the gelfoam group and from 4.3 +/- 2.2 cm before PVE to 4.7 +/- 2.5 cm after PVE in the gelfoam-coil group (p = 0.80). The gelfoam-coil combination was more effective than gelfoam alone for induction of compensatory hypertrophy by PVE in patients with chronic liver disease.

  1. Portal vein stenting as a signiifcant risk factor for biliary stricture in adult living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Min-Ho Shin; Gil-Chun Park; Young-In Yun; Wan-Jun Kim; Woo-Hyoung Kang; Seok-Hwan Kim; Gi-Young Ko; Deok-Bog Moon; Sung-Gyu Lee; Shin Hwang; Ki-Hun Kim; Chul-Soo Ahn; Tae-Yong Ha; Gi-Won Song; Dong-Hwan Jung

    2016-01-01

    BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its in-cidence. METHODS: We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131). RESULTS: The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS. CONCLUSIONS: Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.

  2. Analysis of the reasons of portal vein thrombosis after splenectomy for portal hypertension due to hepatic cirrhosis%肝硬化脾切除术后门静脉血栓形成的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    柯宇

    2012-01-01

    目的 探讨肝硬化脾脏切除后门静脉系统血栓形成的原因,并且对各种可能的影响因素进行分析总结.方法 回顾性分析本院于2009年2月-2012年2月收治的216例肝硬化脾脏切除术后患者的临床资料,分别对患者的性别、年龄、门静脉和脾静脉的直径、脾脏的大小、肝功能分级、术后并发症、手术前后的门静脉血液流速和压力、手术前后的血小板数量和凝血酶原延长时间等因素进行考察和分析.结果 脾切除术后发生门静脉血栓(portal vein thrombosis,PVT)36例,未发生PVT 180例.术后发生PVT患者的门静脉和脾静脉的直径、脾脏的大小、术后门静脉血液流速、手术前后门静脉的压力以及术后并发症的情况与发生门静脉血栓有显著性关联,差异有统计学意义(P<0.05),但是患者的性别、年龄、肝功能分级、手术前后的血小板数目、术前门静脉血液流速和手术前后的凝血酶原延长时间与门静脉血栓的形成无显著性关联,差异无统计学意义(P>0.05).结论 门静脉和脾静脉直径较粗、脾脏较大、手术后门静脉血液流速较慢、手术前后门静脉压力较小以及手术后并发症较多是肝硬化脾切除术后PVT形成的主要危险因素,因此可针对上述指标及时对患者的术后情况进行检测,减少肝硬化脾切除术后PVT的形成,促进患者术后康复.%Objective To explore the risk factors of portal system thrombosis after splenectomy in patient, analyze and summary the various possible influencing factors. Methods 216 patients with liver cirrhosis received in our hospital from Feb. 2009 to Feb. 2012 undergone splenectomy were analyzed retrospectively. The patient's gender, age, diameter of portal vein and splenic vein, spleen size, liver function, postoperative complications, the blood flow rate and pressure of postoperative portal vein, platelet count and prothrombin extending time before and after

  3. Avaliação com Doppler colorido e espectral da veia porta de cães Evaluation of portal vein in dogs by color and spectral Doppler imaging

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    Raquel Sartor

    2009-04-01

    Full Text Available A perfusão total do fígado e suas contribuições relativas, pelo sistema portal e pela artéria hepática, podem estar alteradas por vários processos hepáticos, como doença hepato-celular difusa, neoplasia e shunts intra-hepáticos. O estudo do comportamento do fluxo sangüíneo nos vasos do fígado por meio da ultra-sonografia Doppler tem demonstrado que este é um método viável não-invasivo e de grande auxílio, principalmente na avaliação da hemodinâmica portal. São duas as modalidades de ultra-sonografia Doppler com maior aplicação na rotina para avaliação de fluxo nos vasos abdominais, o Doppler espectral e o Doppler colorido. Na doença hepática crônica, ocorre alteração da complacência hepática devido à fibrose ou à cirrose, as quais acarretam alterações vasculares, levando ao aumento da pressão venosa portal. As principais indicações desse exame são os casos em que há suspeita de hipertensão portal. A hemodinâmica portal é avaliada pela mensuração de sua área, da velocidade média, do volume de fluxo no vaso e do índice de congestão portal. Esta revisão de literatura tem como objetivo descrever os princípios físicos básicos da ultra-sonografia Doppler e sua aplicação na avaliação da hemodinâmica portal nos cães.Total hepatic perfusion by portal system and hepatic arteria as well as its respective average contributions, can be affected for several hepatic processes, such as diffuse liver disease, neoplasm and intrahepatic shunts. Blood flow exams of the liver vessels using Doppler ultrasonography, appeared as a viable, non-invasive and helpful diagnostic method for the hemoportal dynamic evaluation. There are two Doppler ultrasonographic modalities most frequently used in routine for evaluation of the abdominal vessels flow, spectral Doppler imaging and color-flow Doppler imaging. In chronic liver disease, alteration of hepatic complacency occurs because of either fibrosis or cirrhosis

  4. Analysis of the reasons of portal vein thrombosis after splenectomy for portal hypertension due to hepatic cirrhosis%肝硬化脾切除术后门静脉系统血栓形成的原因分析

    Institute of Scientific and Technical Information of China (English)

    朱柯磊; 陆才德; 李定耀; 陈明良; 蒋存兵

    2012-01-01

    To explore the contributory reasons leading to portal vein thrombosis (PVT) after splenectomy and perieardial devascularization for portal hypertension due to hepatic cirrhosis. Methods The cl inieal data of 204 patients with portal hypertension due to hepatic cirrhosis inour hospital from January 2004 to January 2010 were retrospectively analyzed. Results One hundredand fiftypatients underwent splenectomy and perieardial devascularization, whi le54patientsunderwentpartial spleneetamyandperieardialdevascularization.PVT occurred in 30 patients (14. 7%). There was significant difference in the diameter of portal veins and splenic veins,the blood flow of portal veins in two groups of patients with or without PVT (P<0. 05). The incidence of PVT in patients undergone spl eneetomy and perieardial devasculari zation or suffered from postoperative eompl ieat ions were muchhigher than that in the other group (P<0. 05). Conclusion The risk factors of PVT after splenectomy and pericardial devaseularizationforportalhypertensionduetohepaticcirrhosisare: diameterofportalveins, diameterofsplenicveins,blood flow of portal veins and complications. And partial splenectomy can decrease the incidence of PVT.%目的 探讨肝硬化门静脉高压患者行脾脏切除+贲门周围血管离断术后门静脉系统血栓(portal vein thrombosis,PVT)形成的原因.方法 回顾性分析我院2004年1月至2010年1月204例肝炎后肝硬化门静脉高压症行手术治疗患者的临床资料.结果 其中150例行脾切除+贲门周围血管离断术,54例行脾脏部分切除术+贲门周围血管离断术.术后发生PVT30例,未发生PVT174例;发生PVT患者的门静脉和脾静脉直径、术后门静脉血液流速及术后并发症与未发生PVT患者有显著性差异(P<0.05),脾脏部分切除术后患者PVT的发生率明显比脾脏切除患者低,有显著性差异(P<0.05).结论 门静脉和脾静脉直径、门静脉血液流速及术后并发症是肝硬化门脉高压

  5. The value of Doppler ultrasound in cirrhosis and portal hypertension

    NARCIS (Netherlands)

    Kok, T; van der Jagt, EJ; Haagsma, EB; Bijleveld, CMA; Jansen, PLM; Boeve, WJ

    1999-01-01

    Background: Cirrhosis and portal hypertension affect the flow profile of the liver vasculature. In these conditions Doppler ultrasound can provide important information on the hemodynamics of the portal venous system, the hepatic artery and the hepatic veins. Methods: The value of Doppler ultrasound

  6. Prospective intraindividual comparison between respiratory-triggered balanced steady-state free precession and breath-hold gradient-echo and time-of-flight magnetic resonance imaging for assessment of portal and hepatic veins

    Energy Technology Data Exchange (ETDEWEB)

    Willmann, Juergen K.; Goepfert, Kerstin; Lutz, Amelie M.; Marincek, Borut; Weishaupt, Dominik [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Nanz, Daniel [University Hospital Zurich, Department of Medical Radiology, Zurich (Switzerland); McCormack, Lucas; Petrowsky, Henrik [University Hospital Zurich, Department of Visceral and Transplantation Surgery, Zurich (Switzerland); Seifert, Burkhardt [University of Zurich, Department of Biostatistics, Zurich (Switzerland); Hervo, Patrice [GE Healthcare, Buc Cedex (France)

    2007-01-15

    The purpose of this study was to compare respiratory-triggered balanced steady-state free precession (bSSFP) with breath-hold contrast-enhanced dynamic two-dimensional (2D) gradient-echo (GRE) and time-of-flight (TOF) magnetic resonance imaging (MRI) for portal and hepatic vein visualization and assessment of portal and hepatic venous variants. Sixty patients with liver disease underwent nonenhanced bSSFP and contrast-enhanced GRE, bSSFP, and TOF imaging. Contrast-to-noise ratios (CNRs) for portal and hepatic veins were measured. Two readers rated the quality of portal and hepatic vein visualization on a 5-point Likert scale. The diagnostic performance of each MRI series in the detection of portal and hepatic venous variants was assessed in 40/60 patients who also underwent contrast-enhanced multidetector-row computed tomography (MDCT). CNRs for portal and hepatic veins were highest on contrast-enhanced bSSFP images. Image quality of portal and hepatic veins was rated higher for nonenhanced bSSFP than for contrast-enhanced GRE (p<0.03) and TOF (p<0.003) and higher for contrast-enhanced than for nonenhanced bSSFP (p<0.003). Compared with MDCT, portal and hepatic venous variants were identified with an accuracy of 99% on bSSFP images, with an excellent interobserver agreement ({kappa}=0.97). Compared with MDCT, presence of surgically important portal and hepatic venous anatomical variants can be predicted with high accuracy on bSSFP images. (orig.)

  7. Prevalence and pattern of growth abnormalities in children with extrahepatic portal vein obstruction: Response to shunt surgery

    Directory of Open Access Journals (Sweden)

    Toufeeq Ahmad Mir

    2016-01-01

    Full Text Available Objective: Growth retardation is common in children with extrahepatic portal vein obstruction (EHPVO and growth hormone (GH resistance may play a dominant role. The aim of this study was to ascertain growth parameters and growth-related hormones in children with EHPVO, comparing with controls and to study the response of shunt surgery on growth parameters. Materials and Methods: The auxological and growth-related hormone profile (GH; insulin-like growth factor binding protein-3 [IGFBP-3] and IGF-1 of thirty children with EHPVO were compared with controls. The effect of shunt surgery on growth parameters in 12 children was also studied. Results: The mean height standard deviation score (HSDS of cases (−1.797 ± 1.146 was significantly lower than that of controls (−0.036 ± 0.796; the mean weight SDS of cases (−1.258 ± 0.743 was also lower than that of controls (−0.004 ± 0.533. The mean GH level of cases (5.00 ± 6.46 ng/ml was significantly higher than that of controls (1.78 ± 2.04 ng/ml. The mean IGF-1 level of cases (100.25 ± 35.93 ng/ml was significantly lower as compared to controls (233.53 ± 115.06 ng/ml as was the mean IGFBP-3 level (2976.53 ± 1212.82 ng/ml in cases and 5183.28 ± 1531.28 ng/ml in controls. In 12 patients who underwent shunt surgery, growth parameters significantly improved. Conclusions: Marked decrease in weight and height SDSs associated with GH resistance is seen in children with EHPVO, which improves with shunt surgery.

  8. Portal Vein Embolization before Right Hepatectomy: Improved Results Using n-Butyl-Cyanoacrylate Compared to Microparticles Plus Coils

    Energy Technology Data Exchange (ETDEWEB)

    Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr; Bize, Pierre; Gunthern, Daniel [Centre Hospitalo-Univeristaire Vaudois, Digestive and Oncologic Imaging and Interventional Radiology Unit, Department of Radiology and Interventional Radiology (Switzerland); Demartines, Nicolas; Halkic, Nermin [Centre Hospitalo-Univeristaire Vaudois, Department of Visceral Surgery (Switzerland); Denys, Alban [Centre Hospitalo-Univeristaire Vaudois, Digestive and Oncologic Imaging and Interventional Radiology Unit, Department of Radiology and Interventional Radiology (Switzerland)

    2013-10-15

    Background: There is currently no consensus in the literature on which embolic agent induces the greatest degree of liver hypertrophy after portal vein embolization (PVE). Only experimental results in a pig model have demonstrated an advantage of n-butyl-cyanoacrylate (NBCA) over 3 other embolic materials (hydrophilic gel, small and large polyvinyl alcohol particles) for PVE. Therefore, the aim of this human study was to retrospectively compare the results of PVE using NBCA with those using spherical microparticles plus coils. Methods: A total of 34 patients underwent PVE using either NBCA (n = 20), or spherical microparticles plus coils (n = 14). PVE was decided according to preoperative volumetry on the basis of contrast-enhanced CT. Groups were compared for age, sex, volume of the left lobe before PVE and future remnant liver ratio (FRL) (volume of the left lobe/total liver volume - tumor volume). The primary end point was the increase in left lobe volume 1 month after PVE. Secondary end points were procedure complications and biological tolerance. Results: Both groups were similar in terms of age, sex ratio, left lobe volume, and FRL before PVE. NBCA induced a greater increase in volume after PVE than did microparticles plus coils (respectively, +74 {+-} 69 % and +23 {+-} 14 %, p < 0.05). The amount of contrast medium used for the procedure was significantly larger when microparticles and coils rather than NBCA were used (respectively, 264 {+-} 43 ml and 162 {+-} 34 ml, p < 0.01). The rate of PVE complications as well as the biological tolerance was similar in both groups. Conclusion: NBCA seems more effective than spherical microparticles plus coils to induce left-lobe hypertrophy.

  9. A systematic review on the safety and effectiveness of yttrium-90 radioembolization for hepatocellular carcinoma with portal vein tumor thrombosis

    Directory of Open Access Journals (Sweden)

    Zhongzhi Jia

    2016-01-01

    Full Text Available Background/Aim: Over the past two decades, several advances have been made in the management of patients with hepatocellular carcinoma (HCC and portal vein tumor thrombosis (PVTT. Yttrium-90 ( 90 Y radioembolization has recently been made a treatment option for patients with HCC and PVTT. However, there is still a need to systematicly evaluate the outcomes of 90 Y radioembolization for HCC and PVTT. We aimed to assess the safety and effectiveness of 90 Y radioembolization for HCC and PVTT. We performed a systematic review of clinical trials, clinical studies, and abstracts from conferences that qualified for analysis. Materials and Methods: PubMed, EMBASE, Cochrane Database of Systematic Review, CINAHL, and the "gray" literature (Google Scholar were searched for all reports (1991-2016 related to 90 Y radioembolization for HCC and PVTT. Results: A total of 14 clinical studies and three abstracts from conferences including 722 patients qualified for the analysis. The median length of follow-up was 7.2 months; the median time to progression was 5.6 months, and median disease control rate was 74.3%. Radiological response data were reported in five studies, and the median reported value of patients with complete response, partial response, stable disease, and progressive disease were 3.2%, 16.5%, 31.3%, and 28%, respectively. The median survival was 9.7 months for all patients, including the median overall survival (OS were 12.1, 6.1 months of Child-Pugh class A and B patients, and the median OS were 6.1, 13.4 months of main and branch PVTT patients, respectively. The common toxicities were fatigue, nausea/vomiting, abdominal pain, mostly not requiring medical intervention needed no medication intervention. Conclusions: 90 Y radioembolization is a safe and effective treatment for HCC and PVTT.

  10. Establishment of a model of portal hypertension by portal vein coarctation and splenic vein ligation in dogs%门静脉主干缩窄附加脾静脉结扎制备犬门脉高压症模型

    Institute of Scientific and Technical Information of China (English)

    陈云志; 张谊; 廖毅; 曾其强; 程水兵; 张启瑜

    2009-01-01

    Objective To observe the changes of portal vein system after coarctation of portal vein and ligation of splenic vein with the purpose of making sure whether it could prepare a model of portal hypertension with hypersplenism or not.Methods The model was established through coarctation of portal vein and ligation of splenic vein in 15 dogs.Monitoring the hemogram preoperative and weekly after the op-eration.At the point of the 5th,Tth,9th week after the operation, respectively and randomly selected 5 ani-mals to observe the condition of portal vein pressure, sizes of spleen and the collateral circulation, in addi-tion, also to take the pathology examination of the spleens and detect the accrementition of bone marrow.Results After coarctation of portal vein and ligation of splenic vein, the RBC and PLT counts decreased obviously, and could effectively last for 9 weeks.The splenic histopathology changes conformed to the chan-ges of the congestive splenomegaly, and the accrementition of bone marrow was much more active.Conclu-sion The alleosis of portal vein system conformed to the Portal hypertension,especially the condition of hypersplenism was satisfactory, so the model would have favourable value of scientific research.%目的 观察犬门静脉主干缩窄加脾静脉结扎后门静脉系统的变化,为该方法能否建立一种具有脾亢的门静脉高压症大动物模型提供依据.方法 犬15条,采用门静脉主干缩窄加脾静脉结扎的方法建立模型,术前及术后每周观察实验动物血象的变化,在预定时间点分别随机选择5条犬开腹观测门静脉自由压、脾脏大小、门体侧支循环形成情况,并切取脾脏行组织病理学检查.此外,术前及术后预定时间点了解骨髓增生情况变化.结果 建模后,外周血红细胞、血小板下降,脾脏肿大明显,并且能够有效持续到第9周;术后第5、7、9周的脾脏组织病理学改变符合脾脏慢性淤血改变,而且骨髓增生情况

  11. Therapeutic effect and prognostic analysis of intensity-modulated radiotherapy for primary hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus

    Directory of Open Access Journals (Sweden)

    HUANG Long

    2015-06-01

    Full Text Available ObjectiveTo determine the efficacy and prognostic factors of intensity-modulated radiotherapy (IMRT for primary hepatocellular carcinoma (HCC with portal vein and/or inferior vena cava tumor thrombus. MethodsTwenty-three HCC patients with portal vein and/or inferior vena cava tumor thrombus received IMRT with an 8 MV linear accelerator at the Cancer Center of General Hospital of Armed Police Forces, Anhui Medical University, from April 2008 to August 2011. A single dose of 3 to 6 Gy was delivered at five fractions per week, with a total dose of 56 to 96 Gy and a median dose of 60 Gy. Survival time was recorded, and adverse reactions were evaluated. Survival rate calculation and survival analysis were performed using the Kaplan-Meier method. Comparison of categorical between two groups was made by chi-square test. ResultsOne patient did not complete radiotherapy due to upper gastrointestinal bleeding. Of 22 patients who completed IMRT, 4 achieved complete remission and 10 achieved partial remission, with an overall response rate of 63.7%. Our analysis showed that the type of tumor thrombus and tumor size were associated with tumor response rate and were significant prognostic factors (P<0.05. The median survival time was 13.4 months. The 1-, 2-, and 3-year survival rates were 59%, 27%, and 18%, respectively. The 22 patients who completed radiotherapy did not experience acute radiation injury or late adverse outcomes such as radiation-induced liver disease. ConclusionThis study suggests IMRT is a safe and effective treatment option for HCC patients with portal vein and/or inferior vena cava tumor thrombus.

  12. Reversal of hyperglycemia in diabetic rats by portal vein transplantation of islet-like cells generated from bone marrow mesenchymal stem cells

    Institute of Scientific and Technical Information of China (English)

    Xiao-Hong Wu; Chao Liu; Cui-Ping Liu; Kuan-Feng Xu; Xiao-Dong Mao; Jian Zhu; Jing-Jing Jiang; Dai Cui; Mei Zhang; Yu Xu

    2007-01-01

    AIM: To study the capacity of bone marrow mesenchymal stem cells (BM-MSCs) trans-differentiating into islet-like cells and to observe the effect of portal vein transplantation of islet-like cells in the treatment of streptozotocin-induced diabetic rat.METHODS: BM-MSCs were isolated from SD rats and induced to differentiate into islet-like cells under defined conditions. Differentiation was evaluated with electron microscopy, RT-PCR, immunofluorescence and flow cytometry. Insulin release after glucose challenge was tested with ELISA. Then allogeneic islet-like cells were transplanted into diabetic rats via portal vein. Blood glucose levels were monitored and islet hormones were detected in the liver and pancreas of the recipient by immunohistochemistry.RESULTS: BM-MSCs were spheroid adherent monolayers with high CD90, CD29 and very low CD45 expression.Typical islet-like cells clusters were formed after induction. Electron microscopy revealed that secretory granules were densely packed within the cytoplasm of the differentiated cells. The spheroid cells expressed islet related genes and hormones. The insulin-positive cells accounted for 19.8% and mean fluorescence intensity increased by 2.6 fold after induction. The cells secreted a small amount of insulin that was increased 1.5 fold after glucose challenge. After transplantation, islet-like cells could locate in the liver expressing islet hormones and lower the glucose levels of diabetic rats during d 6 to d 20.CONCLUSION: Rat BM-MSCs could be transdifferentiated into islet-like cells in vitro. Portal vein transplantation of islet-like cells could alleviate the hyperglycemia of diabetic rats.

  13. Induction of a glibenclamide-sensitive K-current by modification of a delayed rectifier channel in rat portal vein in insulinoma cells.

    OpenAIRE

    Edwards, G.; Weston, A. H.

    1993-01-01

    In insulinoma cells (RINm5F), the glibenclamide-sensitive K-current (IK(ATP)) which developed spontaneously or after exposure to levcromakalim or to butanedione monoxime was always accompanied by a reduction in the delayed rectifier current (IK(V)). At potentials over which IK(V) was fully activated, the total outward current remained constant. In rat portal vein, the delayed rectifier channel inhibitor, margatoxin, reduced the combined induction of IK(ATP) and inhibition of IK(V) by levcroma...

  14. Demonstration of metabolic and cellular effects of portal vein ligation using multi-modal PET/MRI measurements in healthy rat liver.

    Directory of Open Access Journals (Sweden)

    András Fülöp

    Full Text Available OBJECTIVES: In the early recognition of portal vein ligation (PVL induced tumor progression, positron emission tomography and magnetic resonance imaging (PET/MRI could improve diagnostic accuracy of conventionally used methods. It is unknown how PVL affects metabolic patterns of tumor free hepatic tissues. The aim of this preliminary study is to evaluate the effect of PVL on glucose metabolism, using PET/MRI imaging in healthy rat liver. MATERIALS AND METHODS: Male Wistar rats (n=30 underwent PVL. 2-deoxy-2-(18Ffluoro-D-glucose (FDG PET/MRI imaging (nanoScan PET/MRI and morphological/histological examination were performed before (Day 0 and 1, 2, 3, and 7 days after PVL. Dynamic PET data were collected and the standardized uptake values (SUV for ligated and non-ligated liver lobes were calculated in relation to cardiac left ventricle (SUVVOI/SUVCLV and mean liver SUV (SUVVOI/SUVLiver. RESULTS: PVL induced atrophy of ligated lobes, while non-ligated liver tissue showed compensatory hypertrophy. Dynamic PET scan revealed altered FDG kinetics in both ligated and non-ligated liver lobes. SUVVOI/SUVCLV significantly increased in both groups of lobes, with a maximal value at the 2nd postoperative day and returned near to the baseline 7 days after the ligation. After PVL, ligated liver lobes showed significantly higher tracer uptake compared to the non-ligated lobes (significantly higher SUVVOI/SUVLiver values were observed at postoperative day 1, 2 and 3. The homogenous tracer biodistribution observed before PVL reappeared by 7th postoperative day. CONCLUSION: The observed alterations in FDG uptake dynamics should be taken into account during the assessment of PET data until the PVL induced atrophic and regenerative processes are completed.

  15. Advance in application of portal vein embolization%门静脉栓塞术应用进展

    Institute of Scientific and Technical Information of China (English)

    代文杰; 于洪伟; 姜洪池

    2006-01-01

    肝癌是我国最常见的恶性肿瘤之一,在肝脏移植尚不能普及的今天,手术切除是目前治疗肝癌的最有效方法.但是术后剩余肝脏组织(future liver remnant,FLR)过少则是造成术后肝功能衰竭等并发症的重要因素,限制了肝癌手术的进行,从而使一些患者失去了手术的机会.肝切除术前门静脉栓塞术(portal vein embolization,PVE)可以使栓塞侧肝叶萎缩和对侧肝叶增生,使术后FLR增大,功能提高,从而使不能直接手术切除的肝癌患者获得手术切除的机会,扩大了手术指征.PVE的实施通常采用超声引导下经皮经肝门静脉栓塞术,常用的栓塞材料有:纤维蛋白胶(fibrin glue)、氰基丙烯酸+碘油、明胶海绵+凝血酶,弹簧圈,微粒(如PVA颗粒)和无水乙醇等.目前PVE主要用于原发性肝癌、转移性肝癌、肝门胆管癌和胆囊癌等需要行肝大部切除或扩大肝切除的患者以及多发肝转移瘤需行二期肝切除患者.但在患有严重门静脉高压症的患者不适合行PVE治疗.同时PVE的应用仍存在许多问题:PVE患者的选择尚无统一标准;PVE理想栓塞材料的研究;PVE与现行肝癌治疗手段如动脉栓塞术、辅助化疗等的联合应用等都需要深入的研究.严格把握适应证,PVE在肝癌的治疗中将会发挥越来越重要的作用.

  16. COMPARISON OF ISOFLURANE AND SEVOFLURANE ANESTHESIA IN HOLSTEIN CALVES FOR PLACEMENT OF PORTAL AND JUGULAR VEIN CANNULAS

    Directory of Open Access Journals (Sweden)

    Glen Sellers

    2013-01-01

    Full Text Available Isoflurane and sevoflurane are the two most commonly used inhalation anesthetics in veterinary medicine today. This study compared the anesthetic effects between isoflurane and sevoflurane in 17 calves undergoing surgery for placement of portal and jugular vein cannulas. Using a randomized control trial, calves were assigned to receive sevoflurane or isoflurane. Anesthesia was induced with xylazine and ketamine then maintained with the assigned inhalation anesthetic. Parameters for heart rate, respiratory rate, indirect blood pressures, oxygen hemoglobin saturation and end-tidal carbon dioxide were monitored and recorded during surgery. The anesthetic concentrations of the vaporizers were adjusted according to the calves’ responses, e.g., blood pressure, eye position, respiratory and heart rate, to surgical stimulation. Upon discontinuation of the inhalation anesthetic, calves were placed in sternal recumbency and recovery variables including time to extubation, time to first movement, attempts to stand and time to standing were observed and recorded. Statistical analysis was performed using a two-sample t-test on the recorded variables. There were no statistical differences between isoflurane and sevoflurane for any of the parameters recorded during anesthetic maintenance or recovery. The results of this study showed a faster time to first movement and extubation, 3.38±1.85 min and 11.75±3.73 min for sevoflurane compared to 7.56±5.34 min and 15.56±8.69 min for isoflurane, respectively. Attempts to stand were 3.00±2.14 for sevoflurane and 3.22±1.79 for isoflurane. Though the time to standing during recovery was not statistically different between anesthetics, the values did indicate a quicker trend of recovery from sevoflurane. Both inhalation anesthetics produced comparable anesthetic qualities and there were no statistical differences between the parameters recorded during maintenance of anesthesia. On the basis of the

  17. Does correlated color temperature affect the ability of humans to identify veins?

    DEFF Research Database (Denmark)

    Argyraki, Aikaterini; Clemmensen, Line Katrine Harder; Petersen, Paul Michael

    2016-01-01

    In the present study we provide empirical evidence and demonstrate statistically that white illumination settings can affect the human ability to identify veins in the inner hand vasculature. A special light-emitting diode lamp with high color rendering index (CRI 84–95) was developed...... and the effect of correlated color temperature was evaluated, in the range between 2600 and 5700 K at an illuminance of 40 9 lx on the ability of adult humans to identify veins. It is shown that the ability to identify veins can, on average, be increased up to 24% when white illumination settings that do...

  18. Thrombosed portal vein aneurysm

    OpenAIRE

    Belo-Oliveira, P; Rodrigues, H.; Belo-Soares, P; Teixeira, L; Caseiro-Alves, F

    2006-01-01

    A 74-year-old woman, previously healthy, presented with right upper quadrant pain. She had no history of trauma, surgery, biopsy, or known hepatic disease. On physical examination she had mild tenderness in the right upper quadrant, without hepatosplenomegaly or palpable abdominal masses. Laboratory analyses including liver-associated enzymes were within normal limits.

  19. Noncirrotisk intrahepatisk portal hypertension

    DEFF Research Database (Denmark)

    Dam Fialla, Annette; Havelund, Troels

    2007-01-01

    Non-cirrhotic intrahepatic portal hypertension is characterized by portal hypertension in the absence of liver cirrhosis or portal vein thrombosis. The disease is common in the East and rarely seen in the West. Two cases with oesophageal varices are described. The histopathology is heterogeneous...

  20. Characteristics and diagnosis of multi-slice computed tomography examination of portal vein diseases%门静脉病变的多排螺旋CT检查特征与诊断

    Institute of Scientific and Technical Information of China (English)

    任小军; 潘高争; 王霞; 杨如武

    2015-01-01

    恶性肿瘤引起胆管梗阻17例,肝硬化门静脉海绵样变伴肝内胆管扩张(门静脉高压性胆管病)2例.结论 门静脉病变多排螺旋CT检查主要表现为门静脉狭窄、闭塞或扩张、积气,其继发病变表现为门-腔静脉侧支循环形成及门静脉海绵样变、肠缺血以及门静脉高压性胆病;其原发病变多样,以肝硬化和恶性肿瘤为主.多排螺旋CT检查可清楚显示门静脉病变,对其原发病变与继发病变可进行准确诊断.%Objective To summarize the characteristics of multi-slice computed tomography (MSCT) of portal vein diseases and investigate the CT diagnosis of its primary and secondary diseases.Methods The imaging data of 62 patients from Xi'an Xidian Group Hospital,28 patients from Nuclear Industry 215 Hospital of Shanxi Province and 16 patients from Xi'an Gaoxin Hospital with portal vein diseases from January 2012 to March 2015 were retrospectively analyzed.The CT findings,primary and secondary diseases of portal vein lesions were recorded through plain scan and enhanced scan of MSCT.Results Changes in the width of portal vein:among 106 patients,dilation of main portal vein was detected in 45 cases,stenosis of stem or branches of portal vein in 39 cases,portal vein obstruction in 49 cases (21 patients accompanied with enlargement in stem of portal vein and 6 patients with normal width).The diameters of dilated portal vein were 1.4-2.2 cm with a mean diameter of 1.8 cm.The diameters of portal vein with stenosis and occlusion caused by carcinomas were 1.8-4.0 cm with a mean diameter of 2.3cm.Portal vein fistula and pneumatosis:hepatic artery-portal vein fistulas were detected in 12 patients,posterior right branches of portal vein-inferior vena cava fistulas in 2 patients,inferior vena cavaportal vein fistulas and portal-hepatic vein fistulas in 2 patients,pneumatosis in 2 patients.Lesions of portal vein occlusions:occlusions located at main portal veins were detected in 4 cases

  1. 肝硬化并发门静脉血栓研究进展%Progress in portal vein thrombosis in patients with liver cirrhosis

    Institute of Scientific and Technical Information of China (English)

    臧立娜(综述); 邢慧慧; 王嘉菲; 李明娟; 刘晓峰(审校)

    2014-01-01

    The portal vein thrombosis (PVT) is a common complications in patients with liver cirrhosis. The upper gas-trointestinal hemorrhage usually occurs in patients with PVT. The main mechanism of PVT formation is the reduction of portal vein blood flow velocity. At present,medicine selection is priority to the management of PVT. Studies have shown that anticoagu-lant therapy does not increase the risk of gastrointestinal bleeding,and it is recommended that the patients having the indications should be given anticoagulants for PVT. The routine anticoagulation can reduce the incidence of portal thrombosis in patients having partial splenic artery embolization. So far,many problems are still need to be solved in early diagnosis,monitoring indexes for anticoagulation,the dosage of heparin and prevention of recurrence in dealing with patients with PVT.%肝硬化并发门静脉血栓(Portal vein thrombosis,PVT)将增加肝硬化并发症的发生率。由于PVT可与上消化道出血同时发生,增加了治疗的难度。PVT形成的主要原因是门静脉血流速度降低。目前,治疗PVT仍以药物为主,研究表明抗凝治疗并不增加消化道出血的风险,因此对于有适应症的患者,在食管胃静脉曲张经治疗消失后,应及时针对PVT进行治疗。部分脾动脉栓塞患者,在治疗后常规给予抗凝处理可减少门静脉血栓的发生。在治疗过程中,早期诊断、抗凝治疗的监测指标、肝素用量、预防复发方面仍有较多问题等待解决。

  2. Study of portal vein abnormal echoes with contrast enhanced ultrasonography%门静脉异常回声的超声造影研究

    Institute of Scientific and Technical Information of China (English)

    何志容; 殷军; 宋鑫; 吴小利; 周丽; 肖海燕

    2014-01-01

    目的:探讨提高门静脉异常回声的超声诊断准确性。方法对常规超声检查发现的30例门静脉异常回声进行超声微泡造影。6例经穿刺活检或手术病理检查证实,24例结合临床资料及增强C T或M R检查证实。结果27例癌栓动脉相21例癌栓呈整体性高增强,6例癌栓部分高增强,部分充盈缺损;门脉相呈等或低增强,延迟相呈低增强。3例血栓造影过程中,2例无增强,1例门脉相节段性增强。结论超声造影能准确鉴别癌栓与血栓,为进一步明确病变的检出、性质、分期、治疗及预后提供参考价值。%Objective To improve the accurate ultrasonography of the portal vein abnormal echoes .Methods 30 cases of portal vein abnormal echo with conventional ultrasound examination were contrast-enhanced by ultrasound microbubble .6 cases were con-firmed by biopsy or surgical pathology ,24 cases were confirmed after clinical data and enhanced CT or MR .Results 27 cases of tumor thrombus in the arterial phase ,of which 21 cases were overall uniformity enhanced ,6 cases was part of the high enhance-ment ,partial filling defect ;In portal venous phase all was equal or lower enhancement ;in delayed phase all showed low enhance-ment .3 cases of thrombosis were contrast-enhanced process with 2 cases without enhancement ,1 case of portal vein segmental en-hancement .Conclusion Contrast-enhanced ultrasound microbubble can accurately identify tumor thrombus and thrombosis ,and provid the reference value to further clear of the disease detected in nature ,staging ,treatment and prognosis .

  3. Splenectomy and proximal lieno-renal shunt in a factor five deficient patient with extra-hepatic portal vein obstruction

    Directory of Open Access Journals (Sweden)

    Sahni Peush

    2006-05-01

    Full Text Available Abstract Background The clinico-surgical implication and successful management of a rare case of factor five (V deficiency with portal hypertension and hypersplenism due to idiopathic extra-hepatic portal venous obstruction is presented. Case presentation A 16-year old boy had gastro-esophageal variceal bleeding, splenomegaly and hypersplenism. During preoperative workup prolonged prothrombin time and activated partial thromboplastin time were detected, which on further evaluation turned out to be due to factor V deficiency. Proximal lieno-renal shunt and splenectomy were successfully performed with transfusion of fresh frozen plasma during and after the surgical procedure. At surgery there was no excessive bleeding. The perioperative course was uneventful and the patient is doing well on follow up. Conclusion Surgical portal decompressive procedures can be safely undertaken in clotting factor deficient patients with portal hypertension if meticulous surgical hemostasis is achieved at operation and the deficient factor is adequately replaced in the perioperative period.

  4. An experimental pilot study on controlled portal vein arterialization with an extracorporeal device in the swine model of partial liver resection and ischemia.

    Science.gov (United States)

    Nardo, B; Montalti, R; Puviani, L; Pacilè, V; Beltempo, P; Bertelli, R; Licursi, M; Pariali, M; Cianciavicchia, D

    2006-09-01

    To determine whether the physiologically oxygenated arterial blood reversed in the portal system by means of portal vein arterialization (PVA) through an extracorporeal device which we have called L.E.O2.NARDO (Liver Extracorporeal Oxygen. NARDO) is effective in treating swine with subtotal hepatectomy leading to acute liver failure (ALF). Ten swine with ALF induced by 85-90% liver resection and five minutes of ischemia-reperfusion injury were randomly divided into two groups: five animals received PVA extracorporeal treatment and five swine were not-treated (control group). Blood was withdrawn from the iliac artery and reversed in the portal venous system. An extracorporeal device was interposed between the outflow and the inflow in order to monitoring the hemodynamic parameters. Each treatment lasted 6 hours. Serum and liver samples were collected in both groups. The survival was assessed at 1 week. The PVA-extracorporeal treatment yielded beneficial effects for subtotal hepatectomy-induced ALF swine with decreased serum ammonia, transaminases and total bilirubin as compared with the untreated group. INR recovered rapidly in the PVA-extracorporeal group remaining significantly lower than in untreated animals. The 7-day survival of PVA-extracorporeal group swine was significantly higher than that of untreated animals, with a statistically significant difference (pportal system through the extracorporeal device is easily applicable, efficacious, safe and may represent a novel approach for ALF swine induced by subtotal liver resection.

  5. Significance of molecular markers of prethrombotic state in monitoring portal vein thrombosis in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    LU Xiaomin

    2015-03-01

    Full Text Available ObjectiveTo investigate the levels of molecular markers of prethrombotic state in liver cirrhosis (LC patients with portal vein thrombosis (PVT and their significance. MethodsSeventy-two LC patients who were admitted to our hospital from 2011 to 2013 were selected for analysis. Among the patients, thirty-two were diagnosed with PVT by computed tomography. The plasma levels of granular membrane protein-140 (GMP-140, von Willebrand Factor antigen (vWF:Ag, thrombomodulin (TM, and D-dimer (DD were measured by enzyme-linked immunosorbent assay. The data were analyzed using SPSS 11.0. Continuous data were expressed as mean ± standard deviation and compared between the two groups by independent-samples t test. ResultsThe concentrations of GMP-140, TM, vWF:Ag, and DD in patients with PVT were significantly higher than those in patients without PVT (20.68±1.49 vs 13.05±0.97 μg/L, P<0.05; 47.24±1.36 vs 34.05±5.03 μg/L, P<0.05; 194.32%±7.68% vs 136.21%±3.68%, P<0.05; 0.86±0.12 vs 0.42±0.08 mg/L, P<0.05. The plasma levels of GMP-140, TM, vWF:Ag, and DD in PVT patients with severe esophageal varices were significantly higher than those in patients with mild esophageal varices (19.68±1.29 vs 12.05±1.07 μg/L, P<0.05; 45.24±1.26 vs 3505±4.83 μg/L, P<0.05; 196.32%±6.68% vs 141.21%±3.45 %, P<0.05; 0.79±0.12 vs 0.36±0.08 mg/L, P<0.05.The plasma levels of GMP-140, TM, vWF:Ag, and DD in PVT patients with gastrointestinal bleeding were significantly higher than those in patients without gastrointestinal bleeding (18.98±1.18 vs 11.98±1.12 μg/L, P<0.01; 46.78±1.35 vs 36.02±4.78 μg/L, P<001; 19732%±6.39% vs 138.21%±4.12 %, P<0.01; 0.81±0.14 vs 0.35±0.12 mg/L, P<0.01. ConclusionThe levels of molecular markers of prethrombotic state can be used to monitor PVT in LC patients.

  6. 肝硬化合并门静脉血栓的发病机制及诊治%Study on the Pathogenesis,Diagnosis and Treatment of Cirrhosis Complicated by Portal Vein Throm-bosis

    Institute of Scientific and Technical Information of China (English)

    张丹丹(综述); 袁捷(审校)

    2015-01-01

    门静脉血栓( PVT)是肝硬化失代偿期门静脉高压症并发症之一。随着诊断技术的进步, PVT的检出率不断提高,但其发病机制复杂,目前的研究结果倾向于多种因素共同作用。对于已经确诊的PVT,除了全身抗凝、溶栓及手术治疗外,介入治疗也有较大价值。迄今为止,尚未形成正式的指南来指导肝硬化门静脉高压症患者PVT的治疗。该文就目前PVT的发病机制、临床表现、诊断方法及治疗的研究进展予以综述。%Portal vein thrombosis is one of the complications of decompensated cirrhosis .Along with the progress of diagnosis technology,the detection rate of portal vein thrombosis is constantly improving.But its pathogenesis is complex,the current study results tend to reveal that multiple factors are involved in it .For confirmed portal vein thrombosis,besides systemic anti-coagulation,thrombolysis therapy and surgery,inter-ventional therapy also has great value,yet there has not been any widely accepted guideline for the treatment of liver cirrhosis patients with portal vein thrombosis and portal hypertension .Here is to make a review of research progress on the pathogenesis,clinical manifestations,diagnostic methods and treatment of portal vein thrombosis.

  7. Hemodynamics in the portal vein evaluated by pulse wave Doppler ultrasonography in patients with chronic hepatitis C treated with interferon

    Institute of Scientific and Technical Information of China (English)

    Shigeo Nakanishi; Katsuya Shiraki; Kouji Yamamoto; Mutsumi Koyama; Noboru Kimura; Takeshi Nakano

    2005-01-01

    AIM: To employ pulse wave Doppler ultrasonography to evaluate the changes in portal blood flow velocity in patients with chronic hepatitis C (CHC) receiving interferon (IFN)treatment.METHODS: The subjects in this study were 14 patients (13 men and 1 woman) with CHC who received IFN treatment. Portal blood flow velocity was measured in the vessels at the porta hepatis at four time points: before IFN administration (pre-IFN), 2 wk after the start of administration (wk 2), 24 wk after the start of administration (wk 24, i.e.,the end of IFN administration), and 24 wk after the end of administration (wk 48).RESULTS: The patients with CHC in whom IFN treatment resulted in complete elimination or effective elimination of viruses showed a significant increase in portal blood flow velocity at the end of IFN treatment compared with that before IFN treatment. In contrast, when IFN was ineffective, no significant increase in portal bloocl flow velocity was observed at wk 24 or 48 compared with the pre-IFN value. In addition,the patients with CHC in whom IFN was ineffective showed significantly lower portal blood flow velocity values than control subjects at all measurement time points.CONCLUSION: Pulse wave Doppler ultrasonography is a noninvasive and easily performed method for evaluating the effects of IFN treatment in patients with CHC. This technique is useful for measuring portal blood flow velocity before and 24 wk after IFN administration in order to evaluate the changes over time, thus assessing the effectiveness of IFN treatment.

  8. [Effect of n-3 polyunsaturated fatty acids on gut microbiota and endotoxin levels in portal vein of rats fed with high-fat diet].

    Science.gov (United States)

    Cao, Zhan-jiang; Yu, Jian-chun; Kang, Wei-ming; Ma, Zhi-qiang; Ye, Xin; Tian, Shu-bo

    2014-10-01

    To investigate the effect of n-3 polyunsaturated fatty acids (n-3PUFAs) on gut microbiota and endotoxin levels in portal vein of rats fed with a high-fat diet (HFD). Thirty-six male Sprague-Dawley rats were randomly divided into four groups and fed with normal control diet (CD), HFD, CD supplemented with n-3PUFAs, and HFD supplemented with n-3PUFAs, respectively. Fresh fecal samples were collected to analyze the gut microbiota 10 weeks after feeding. DNA was exacted from the fresh fecal samples. Quantitative PCR was used to detect the composition of the gut microbiota. The endotoxin levels were detected through modified azo chromogenic substrate limulus amebocyte lysate assay. The differences in body weight before breeding in each group were not statistically significant among these four groups (P=0.613). The increase in the body weight was significantly larger in the HFD group than in the CD group (P=0.0002), CD+n-3PUFAs group (P=0.0001), and HFD+n-3PUFAs group (P=0.022). There were significantly more firmicutes (P=0.002) and enterobacteriales (P=0.022) and significantly less bacteroidetes (P=0.026) and bifidobactera (P=0.034) in the gut of rats from HFD group than those from the CD group. There were significantly more bacteroidetes in the fecal samples of the rats from the CD+n-3PUFAs group compared to those from the CD group (P=0.043). There were significantly more firmicutes (P=0.044)and enterobacteriales (P=0.012) and less bacteroidetes (P=0.042) in the fecal samples of the rats from HFD group compared to those from the HFD+n-3PUFAs group. The endotoxin in plasma form portal vein of rats in HFD group were significantly higher than in CD group (P=0.007) and HFD+n-3PUFAs group (P=0.042) but showed no significant difference between CD+n-3PUFAs and CD group (P=0.210). HFD can increase body weight and change gut microbiota. Supplementation of n-3PUFAs can partially counteract such gut dysbiosis, lower endotoxin level in portal vein blood, and improve the body

  9. Comparison of intra-arterial chemoembolization with and without radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a meta-analysis

    Science.gov (United States)

    Zhao, Qianqian; Zhu, Kunli; Yue, Jinbo; Qi, Zhonghua; Jiang, Shumei; Xu, Xiaoqing; Feng, Rui; Wang, Renben

    2017-01-01

    Purpose Numerous studies have tried to combine transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) with radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). However, the efficacy of TACE or HAIC combined with RT versus TACE or HAIC alone remains controversial. Thus, we performed a meta-analysis to compare the efficacy and safety of intra-arterial chemoembolization combined with RT versus intra-arterial chemoembolization alone for the treatment of HCC patients with PVTT. Methods PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies. Two authors independently reviewed the abstracts, extracted relevant data and rated the quality of studies. The major end points were objective response rate (ORR), overall survival (OS), and adverse events. Results Eight studies with a total of 1,760 patients were included in this meta-analysis. The pooled results showed that intra-arterial chemoembolization combined with RT significantly improved ORR of PVTT (OR, 4.22; 95% CI, 3.07–5.80; P<0.001) and OS (HR, 0.69; 95% CI, 0.57–0.83; P=0.001), but did not affect ORR of primary liver tumor (OR, 1.37; 95% CI, 0.67–2.79; P=0.390). The incidence of grade 3 or 4 leukopenia (OR, 5.80; 95% CI, 2.478–13.56; P<0.001) and thrombocytopenia (OR, 3.77; 95% CI, 1.06–13.43; P=0.041) was higher in the intra-arterial chemoembolization plus RT group than in the intra-arterial chemoembolization group. Conclusion Combination therapy of intra-arterial chemoembolization and RT for HCC patients with PVTT could bring higher ORR of PVTT and better survival benefits. This combination therapy was also associated with a significantly increased risk of adverse events. However, they were mostly mild to moderate and successfully treated with conservative treatment. PMID:28053537

  10. Factor V Leiden mutation, prothrombin gene mutation, and deficiencies in coagulation inhibitors associated with Budd-Chiari syndrome and portal vein thrombosis: results of a case-control study

    NARCIS (Netherlands)

    H.L.A. Janssen (Harry); J.P. Vandenbroucke; F.R. Rosendaal (Frits); B. van Hoek (Bart); J.R. Meinardi; F.P. Vleggaar (Frank); S.H. van Uum; E.B. Haagsma (Els); F.J.M. van der Meer; J. van Hattum (Jan); R.A. Chamuleau; R.P.R. Adang (Rob)

    2000-01-01

    textabstractIn a collaborative multicenter case-control study, we investigated the effect of factor V Leiden mutation, prothrombin gene mutation, and inherited deficiencies of protein C, protein S, and antithrombin on the risk of Budd-Chiari syndrome (BCS) and portal vein thrombosi

  11. Adaptation of the Main Peripheral Artery and Vein to Long Term Confinement (MARS 500)

    OpenAIRE

    Philippe Arbeille; Romain Provost; Nicole Vincent; Andre Aubert

    2014-01-01

    PURPOSE: The objective was to check if 520 days in confinement (MARS 500), may affect the main peripheral arterial diameter and wall thickness and the main vein size. METHOD: Common carotid (CC) femoral artery (FA) portal vein (PV), jugular (JG), femoral vein (FV) and tibial vein were assessed during MARS 500 by echography, performed by the subjects. A hand free volumic echographic capture method and a delayed 3D reconstruction software developed by our lab were used for collecting and measur...

  12. Serial changes of clinical parameters in a patient with advanced hepatocellular carcinoma with portal vein thrombosis achieving complete response after treatment with sorafenib

    Directory of Open Access Journals (Sweden)

    Kee KM

    2014-05-01

    Full Text Available Kwong-Ming Kee,1,2 Chao-Hung Hung,1,2 Jing-Houng Wang,1,2 Sheng-Nan Lu1,2 1Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Chang Gung University College of Medicine, Kaohsiung, Taiwan Abstract: The prognosis is usually poor in advanced hepatocellular carcinoma (HCC. Sorafenib is approved for Child-Pugh class A patients with unresectable and advanced HCC. We report here a rare case of a patient with advanced HCC with right portal vein thrombosis (PVT who achieved a complete response after treatment with sorafenib. This 74-year-old man was a case of non-hepatitis B and C virus-related cirrhosis. Multiphase liver computed tomography showed an 8 cm tumor with early enhance, early wash out, and right PVT at segment 8 of the right lobe. A liver tumor biopsy confirmed the diagnosis of poorly differentiated HCC. Blood tests showed Child-Pugh class A cirrhosis and an alpha-fetoprotein level of 33,058 ng/mL. Sorafenib was initiated at 800 mg/day but was eventually reduced to 400 mg every other day because of a grade 3 hand-foot skin reaction. The alpha fetoprotein (AFP level decreased rapidly with a linear trend after treatment. After log transformation, the calculated half-life of AFP was 6.84 days. There was no more tumor arterial enhancement, and tumor size was decreased to 3.7 cm on day 42. PVT shrank gradually and localized to the right anterior branch at month 9. There was no recurrence of tumor at the end of follow-up in month 19. Typical serial changes of clinical parameters were demonstrated in this patient. Keywords: hepatocellular carcinoma, sorafenib, complete response, portal vein thrombosis

  13. Radiation doses to operators performing transjugular intrahepatic portosystemic shunt using a flat-panel detector-based system and ultrasound guidance for portal vein targeting.

    Science.gov (United States)

    Miraglia, Roberto; Gerasia, Roberta; Maruzzelli, Luigi; D'Amico, Mario; Luca, Angelo

    2017-05-01

    The aim of this study was to prospectively evaluate effective dose (E) of operators performing transjugular intrahepatic portosystemic shunts (TIPS) in a single centre. Patients' radiation exposure was also collected. Between 8/2015 and 6/2016, 45 consecutive TIPS were performed in adult patients using a flat-panel detector-based system (FPDS) and real-time ultrasound guidance (USG) for portal vein targeting. Electronic personal dosimeters were used to measure radiation doses to the primary and assistant operators, anaesthesia nurse and radiographer. Patients' radiation exposure was measured with dose area product (DAP); fluoroscopy time (FT) was also collected. Mean E for the primary operator was 1.40 μSv (SD 2.68, median 0.42, range 0.12 - 12.18), for the assistant operator was 1.29 μSv (SD 1.79, median 0.40, range 0.10 - 4.89), for the anaesthesia nurse was 0.21 μSv (SD 0.67, median 0.10, range 0.03 - 3.99), for the radiographer was 0.42 μSv (SD 0.71, median 0.25, range 0.03 - 2.67). Mean patient DAP was 59.31 GyCm(2) (SD 56.91, median 31.58, range 7.66 - 281.40); mean FT was 10.20 min (SD 7.40, median 10.40, range 3.8 - 31.8). The use of FPDS and USG for portal vein targeting allows a reasonably low E to operators performing TIPS. • The operators' E vary according to the complexity of the procedure. • FPDS and USG allow a reasonably low E to TIPS operators. • FPDS and USG have an important role in reducing the occupational exposure.

  14. Interrelationship of oxygen supply by hepatic artery and portal vein: rapid analysis of ischemia-reflow-induced changes in hepatic oxygenation in experimental and clinical subjects by tissue near-infrared spectroscopy.

    Science.gov (United States)

    Tokuka, A; Tanaka, A; Kitai, T; Yanabu, N; Mori, S; Sato, B; Tanaka, K; Yamaoka, Y; Hirao, K

    1994-01-01

    The rapid changes in extracellular oxygenation and intracellular oxidation during ischemia and reflow were measured in deep liver tissue by a novel method combining tissue near-infrared spectroscopy with multicomponent curve-fitting analysis. This method enabled us to make real-time measurements of oxygen saturation (SO2) and amount (THB) of hemoglobin in the liver sinusoid as parameters of extracellular oxygenation state and of redox transition of cytochrome aa3 as intracellular oxidation state. Clamping of the hepatic artery in rabbit decreased the THB with a transient fall of SO2. Clamping of the portal vein decreased both SO2 and THB. The decreases of SO2 and THB caused by Pringle's maneuver were larger than the sum of decreases by hepatic artery and portal vein. These changes in SO2 were correlated with intramitochondrial oxidation state as measured by cytochrome aa3. These results indicate the presence of an interrelationship of oxygen supply by hepatic artery and portal vein. This method was clinically applied during and after clamping of hepatic artery and portal vein in 19 cases of hepatic resection with or without chronic hepatic diseases. The decrease in SO2 values before and after clamping (SO2D) and the slope of SO2 recovery (SO2R) after release were calculated. SO2D and SO2R values of the portal vein in cirrhotics were significantly higher and lower, respectively, than those in the normal liver. These data indicate that the present method provides a rapid and reliable method of quantifying hepatic oxygenation during liver surgery and its perioperative management.

  15. Portal vein glucose entry triggers a coordinated cellular response that potentiates hepatic glucose uptake and storage in normal but not high-fat/high-fructose-fed dogs.

    Science.gov (United States)

    Coate, Katie C; Kraft, Guillaume; Irimia, Jose M; Smith, Marta S; Farmer, Ben; Neal, Doss W; Roach, Peter J; Shiota, Masakazu; Cherrington, Alan D

    2013-02-01

    The cellular events mediating the pleiotropic actions of portal vein glucose (PoG) delivery on hepatic glucose disposition have not been clearly defined. Likewise, the molecular defects associated with postprandial hyperglycemia and impaired hepatic glucose uptake (HGU) following consumption of a high-fat, high-fructose diet (HFFD) are unknown. Our goal was to identify hepatocellular changes elicited by hyperinsulinemia, hyperglycemia, and PoG signaling in normal chow-fed (CTR) and HFFD-fed dogs. In CTR dogs, we demonstrated that PoG infusion in the presence of hyperinsulinemia and hyperglycemia triggered an increase in the activity of hepatic glucokinase (GK) and glycogen synthase (GS), which occurred in association with further augmentation in HGU and glycogen synthesis (GSYN) in vivo. In contrast, 4 weeks of HFFD feeding markedly reduced GK protein content and impaired the activation of GS in association with diminished HGU and GSYN in vivo. Furthermore, the enzymatic changes associated with PoG sensing in chow-fed animals were abolished in HFFD-fed animals, consistent with loss of the stimulatory effects of PoG delivery. These data reveal new insight into the molecular physiology of the portal glucose signaling mechanism under normal conditions and to the pathophysiology of aberrant postprandial hepatic glucose disposition evident under a diet-induced glucose-intolerant condition.

  16. Safety, efficacy, and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis: a propensity score matching analysis

    Directory of Open Access Journals (Sweden)

    Jung Wha Chung

    2014-12-01

    Full Text Available Background/AimsPortal-vein thrombosis (PVT develops in 10-25% of cirrhotic patients and may aggravate portal hypertension. There are few data regarding the effects of anticoagulation on nonmalignant PVT in liver cirrhosis. The aim of this study was to elucidate the safety, efficacy, and predictors of response to anticoagulation therapy in cirrhotic patients.MethodsPatients with liver cirrhosis and nonmalignant PVT were identified by a hospital electronic medical record system (called BESTCARE. Patients with malignant PVT, Budd-Chiari syndrome, underlying primary hematologic disorders, or preexisting extrahepatic thrombosis were excluded from the analysis. Patients were divided into two groups (treatment and nontreatment, and propensity score matching analysis was performed to identify control patients. The sizes of the thrombus and spleen were evaluated using multidetector computed tomography.ResultsTwenty-eight patients were enrolled in this study between 2003 and 2014: 14 patients who received warfarin for nonmalignant PVT and 14 patients who received no anticoagulation. After 112 days of treatment, 11 patients exhibited significantly higher response rates (complete in 6 and partial in 5 compared to the control patients, with decreases in thrombus size of >30%. Compared to nonresponders, the 11 responders were older, and had a thinner spleen and fewer episodes of previous endoscopic variceal ligations, whereas pretreatment liver function and changes in prothrombin time after anticoagulation did not differ significantly between the two groups. Two patients died after warfarin therapy, but the causes of death were not related to anticoagulation.ConclusionsWarfarin can be safely administered to cirrhotic patients with nonmalignant PVT. The presence of preexisting portal hypertension is a predictor of nonresponse to anticoagulation.

  17. 3.0T非对比剂肝门静脉磁共振血管成像技术研究%Non-contrast-enhanced Magnetic Resonance Angiography of the Hepatic Portal Vein at 3.0 Tesla

    Institute of Scientific and Technical Information of China (English)

    姚斐斐; 程敬亮; 杨子涛; 李莹; 鲁果果

    2013-01-01

    Purpose To explore the methods of selectively visualizing hepatic portal vein by using three-dimensional fast imaging employing steady state acquisition combined with in-flow inversion recovery labeling pulse at 3.0 Tesla. Materials and Methods Ten healthy volunteers were examined under different TI (1200, 1400, 1600, 1800 ms), and the vessel-to-liver contrast ratio of the main portal vein, right portal vein, and left portal vein were measured. Results Non-contrast-enhanced MRA images of portal vein were obtained successfully in all ten volunteers. The signal intensity of peripheral portal branches gradually increased when TI increased from 1200 ms to 1600 ms, and the highest vessel-to-liver contrast ratio occurred when TI was 1400 ms. Conclusion Non-contrast enhanced magnetic resonance angiography of the hepatic portal vein can be successfully achieved at 3.0T high field MRI. A fixed TI of 1400 ms is preferable.%目的:在3.0T高场强MR成像仪上,探讨流入反转恢复标记脉冲带与三维稳态采集快速成像序列相结合选择性地显示肝脏门静脉的方法,并对扫描参数进行优化。资料与方法对10名健康志愿者分别进行反转时间(TI)为1200、1400、1600、1800 ms扫描,比较不同TI下肝脏门静脉主干、左支、右支与肝实质的相对信号强度。结果10名志愿者均成功实现了非对比剂肝门静脉血管成像。TI由1200~1600 ms,门静脉远端分支的信号强度逐渐增强。在TI=1400 ms时,肝门静脉血管与肝实质之间的相对信号强度最高。结论3.0T MRI可以实现非对比剂肝门静脉血管成像,TI为1400 ms时成像效果较好。

  18. Clinical Analysis of Portal Vein Thrombosis after Splenectomy%脾切除术后门静脉系统血栓形成的临床分析

    Institute of Scientific and Technical Information of China (English)

    陈国富; 范国华

    2012-01-01

    目的 探讨脾切除术后门静脉血栓形成(portal vein thrombosis,PVT)的原因、诊断和治疗.方法 对我院2002年8月至2008年8月期间收治的因肝硬变门静脉高压症及外伤脾破裂行脾切除术后发现PVT的29例患者的临床资料进行回顾性分析.结果 29例PVT患者中27例经抗凝溶栓治疗后血栓完全或部分溶解吸收、康复出院;1例因腹膜炎、感染性休克和多器官功能衰竭死亡;1例因呕血、肝昏迷及多器官功能衰竭死亡.24例患者获随访,3例失访,随访时间0.5~3年,平均2年,其中2例因大出血死亡、1例因肝性脑病死亡、1例因肝功能衰竭死亡,2例于出院1年后发生下肢深静脉血栓,其余患者未再发生静脉血栓.结论 PVT与脾切除术后血小板升高及血流动力学改变有关,手术操作规范化、早期诊断以及抗凝祛聚是防治PVT的有效方法.%To explore the cause, diagnosis, and treatment methods of portal vein thrombosis (PVT) after splenectomy. Methods The clinical data of 29 patients who were got splenectomy because of portal hypertension or traumatic splenic rupture from August 2002 to August 2008 in our hospital were analyzed retrospectively. Results Tweenty-seven patients with PVT were treated successfully, whose thrombi were absorbed completely or partially. One case died of peritonitis, septic shock, and multiple organ failure. One case died of hematemesis, hepatic coma, and multiple organ failure. Tweenty-four patients were followed up, the follow-up time was 0.5 to 3 years, the average was 2 years. Two cases died of massive hemorrhage, 1 case died of hepatic encephalopathy, and 1 case died of liver failure. Two cases occurred deep venous thrombosis in one year after treatment, and the remaining patients had no recurrence of venous thrombosis. Conclusions PVT have some connection with the raise of blood platelet and the hemodynamic changes of the portal vein system after splenectomy. Standardization of

  19. Portal biliopathy.

    Science.gov (United States)

    Khuroo, Mohammad S; Rather, Ajaz A; Khuroo, Naira S; Khuroo, Mehnaaz S

    2016-09-21

    Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy).

  20. Does correlated color temperature affect the ability of humans to identify veins?

    DEFF Research Database (Denmark)

    Argyraki, Aikaterini; Clemmensen, Line Katrine Harder; Petersen, Paul Michael

    2016-01-01

    In the present study we provide empirical evidence and demonstrate statistically that white illumination settings can affect the human ability to identify veins in the inner hand vasculature. A special light-emitting diode lamp with high color rendering index (CRI 84–95) was developed and the eff......In the present study we provide empirical evidence and demonstrate statistically that white illumination settings can affect the human ability to identify veins in the inner hand vasculature. A special light-emitting diode lamp with high color rendering index (CRI 84–95) was developed...... and the effect of correlated color temperature was evaluated, in the range between 2600 and 5700 K at an illuminance of 40 9 lx on the ability of adult humans to identify veins. It is shown that the ability to identify veins can, on average, be increased up to 24% when white illumination settings that do...... not resemble incandescent light are applied. The illuminance reported together with the effect of white illumination settings on direct visual perception of biosamples are relevant for clinical investigations during the night. © 2015 Optical Society of America...

  1. 正常成年人MDCT门静脉测量的区域性研究%Regional Studies of MDCT Measurement of the Portal Vein in the Normal Adult

    Institute of Scientific and Technical Information of China (English)

    李帮雪; 郭顺林; 曾苗苗; 苏李娜

    2016-01-01

    Objective To measure the diameters of the portal vein and abdominal aorta of the normal adult in Gansu Province by Multi-detector Row Spiral CT, and determine the normal CT scale of portal vein and abdominal aorta of adult.Methods Retrospective analysis 300 normal cases that were performed enhanced abdomen CT in the First Hospital of Lanzhou University from February 2014 to April 2015. They were equally assigned to 3 groups according to their age (A group:18—39years,B group:40-59 years,C group:be equal or greater than 60 years;50 females and 50 males in each group). Measurements were done on 3D reconstruction image with precise landmarks, and these data were statistically analyzed by SPSS22.0.Results There were significant differences in the diameters of the left portal vein between group A and group C(P<0.05), and the diameters of the main portal vein were significantly diffrent between group A and group C, group B and group C(P<0.05), and the diameters of abdominal aorta and R3 differed significantly among each group(P<0.01). The diameters of left portal vein,right portal vein,main portal vein, and abdominal aorta differed significantly among the genders(P<0.05).Conclusion The diameters of main portal vein and abdominal aorta differed significantly among the age and genders. Imaging standard is provided for Gansu Province adult in early diagnosis of liver or portal vein disease.%目的:利用多排螺旋CT(MDCT)测量甘肃地区健康成人门静脉及腹主动脉直径,建立正常成年人门静脉及腹主动脉直径的数值标准。方法回顾性分析2014年2月至2015年4月在兰州大学第一医院行上腹部CT增强检查的正常成年人300例,按年龄分组:18-39岁(A组),40-59岁(B组),≥60岁(C组);各组均包括男50例,女50例。扫描图像经工作站3D重建后进行测量,所得结果利用SPSS22.0统计分析。结果 LPV在A组与C组间有明显差异(P<0.05),MPV在A组与C组、B

  2. 彩色多普勒血流显像及超声造影鉴别诊断门静脉良恶性栓子%CDFI and CEUS in identification of benign or malignant portal vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    冯群群; 黄道中

    2013-01-01

    Objective To observe the value of CDFI and CEUS in identification of benign or malignant portal vein thrombosis. Methods The images of CDFI and CEUS of 33 patients with portal vein thrombosis (PVT) were retrospectively analyzed. There were 23 cases of portal vein tumor thrombosis and 10 cases of portal vein blood thrombosis. Results In 23 portal vein tumor thrombosis, there were 17 complete embolization and 6 partial embolization. In 10 portal vein blood thrombosis, there were 3 complete embolization and 7 partial embolization. The rate of the complete embolization in the portal vein tumor thrombosis was higher than that in the portal vein blood thrombosis (P=0. 026), indicating that complete embolization was more usual in the tumor thrombosis, while partial embolization happened more often in the blood thrombosis. Moreover, CDFI showed that more tumor thrombosis located in the branches of portal vein with higher and heterogeneous echo, while blood thrombosis was opposite and might occur secondary to splenectomy and liver cirrhosis. CEUS mainly showed the fast "wash-in" and fast "wash-out" in tumor thrombosis, but no enhancement of blood thrombosis. Conclusion CDFI helps to identify the nature of PVTs. CEUS is of significant value in differential diagnosis of tumor thrombosis and blood thrombosis.%目的 探讨CDFI及CEUS鉴别诊断门静脉良恶性栓子的价值.方法 回顾性分析33例门静脉栓塞患者门静脉栓子的CDFI及CEUS灌注表现,包括门静脉癌栓23例,血栓10例.结果 23例癌栓中,完全填充17例,部分填充6例;10例血栓中,完全填充3例,部分填充7例.癌栓完全填充率高于血栓完全填充率(P=0.026),表明门静脉癌栓以完全填充为主,血栓以部分填充为主.CDFI显示癌栓自肝内向肝外生长多见,回声较强且不均匀;血栓则相反,且多见于脾切除后、肝硬化等患者.CEUS示门静脉癌栓均呈“快进快出”表现,而血栓内始终未见造影剂填充.结论 CDFI对

  3. Value of 64-slices spiral computed tomography in the diagnosis of cavernous transformation of portal vein%64层螺旋CT对门静脉海绵样变性的诊断价值

    Institute of Scientific and Technical Information of China (English)

    李金平; 赵德利; 王彦民; 李大庆; 李艳英; 姜慧杰

    2011-01-01

    目的 探讨64层螺旋CT在门静脉海绵样变性(CTPV)诊断中的价值.方法 对CT检查发现的CTPV患者22例,采用MPR、MIP、VR等图像后处理技术显示异常的门静脉及侧支血管情况.结果 22例CTPV 在CT平扫上显示门静脉结构不清,肝门区可见多发的结节状、条状软组织影.增强扫描显示6例动脉期肝实质灌注异常;门静脉期11例患者门静脉主干和(或)左右分支增粗,内可见充盈缺损,4例门静脉显示不清;2例门静脉主干和(或)左右分支在正常范围内;4例门静脉主干变细;1例门静脉主干受侵致管腔狭窄.胆管周围静脉丛(86.36%)、胆囊静脉(77.27%)及食管胃底静脉(77.27%)呈点状、细网状、簇状扩张.结论 64层螺旋CT能准确显示CTPV的部位、范围,立体地显示各曲张血管的走行及曲张程度,是检查CTPV的有效手段.%Objective To investigate the value of 64-slice spiral computed tomography in the diagnosis of cavemous transformation of portal vein (CTPV). Methods A 64-slices spiral CT scanner was used to perform plain and three-phase contrast enhanced abdominal scanning in 22 patients with CTPV. Image post-processing techniques,including MPR,MIP and VR,were applied to depict the abnormal portal vein and its collateral vessels.Results The portal vein was not clearly seen on plain in 22 cases,while multiple soft tissue nodules and strips were found in the porta hepatis region. On dynamic enhanced scans,abnormal hepatic perfusion during arterial phase in 6 cases was demonstrated. On portal vein phase images the main trunk of portal vein and/or its left and right branches were dilated with filling defects in 11 cases. Inconspicuous portal veins were demonstrated. The main trunk of portal vein looked thin in 4 cases. The main trunk of portal vein was lumen stenosis as a result of tumor-infiltrating in 1 case. Pericholedochal venous plexus (86.36%) , cystic vein (77.27%)and esophageal gastric veins (77.27

  4. 门静脉系统血栓的64层螺旋CT诊断价值%The Diagnostic Value of Thrombus in Portal Vein on 64-slice Spiral CT

    Institute of Scientific and Technical Information of China (English)

    韩新巍; 周朋利; 郑颖; 丁鹏绪; 路慧彬; 司江涛

    2009-01-01

    Objective To study the 64-slice spiral CT feature of the thrombus in portal vein. Materials and Methoils Noocontrast-enhanced CT and contrast enhanced CT were performed in all 15 patients. MIP,VR and MPR were used for three dimensional reconstruction. The features of the throw.bus in portal vein were analyzed. Results In 15 cases, 13 cases(83%) occurred in trunk vein,6 cases in right branch,7 cases in left branch,3 cases in splenic vein,9 cases in superior mesenterie vein. Yerdel Grade:Grade Ⅰ1 case,Grade Ⅱ10 cases, Grade Ⅲ 3 cases,GradelV 1 case. 10 cases showed high-dense in thrombus ,3 cases appeared low-dense. 12 cases presented partial filling defect, which is described as stripe and bundles in contrasted vein. All the involved vein had smooth and successive wall and had no appeared nodes protrude out at portal vein period. All the cases with thrombus showed typical track sign or line augmentation sign in involved vein wall. 12 cases displayed collateral circulation in esophag-ogastricand splenic vein, and 4 cases displayed pericholecystic and pericholedochal collateral branches. No case visualized A-P shunt. Conclusion 64-slice spiral CT can display the location, feature and cumulative branch of the thrombus in portal vein distinctly and stereoscopically. 64-slice spiral CT is very important modality for the thrombus in portal vein.%目的 探讨门静脉系统血栓(portal vein thrombosis,PVT)的64层螺旋CT表现特征.资料与方法 15例PVT行64层螺旋CT平扫和双期增强扫描,采用最大密度投影(MIP)、容积再现(VR)及多平面重组(MPR)观察其影像学特征.结果 15例中,血栓发生于门静脉(PV)主干13例,右支6例,左支7例,脾静脉(SV)3例,肠系膜上静脉(SMV)9例,其中血栓同时累及PV主干和SMV 8例,同时累及PV左右支、主干和SMV 4例,累及PV主干和右支6例,累及PV主干和左支6例,累及SV和SMV 2例,PV主干、SV、SMV三岔口处血栓1例.Yerdel分级:Ⅰ级1例,Ⅱ级10例,Ⅲ级3

  5. 肝硬化食管静脉曲张程度门脾静脉内径及Child-Pugh分级的关系%Research on the Relationship among the Esophageal Varices, the Diameter of Portal Vein and Spleen Vein, and ChildPugh's Score in Patients with Liver Cirrhosis

    Institute of Scientific and Technical Information of China (English)

    蒋志凌; 陈旭平; 付冰; 陈霞; 付丹

    2011-01-01

    Objective To discuss the relationship among the esophageal varices, the diameter of portal vein and spleen vein, and Child-Pugh score in patients with liver cirrhosis. Methods The study included 56 patients who had liver cirrhosis between January 2007 and January 2010. We measured their portal vein and spleen vein diameter with CT; used Child-Pugh score to grade their hepatic function; and detected the degree of the esophageal varices by endoscopy. Results There was a positive correlation between the degree of esophageal varices and diameter of portal vein and spleen vein, while no correlation showed between portal vein and spleen vein diameter, degree of esophageal varices, and Child-Pugh score. Conclusion The upper gastrointestinal bleeding in patients with liver cirrhosis can be predicted by the diameter of portal vein and spleen vein, assessment of upper gastrointestinal bleeding based on ChildPugh score should also be taken into account.%目的 探讨肝硬化食管静脉曲张程度与门脾静脉内径、肝功能Child-Pugh分级间的关系.方法 对2007年1月-2010年1月间56例肝硬化患者行增强CT,测量门静脉主十及脾门部脾静脉直径,采用Child-Pugh分级标准进行肝功能分级,并行胃镜了解食管静脉曲张的程度.结果 食管静脉曲张程度与门、脾静脉内径呈正相关,而Child-Pugh分级与门脾静脉内径、食管静脉曲张程度无相关性.结论 根据门、脾静脉内径可预测肝硬化上消化道出血的可能性;在Child-Pugh分级基础上对患者上消化道出血的风险进行评估显得尤为重要.

  6. Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Francica, G.; Marone, G.; D' Angelo, V. [Divisione di Gastroenterologia, Ospedale ' ' Cardinale Ascalesi' ' , Naples (Italy); Solbiati, L. [Divisione di Ecografia e Radiologia Interventistica, Ospedale Generale Busto Arsizio (Italy); Siani, A. [Servizio di Radiologia, Ospedale Civile ' ' S. Maria Delle Grazie' ' , Pozzuoli (Italy)

    2000-06-01

    A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures. (orig.)

  7. Portal cholangiopathy: case report

    Directory of Open Access Journals (Sweden)

    Maria Cecilia Almeida Maia

    2014-01-01

    Full Text Available The present report describes the case of a child that after blunt abdominal trauma presented with portal thrombosis followed by progressive splenomegaly and jaundice. Ultrasonography and percutaneous cholangiography revealed biliary dilatation secondary to choledochal stenosis caused by dilated peribiliary veins, characterizing a case of portal biliopathy. The present case report is aimed at presenting an uncommon cause of this condition.

  8. 儿童门静脉海绵样变性的多层螺旋CT研究%Spiral CT Diagnosis of Cavernous Transformation of the Portal Vein in Children

    Institute of Scientific and Technical Information of China (English)

    刘玥; 彭芸; 段晓珉; 曾津津; 孙国强

    2011-01-01

    Objective To investigate the value of 64-slice multi-detector computed tomography(MDCT) in the diagnosis of cavernous transformation of portal vein(CTPV) in children. Materials and Methods 22 patients were screened out by uhrasonography (US) at first,then received contrast enhanced CT scan(arterial and venous phase). Imaging data of CTPV were processed with CT reconstruction. All CT images were evaluated by two radiologists and a consensus was reached regarding liver parenchyma, portal vein and collateral circulation. Results In all 22 cases,the trunk and branches of portal vein of 14 eases(64% ) were broaden and circuitous with narrow intrahepatic portal vein. The congenital absence of portal vein were observed in 4 cases( 18% ) including 1 trunk and 3 left branch. Four cases( 18% )showed portal vein thrombosis including 1 tumor embolus and 3 thrombus. 22 cases of CTPV showed collateral veins, which were biliary collateral veins of the portal vein (n = 22,100% ), gallbladder vein (n = 16,73 % ), gastric collateral veins (n= 21,95 % ), pancreatieoduodehal region collateral veins(n =5,23% ) and parumbilical collateral veins (n = 1,5% ). The other forms of portal-systemic shunt collateral veins included spleen-gastric collateral veins,ascending lumbar vein-spleen vein and spleen-kidney vein( n = 18,82% ). Abnormal hepatic perfusion was detected in 3 cases. 11 cases(50% ) appeared disproportion of liver lobes,20 cases showed splenomegaly and 4 hepatomegaly. The other characteristic features included congenital anomaly of bile ducts (n = 1 ), thicken walls of gastrointestinal tract, mesentery and lesser omentum swelling( n = 5 ) and ascites/pleural fluid (n = 8). Conclusion MDCT is an effective method to diagnose CTPV and may be great helpful for clinical treatment.%目的 探讨64排螺旋CT在诊断儿童门静脉海绵样变性(cavernous transformation of the portal vein,CTPV)中的临床价值.资料与方法 22例CTPV患者

  9. Mesenteric vein thrombosis: CT identification

    Energy Technology Data Exchange (ETDEWEB)

    Rosen, A.; Korobkin, M.; Silverman, P.M.; Dunnick, N.R.; Kelvin, F.M.

    1984-07-01

    Superior mesenteric vein thrombosis was identified on computed tomographic scans in six patients. In each case, contrast-enhanced scans showed a high-density superior mesenteric vein wall surrounding a central filling defect. Four fo the six patients had isolated superior mesenteric vein thrombosis. A fifth patient had associated portal vein and splenic vein thrombosis, and the sixth patient had associated portal vein and inferior vena cava thrombosis. One of the six patients had acute ischemic bowel disease. The other five patients did not have acute ischemic bowel symptoms associated with their venous occlusion. This study defines the computed tomographic appearance of mesenteric vein thrombosis.

  10. El Portal Latino Alzheimer's Project: model program for Latino caregivers of Alzheimer's disease-affected people.

    Science.gov (United States)

    Aranda, Maria P; Villa, Valentine M; Trejo, Laura; Ramírez, Rosa; Ranney, Martha

    2003-04-01

    The article describes the El Portal Latino Alzheimer's Project--a dementia-specific outreach and services program targeting Latino caregivers in the Los Angeles County area. The project is an example of an interorganizational community-based collaborative developed to provide an array of coordinated, ethnic-sensitive services to Latino dementia-affected adults and their family caregivers, using culturally specific outreach and services delivery strategies. Results of an evaluation of service utilization indicate a reduction in barriers to care and an increase in services utilization. Los Angeles County provides a natural urban laboratory to study the special needs and circumstances of older Latinos dealing with chronic and debilitating illnesses. Implications for social work practice are discussed.

  11. Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization-the effect of collaterals on embolized liver volume.

    Science.gov (United States)

    Zeile, Martin; Bakal, Artur; Volkmer, Jan E; Stavrou, Gregor A; Dautel, Philip; Hoeltje, Jan; Stang, Axel; Oldhafer, Karl J; Brüning, Roland

    2016-12-01

    The purpose of this retrospective study was to monitor hypertrophy of future liver remnant following portal vein embolization (PVE) before planned extended right hepatectomy. However, because individual responses to PVE are highly variable, our focus was to identify cofactors of successful hypertrophy. 28 patients with primary or secondary liver tumours, mean age 64.1 ± 12.9 years, underwent PVE. Volumetric analysis of hypertrophy before and after PVE (median 39.0 ± 15.7 days) was performed. The embolized liver segments were investigated for occurrence of reperfusion of their portal branches. Blood parameters before PVE were additionally investigated. Patients were divided into responders (21/28) and non-responders (7/28) by post-PVE standardized future liver remnant being above or below 25%, respectively. No significant differences between the groups were found regarding biometric and volumetric parameters before PVE. In the entire group after PVE, the mean absolute increase of Segments 2 and 3 was 196.0 ± 84.7 cm(3) and the median relative increase was 46.6 ± 98.8%. The formation of left to right hepatic portoportal collaterals exhibited a negative correlation to successful hypertrophy (p = 0.004) as well as low plasma total protein (p = 0.019). Successful embolization of Segment IV showed only a trend to significance (p = 0.098). Cofactors associated with a favourable outcome regarding hypertrophy were the absence of collaterals in the control CT scans and high plasma total protein. Advances in knowledge: Portoportal collaterals negatively influence hypertrophy after PVE. On the other hand, plasma total protein is a positive prognostic indicator on hypertrophy of the liver in our cohort.

  12. 肝移植术后门静脉狭窄-肠系膜上静脉血栓的影像诊断%Imaging diagnosis of portal vein stricture complicated with superior mesenteric venous thrombosis after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    姜英丽; 陈虹; 李朝阳; 叶道斌; 张庆; 范铁艳; 沈中阳

    2010-01-01

    @@ 肠系膜上静脉血栓(superior mesenteric venous thrombosis,SMVT)发病率较低,多与肝移植行脾切除后门静脉高压及红细胞黏度增高等有关,其临床表现无特异性,易误诊、漏诊.本研究回顾性分析2009年12月26日我所收治的肝移植术后门静脉狭窄伴SMVT患者的临床资料,总结该病的影像学诊断要点.%Portal vein stricture complicated with superior mesenteric venous thrombosis is rarely seen in clinical practice. On December 26, 2009, a 51-year-old male patient who had a liver transplantation history was admitted to The General Hospital of Chinese People's Armed Police Forces with the chief complaint of intermittent abdominal pain and diarrhea.A plain and enhanced CT scan showed that the portal vein was constrictive and thrombosis had formed in the main trunk of the superior mesenteric vein, and varicose veins were seen in surrounding tissues of the esophagus. Edema was observed at the end of the ileum and cecum. The results of colonoscopy showed inflammatory changes and varicose veins of the colon. The patient received medical treatment. The thrombosis was dissolved 9 days later, and all symptoms disappeared 12 days later.

  13. High Incidence of Hepatitis B Infection-Associated Cirrhosis and Hepatocellular Carcinoma in the Southeast Asian Patients with Portal Vein Thrombosis

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    Auewarakul Chirayu U

    2011-06-01

    Full Text Available Abstract Background Portal vein thrombosis (PVT is a rare condition associated with serious morbidity and mortality. The objective of this study was to determine the frequency, clinical presentations, and risk factors of PVT from the set of data firstly collected among the Southeast Asian population. Methods A retrospective study was undertaken to identify patients diagnosed with thrombosis of the portal system and other abdominal veins. The hospital medical records were retrieved based on the selected ICD-10 codes. Clinical presentations were collected and risk factors determined. Results From 2000-2009, 467 hospital charts with designated ICD-10 codes of I81, I82.2, I82.3, I82.8, I82.9, or K55.0 were identified. PVT (I81 was the most common thrombosis (194 cases, 41.54%. The majority of PVT patients were males (65%, older than 40 years (75%, and presented with abdominal distension/ascites (69%, splenomegaly (54.6%, and abdominal pain (50.5%. Overall, the predominant risk factor was hepatocellular carcinoma (HCC (52.5%, followed by liver cirrhosis without cancer (9.3%, abdominal infection/inflammation (9.3%, cholangiocarcinoma (8.2%, and abdominal intervention (7.7%. In young patients, abdominal interventions including umbilical catheterization (23.1% and hepatectomy (7.7% were the most frequent risks whereas in older cases, primary hepatobiliary cancer and cirrhosis (78% were the major risks. Liver metastases from other organs were infrequently found. Chronic hepatitis B virus (HBV infection was the main etiology associated with cirrhosis/HCC leading to PVT in this cohort. A third of the older PVT patients (age >40 had HBV and very few carried hepatitis C virus (HCV whereas none of the young PVT patients (age Conclusion HBV is the major risk of PVT in the Southeast Asian population. Several risk factors identified in this population have rarely been described and some are remarkably different from those reported in the West. Host and

  14. VCT 640 Layer 4 d- DSA in the Diagnosis of Liver Portal Vein Disease%640层VCT 4D-DSA对肝癌门静脉病变的诊断

    Institute of Scientific and Technical Information of China (English)

    李波; 王凯; 王金珠; 姜涛; 葛欣然; 齐宏伟; 王勇

    2016-01-01

    目的:探讨640层容积CT 4D-DSA技术评价肝癌门静脉病变异及的应用价值。方法回顾分析2012年5月—2015年5月该院确诊的80例肝癌患者640层容积CT 4D-DSA技术检查影像资料。将获得的所有容积数据导入后处理工作站,选择肝门静脉显示最佳的图像分析肝癌门静脉病变。选择80名患者三期肝脏增强扫描后所受辐射剂量进行对比。结果共有80例图像质量符合标准,存在门静脉双重供血动脉4例,80例患者中门静脉病变的36例,单纯肝动脉-门静脉瘘6例(占16.6%),单纯门静脉癌栓7例(占19.4%),肝动脉-门静脉瘘合并门静脉癌栓18例(占50%),门静脉闭塞5例(占13.8%),门静脉癌栓阻塞合并门静脉海绵样变3(占8.3%)。两种检查序列辐射剂量的有效剂量ED分别为10.539 mSv、23.159 mSv,对比结果,差异具有统计学意义P<0.05。结论640层容积CT的低辐射剂量、高清晰模仿DSA图像能应用与肝癌门静脉病变的诊断,并有助于治疗方案和预后的评价。%Objective To explore the application value of 640 slice volume 4D-DSA CT technique in the evaluation of hepatic portal vein disease variation Methods A retrospective analysis of 80 cases of hepatocellular carcinoma in our hospital from May 2012 to May 2015 was diagnosed by 640 slice volume 4D-DSA CT technique. Male 41 cases, female 39 cases, age 40~72 years old, average age (58.5±5.9) years old. All the volume data were imported into the post pro-cessing station, and the data were processed according to the time order. Selection of hepatic portal vein to display the best image analysis of hepatic portal vein lesion. The radiation doses were compared between 80 patients with stage three liver enhancement scan. Results A total of 80 patients with image quality conforms to the standard, there portal double blood supply artery in 4 cases. Including 36 patients with portal vein diseases, simple hepatic artery portal vein fistula in 6 cases (16

  15. Tromboflebite séptica da veia porta secundária à apendicite Septic thrombophlebitis of the portal vein as a complication of appendicitis

    Directory of Open Access Journals (Sweden)

    Olival Cirilo Lucena da Fonseca-Neto

    2007-06-01

    Full Text Available INTRODUÇÃO: A tromboflebite séptica da veia porta ou pileflebite é evento raro e associado com alta mortalidade e seu diagnóstico requer a demonstração de trombo portal. RELATO DO CASO: Mulher de 19 anos com história de dor abdominal há 40 dias com piora há 10 foi admitida no hospital. Referia dor de forte intensidade em hipocôndrio direito, vômitos, febre, e calafrios. No exame físico de entrada tinha sinais e sintomas de sepse abdominal. Submetida à laparotomia exploradora foi encontrado abscesso hepático e apêndice ileiocecal rôto e bloqueado. Realizada apendicectomia e drenagem de abscesso, que evoluiu com necessidade de re-laparotomia no 6º dia e drenagem de novos abscessos hepáticos. Após longa internação, recebeu alta e no seguimento de 6 meses estava bem. CONCLUSÃO: A pileflebite é complicação rara, porém grave, devendo ser rapidamente diagnosticada e o seu manejo multidisciplinar instituído prontamente.BACKGROUND:Portal vein septic thrombophlebitis or pylephlebitis is a rare event associated with high mortality rates and its' diagnosis requires portal thrombosis demonstration. CASE REPORT: Nineteen year-old female was admitted to the hospital with a history of abdominal pain for the last 40 days, worsening for the last 10. The patient complained of intense and strong pain in the right hypochondrium, vomit, fever and cold chills. During physical examination the patient showed signs and symptoms of abdominal sepsis. She was then submitted to exploratory laparotomy, during which a hepatic abscess and blocked and ruptured ileocecal appendix was found. Appendicectomy and drainage of the abcess was performed, having the necessity of a second laparotomy in the sixth day and further drainage of new formatted hepatic abscesses. After a long period of admission, the patient was discharged and was well following the next six months. CONCLUSION: Pylephlebitis is a rare and severe complication, which has the urgency of

  16. Aneurisma venoso na junção esplenomesentérica e emergência da veia porta: relato de caso Venous aneurysm at the splenomesenteric confluence at the level of portal vein emergence: a case report

    Directory of Open Access Journals (Sweden)

    Mário Müller Lorenzato

    2009-06-01

    Full Text Available Os aneurismas no sistema esplenoportomesentérico são uma entidade clínica rara e de etiologia desconhecida, tendo como fatores contribuintes hipertensão portal, doença hepática crônica e trauma, entre outros. Os autores apresentam os achados de imagem de um caso de aneurisma na junção esplenomesentérica ao nível da emergência da veia porta, em uma paciente de 62 anos de idade sem fatores predisponentes.Aneurysms in the splenoportomesenteric system constitute a rare entity whose etiology is still to be determined. Predisponent factors include portal hypertension, chronic hepatic disease and trauma, among others. The authors present a case of an aneurysm at the splenomesenteric confluence where it joins the portal vein, in a female, 62-year-old patient with no predisponent factor.

  17. Influência do grau de insuficiência hepática e do índice de congestão portal na recidiva hemorrágica de cirróticos submetidos a cirurgia de Teixeira-Warren Role of liver function and portal vein congestion index on rebleeding in cirrhotics after distal splenorenal shunt

    Directory of Open Access Journals (Sweden)

    Fabio Gonçalves Ferreira

    2007-06-01

    distal em relação aos Child-Pugh A.BACKGROUND: Bleeding from esophagogastric varices is the worst and most lethal complication of cirrhotic portal hypertension. Distal splenorenal shunt (Warren’s surgery is used in the therapeutic of this patients, Child A and B, with rebleeding after clinical endoscopic therapy. The portal vein congestion index is elevated in cirrhotic portal hypertension and could predict rebleeding after Warren’s surgery in these patients. AIM: To verify if the portal vein congestion index or liver function (Child-Pugh at preoperative are predictive factors of rebleeding after Warren’s surgery. METHODS: Sixty-two cirrhotic patients were submitted to Warren’s surgery at "Santa Casa" Medical School and Hospital - Liver and Portal Hypertension Unit, São Paulo, SP, Brazil. Fifty-eight were analyzed for Child-Pugh class and 36 for portal vein congestion index, divided in two groups: with or without rebleeding and statistical analysis was performed. RESULTS: In the rebleeding group, 69% were Child B, with portal vein congestion index = 0.09. The group without rebleeding show us 62% patients Child A with portal vein congestion index = 0.076. The difference was significant for Child-Pugh class but not to portal vein congestion index. CONCLUSION: Portal vein congestion index was not predictive of rebleeding after Warren’s surgery, but cirrhotics Child B have more chance to rebleed after this surgery than Child A.

  18. Dietary fructooligosaccharides and transgalactooligosaccharides can affect fermentation characteristics in gut contents and portal plasma of growing pigs

    NARCIS (Netherlands)

    Houdijk, J.G.M.; Verstegen, M.W.A.; Bosch, M.W.; Laere, van K.J.M.

    2002-01-01

    We studied whether dietary non-digestible oligosaccharides (NDOs) affected pH and volatile fatty acids (VFAs) in gastrointestinal contents and in portal plasma of young pigs. Five groups of five 57-day-old pigs received for 44 days either a corn-based control diet or this diet with 7.5 or 15 g/kg fr

  19. Regional differences of reactivity to stimulants in the dog portal tree.

    OpenAIRE

    Fujii, K.; Fujiwara, M.; Kumada, K; Kurahashi, K; Usui, H.

    1987-01-01

    We studied the regional differences both of reactivity to various stimulants and of neurogenic responses elicited by transmural stimulation in the longitudinal and circular muscles of the truncal portal vein, mesenteric vein, splenic vein and gastric vein of the dog portal tree. Strong spontaneous activity appeared in the longitudinal muscle of the truncal portal vein (96% of preparations tested). Weak spontaneous activity sometimes appeared in the circular muscle of the truncal portal vein (...

  20. Influence of percutaneous transhepatic fundus vein embolism and splenic arterial embolism on portal hemodynamics in hepatocirrhosis%胃底静脉栓塞及脾动脉栓塞对门脉血流动力学的影响

    Institute of Scientific and Technical Information of China (English)

    杨艳; 朱曙光; 杨秀成; 盖伟; 柴同海; 刘春安

    2008-01-01

    Objective To study influence of percutaneous transhepatic fundus venous embolism (PTVE) and partial splenic embolism(PSE) on portal hemodynamics. Methods FINE and PSE were performed on 43 patients with portal hypertension. Free portal pressure (FPP) was determined, respectively, before and after VINE and after PTVE + PSE. At the same time, color Doppler ultrasonic angiography was used to measure diameter and maximal blood flow rate of portal vein (PV) and splenic vein (SV). Average rates of these venae were calculated and volumes of blood flow were estimated. Results FPP was respectively, before and after PTVE (P > 0.05). FPP was significantly different from that before operation (P 0.05).PTVE+PSE后FPP明显下降(P<0.05).PV、SV直径明显缩小、血流速度显著改善(P<0.05).结论 联合PTVE及PSE在快速有效的降低门脉压力的同时并不影响门脉平均血流量.在显著改善食管静脉曲张的同时能较好的维持肝脏灌流,对相应症状的改善有重要意义.

  1. Diagnosis of portal vein aneurysns ant its rare complications with 3D DCE-MRA%门静脉瘤及少见并发症的3D DCE-MRA诊断

    Institute of Scientific and Technical Information of China (English)

    陈炜; 程晓青; 田建明; 陆建平; 刘崎; 王丽

    2011-01-01

    目的:回顾性分析门静脉瘤(portal vein ametryem,PVA)合并少见并发症的影像学特点,并探讨三维增强磁共振血管成像(3D DCE-MRA)对PVA的诊断价值.方法:利用3DDCE-MRA对10例PVA患者进行回顾性分析,显示及记录PVA的部位、大小、范围及并发症的情况.结果:10例PVA患者,瘤体位于脾静脉3例,肝内门静脉3例,肠系膜上静脉与脾静脉汇合部2例,门静脉主干2例.PVA最大径从8.39cm到2.00cm不等.PVA患者伴发多种少见并发症,通过3D DCE-MRA不同的三维重组技术能很好的显示.结论:3D DCE-MRA有效的诊断PVA,充分的显示门静脉的并发症,为临床治疗提供更多的影像学资料.%Objective:To investigate imaging features of portal vein aneurysms CPVA) associated with multiple associated findings and to discuss the value of three-dimensional multiphase contrast-enhanced MR angiography (3D DCE-MRA) in detecting PVA. Methods: 3D DCE-MRA with comprehensive use of various post processing methods was performed in 10 PVA patients. Imaging features of these PVA were analyzed. Results: Of the 10 patients. PVA were located in the spleen vein in 3 cases, in the intrahepatic portal vein in 3 cases, in the confluence of the superior mesenteric vein and spleen vein in 2 cases, and in the main portal vein in 2 cases. The maximal diameter of the PVA varied from 8. 39 cm to 2. 0 cm (mean ± SD, 3. 72±1. 84 cm). There were several cases associated with multiple associated findings of PVA. The various post processing methods were good for diagnosing the different associated findings. Conclusion: 3D DCE-MRA proved to be effective in detecting PVA, improve the diagnosis of associated findings, and supply more information for clinical treatment of PVA.

  2. Association between Portal Vein Thrombosis and Survival in Non-Liver-Transplant Patients with Liver Cirrhosis: A Systematic Review of the Literature

    Directory of Open Access Journals (Sweden)

    Xingshun Qi

    2015-01-01

    Full Text Available A systematic review of the literature was performed to analyze the association between portal vein thrombosis (PVT and survival in non-liver-transplant patients with liver cirrhosis. PubMed, EMBASE, and Cochrane Library databases were searched for all relevant papers which evaluated the prognostic value of PVT in predicting the survival of liver cirrhosis. Meta-analyses were not conducted because the ways of data expression and lengths of follow-up were heterogeneous among studies. Overall, 13 papers were included. The 5-day, 6-week, and 1-year mortality were investigated in 1, 3, and 1 studies, respectively; and all of them were not significantly different between cirrhotic patient with and without PVT. By comparison, the 3-year mortality was reported in 1 study; and it was significantly increased by the presence of PVT. The overall mortality was analyzed in 5 studies; and the association with overall mortality and PVT was significant in 4 studies, but not in another one. However, as for the cirrhotic patients undergoing surgical or interventional shunts, the overall mortality was not significantly associated with the presence of PVT in 4 studies. In conclusion, the presence of PVT might be associated with the long-term mortality in non-liver-transplant patients with liver cirrhosis, but not with the short-term mortality.

  3. Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history

    Energy Technology Data Exchange (ETDEWEB)

    Marin, Daniele [Duke University Medical Center, Department of Radiology, Durham, NC (United States); University of Rome Sapienza, Department of Radiological Sciences, Rome (Italy); Galluzzo, Anna; Brancatelli, Giuseppe [Universita di Palermo, Istituto di Radiologia, Palermo (Italy); Plessier, Aurelie; Valla, Dominique [Service d' Hepatologie, Hopital Beaujon, Clichy (France); Vilgrain, Valerie [Assistance Publique des Hopitaux de Paris, APHP, Hopital Beaujon, Department of Radiology, Clichy (France); Universite Paris 7 Denis Diderot, Paris (France)

    2011-10-15

    To retrospectively investigate the prevalence, MR findings, natural history, and association with other hepatic lesions of focal nodular hyperplasia (FNH)-like lesions in a cohort of consecutive patients with cavernous transformation of the portal vein (CTPV). This retrospective IRB-approved study comprised 58 patients (32 men, 26 women; average age, 50 years) with CTPV who underwent liver MR imaging between 2000 and 2008. MR images were assessed by two radiologists in consensus for the presence of (a) FNH-like lesions and other liver lesions, and (b) other imaging findings. Patients were assigned to a stable or progressive clinical course based on lesion characteristics at follow-up. Twelve of 58 patients (21%) had 38 FNH-like lesions (average size, 1.3 cm). Common findings of FNH-like lesions were isointensity on T2-weighted images (82%), intense and homogeneous enhancement during the arterial phase, and lack of washout during the hepatic venous and interstitial phases (100%). FNH-like lesions were found with other benign liver lesions (1 hemangioma, 1 adenoma) in two patients. Three (25%) patients with FNH-like lesions showed a progressive clinical course. FNH-like lesions are commonly detected in patients with CTPV. Most lesions demonstrate benign imaging findings and stable clinical course. (orig.)

  4. Transarterial Chemoembolization for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: Prognostic Factors in a Single-Center Study of 188 Patients

    Directory of Open Access Journals (Sweden)

    Lei Liu

    2014-01-01

    Full Text Available Transarterial chemoembolization (TACE could achieve a better survival benefit than conservative treatment for advanced hepatocellular carcinoma (HCC with portal vein tumor thrombosis (PVTT. In this retrospective study, all HCC patients with Child-Pugh score <7 and PVTT who were consecutively admitted to our center between January 2006 and June 2012 and underwent TACE were enrolled. The efficacy and safety of TACE were analyzed. Prognostic factors were determined by Cox regression analysis. Of the 188 patients included, 89% had hepatitis B virus infection, 100% were at Barcelona Clinic Liver Cancer stage C, and 81% (n=152 and 19% (n=36 were at Child-Pugh classes A and B, respectively. The incidence of procedure-related complications was 88%. No procedure-related death was found. The median overall survival was 6.1 months. Type of PVTT (hazard ratio [HR] = 2.806, number of tumor lesions (HR = 2.288, Child-Pugh class (HR = 2.981, and presence of metastasis (HR = 1.909 were the independent predictors of survival. In conclusion, TACE could be selectively used for the treatment of advanced HCC with PVTT. But a high rate of postoperative adverse events should not be undermined in spite of no procedure-related death. Preoperative type of PVTT, number of tumor lesions, Child-Pugh class, and metastasis could predict the prognosis of these patients.

  5. Portal vein embolization with n-butyl-cyanoacrylate through an ipsilateral approach before major hepatectomy: single center analysis of 50 consecutive patients.

    Science.gov (United States)

    Luz, José Hugo Mendes; Luz, Paula Mendes; Bilhim, Tiago; Martin, Henrique Salas; Gouveia, Hugo Rodrigues; Coimbra, Élia; Gomes, Filipe Veloso; Souza, Roberto Romulo; Faria, Igor Murad; de Miranda, Tiago Nepomuceno

    2017-09-20

    To evaluate the efficacy of portal vein embolization (PVE) with n-Butyl-cyanoacrylate (NBCA) through an ipsilateral approach before major hepatectomy. Secondary end-points were PVE safety, liver resection and patient outcome. Over a 5-year period 50 non-cirrhotic consecutive patients were included with primary or secondary liver cancer treatable by hepatectomy with a liver remnant (FLR) volume less than 25% or less than 40% in diseased livers. There were 37 men and 13 women with a mean age of 57 years. Colorectal liver metastases were the most frequent tumor and patients were previously exposed to chemotherapy. FLR increased from 422 ml to 629 ml (P < 0.001) after PVE, corresponding to anincrease of 52%. The FLR ratio increased from 29.6% to 42.3% (P < 0.001). Kinetic growth rate was 2.98%/week. A negative association was observed between increase in the FLR and FLR ratio and FLR volume before PVE (P = 0.002). In 31 patients hepatectomy was accomplished and only one patient presented with liver insufficiency within 30 days after surgery. PVE with NBCA through an ipsilateral puncture is effective before major hepatectomy. Meticulous attention is needed especially near the end of the embolization procedure to avoid complications. Clinical Study ISRCTN registration number: ISRCTN39855523 . Registered March 13th 2017.

  6. Volume Change and Liver Parenchymal Signal Intensity in Gd-EOB-DTPA-Enhanced Magnetic Resonance Imaging after Portal Vein Embolization prior to Hepatectomy

    Directory of Open Access Journals (Sweden)

    Ayako Akiba

    2014-01-01

    Full Text Available Purpose. To investigate the liver volume change and the potential of early evaluation by contrast-enhanced magnetic resonance imaging (MRI using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA after portal vein embolization (PVE. Materials and Methods. Retrospective evaluations of computed tomography (CT volumetry of total liver and nonembolized areas were performed before and 3 weeks after PVE in 37 cases. The percentage of future liver remnant (%FLR and the change ratio of %FLR (%FLR ratio were calculated. Prospective evaluation of signal intensities (SIs was performed to estimate the role of Gd-EOB-DTPA-enhanced MRI as a predictor of hypertrophy in 16 cases. The SI contrast between embolized and nonembolized areas was calculated 1 week after PVE. The change in SI contrast before and after PVE (SI ratio was also calculated in 11 cases. Results. %FLR ratio significantly increased, and SI ratio significantly decreased (both P<0.01. There were significant negative correlations between %FLR and SI contrast and between %FLR and SI ratio (both P<0.01. Conclusion. Hypertrophy in the nonembolized area after PVE was indicated by CT volumetry, and measurement of SI contrast and SI ratio in Gd-EOB-DTPA-enhanced MRI early after PVE may be useful to predict the potential for hepatic hypertrophy.

  7. Observation on the course and distribution of the right posterior branch of portal vein in 100 cases%100例门静脉右后支的走行与分布观察

    Institute of Scientific and Technical Information of China (English)

    谢于; 胡文炜; 蔡守旺; 董家鸿

    2011-01-01

    目的 根据肝内门静脉的走行分布,对门静脉的右后支进行分类,为影像学和肝脏外科提供资料.方法 采用100 例正常的活体肝移植供肝影像资料,研究右后叶肝内门静脉的走行和分布.结果 100 例资料中门脉的右后支呈弓型的34 例,呈两支型的27 例,呈三支型的9 例,存在右前支变异的30 例.结论 右后叶大约有30%在解剖学上不能完全分界,不符合Couinaud 的分段方法.%Objective To evaluate the intrahepatic portal veins and hepatic veins of right posterior lobe of liver, put up a definition of hepatic segment for the imaging and liver surgery. Methods Using 100 successive sections of the upper abdomen of adult MRI enhanced images of living donor for liver transplantation.The course and division pattern of the intrahepatic portal vein and the hepatic veins, and also the relationship between them were investigated. Results Among the 100 right posterior of portal veins. arch-like pattern seen in 34 cases. two branches appeared in 27. three branches appeared in 9, variant appeared in 30.Conclusion The right posterior segments can not be identified about 30% by Couinaud's classification.

  8. 部分脾栓塞术后门静脉系统血栓形成%Portal vein thrombosis after partial splenic embolization

    Institute of Scientific and Technical Information of China (English)

    蔡明岳; 孟晓春; 陈俊伟; 黄文薮; 周斌; 郭永建; 朱康顺; 单鸿

    2011-01-01

    Objective To investigate the clinical outcome and treatment of portal vein thrombosis (PVT) following partial splenic embolization (PSE).Methods From April 2006 to April 2010,105patients with hypersplenism caused by cirrhotic portal hypertension were treated with PSE.Contrastenhanced abdominal computed tomography or magnetic resonance imaging was performed routinely in 60patients before PSE and 1 -3 months after PSE.PVT was detected in 10 patients on images after the procedures.After PVT was diagnosed,4 patients received anticoagulant therapy immediately,and the other 6 patients did not receive therapy.Clinical data of these 10 PVT patients were analyzed retrospectively.Results 3 of 4 patients who received anticoagulant therapy had complete or partial resolution of the thrombus,and one developed mild ascites without thrombosis progression.Of the 6 patients who did not receive anticoagulant therapy,follow-up studies (6- 48 months,mean 16.9 months) demonstrated partial clot calcification in one,thrombosis progression in 5.Among those 5 patients with thrombosis progression,two experienced hematemesis due to variceal rupture and underwent transjugular intrahepatic portosystemic shunt,2 developed cavernous transformation,extensive collateral circulation,ascites and variceal progression,and one had variceal progression with melena during the follow-up period.Conclusions PVT is a severe complication of PSE.Early diagnosis and prompt anticoagulant therapy is effective in preventing PVT.%目的 探讨部分脾栓塞术(partial splenic embolization,PSE)后门静脉血栓形成(portal vein thrombosis,PVT)的治疗方法和转归.方法 2006-2010年中山大学第三医院放射科对105例肝硬化患者(因脾功能亢进)行PSE治疗,其中60例在术后1~3个月行上腹部增强CT或MRI检查,发现PVT10例.10例中4例接受早期抗凝治疗,6例未行抗凝治疗.并对10例患者的临床转归情况做回顾性分析.结果 抗凝治疗患者中,

  9. Factors Affecting the Use of an E-Learning Portal at University

    Science.gov (United States)

    Cegarra-Navarro, Juan-Gabriel; Rodriguez, Francisco Javier Canovas

    2012-01-01

    Electronic learning (e-learning) portals can be defined as websites that store and present materials for online learning, training, performance assessment, and certification. Few, if any, studies have investigated the factors that might contribute to the integration or implementation of e-learning portals in universities. With the development of…

  10. Preliminary experiences of Rex shunt for extrahepatic portal vein obstruction via a conduit of internal jugular vein%颈内静脉搭桥Rex手术治疗小儿肝外门静脉梗阻的初步探讨

    Institute of Scientific and Technical Information of China (English)

    温哲; 王哲; 刘涛; 张向向; 王红英; 申刚; 张靖; 梁奇峰; 刘斐

    2016-01-01

    Objective To evaluate the outcomes of treating extrahepatic portal vein obstruction (EHPVO) by Rex shunt (superior mesenteric-left port vein bypass) with internal jugular vein graft.Methods From October 2014 to June 2015,8 patients of extrahepatic portal vein obstruction underwent Rex shunting with internal jugular vein as a venous graft.The surgical outcomes were evaluated over a follow-up period of 1-9 months.A median longitudinal abdominal incision was made.After peritoneal cavity was satisfactorily opened,round hepatic ligament was resected and lifted.For inflow vein,left portal vein in Rex recess was liberated for around 3 cm.Superior mesenteric vein was identified by tracking mid-colon vein and dissected around 3 crn for outflow.Through 2 small transverse incisions on left side of neck,7~9 cm of left internal jugular vein was harvested as a venous graft.Shunt was established by two end-to-side anastomoses at both ends of jugular vein graft between left portal and superior mesenteric veins.Results There were 5 boys and 3 girls with an average age of 4 (1.3~7) years.The manifestations included gastrointestinal hemorrhage (n =6),hypersplenism (n =6) and hemorrhage & splenomegaly (n =4).Preoperative liver function and blood coagulation were all normal while endoscopy revealed esophageal gastric varices (n =7).Portal vein cavernoma was identified by ultrasound and computed tomography (CT).Portal vein system retrograde angiography showed the presence of left portal vein bifurcation (n =7) and unidentifiable (n =1) (confirmed intraoperatively as atresia).Vascular patency of left portal vein in Rex recess was confirmed (n =7) during surgical exploration followed by Rex shunting.Warren shunt was performed for left portal vein atresia.After shunting,angiography through superior mesenteric vein demonstrated patency of vein graft,better development of intrahepatic portal system and regression of extrahepatic collateral varicose vessels.Portal vein pressure (PVP) was

  11. 256层螺旋CT对肝泡性包虫切除术后门静脉的评价%256 slice spiral CT in the evaluation of portal vein of patients after resection of hepatic alveolar echinococcosis

    Institute of Scientific and Technical Information of China (English)

    韩淼; 鲍海华

    2016-01-01

    Objective:Using 256 slice spiral CT for hepatic alveolar echinococcosis hepatic portal vein imaging before and after resection,then to evaluate the situation of portal vein before and after the operation.Methods:We made a retrospective analysis of 20 patients with hepatic alveolar echinococcosis examined by liver CT examination.CT showed that the lesions were involved in 3 segments of the liver and above,the left and right branches or trunk of the portal vein were violated in different degrees,partial hepatectomy was performed in 20 patients,after 14~20 days performed the liver CT examination,we selected the portal phase of three period enhancement in liver to observe and evaluate,in order to compare the difference of portal vein before and after operation,measuring the diameter of the portal vein to judge the portal vein of patient and whether corresponding complications exist.Results:In 20 cases of patients before the surgery,5 patients with the left branch involved,12 patients with the right branch involved,3 patients with the both branches involved,in which 12 cases of patients with portal vein compression significantly,8 cases of patients with mild portal compression.The MSCT images showed after surgery that 20 cases of patients with portal pressure were improved,and the contrast agent filling well.The diameter measurement results showed that all patients’portal vein were broadening in different degrees,restored to normal level.Conclusion:Multi slice spiral CT can not only evaluate the preoperative portal vein in alveolar echinococcosis disease,providing operational information,but also can provide detailed imaging judgment on the recovery of residual liver portal vein after resection.%目的:利用256层螺旋CT对肝泡性包虫切除前后肝门静脉进行成像,进而对手术前后门脉情况进行评估。方法:回顾性分析行肝脏CT检查确诊为肝泡性包虫病患者20例,CT显示病灶均累及肝脏3段及以上,门脉左右支

  12. A study of the relationship between the portal vein thrombosis and clinical progression in portal hypertension on multi-slice CT portal venography%MSCT门静脉成像对门脉高压症中门静脉血栓形成与临床病情关系的研究

    Institute of Scientific and Technical Information of China (English)

    王克扬; 贺文; 赵丽琴

    2012-01-01

    目的:采用64排螺旋CT门静脉成像探讨肝硬化(LC)门脉高压症(PH)门静脉血栓(PVT)形成对临床病程进展的影响.方法:对183例LC患者行CT检查,其中并发PVT者109例,无血栓者74例,应用MIP、MPR、CPR方法多角度多层面显示门静脉系统血管结构和侧支循环,测量血栓范围和狭窄程度.分别比较PVT组和对照组之间、不同Child-Pugh(CP)分级亚组间的肝功能、凝血功能、门脉系统血管宽度、侧支循环、脾脏大小的差异,分析PVT组各影像特之间及其与肝功能的相关性.结果:PVT组与对照组间的血清总胆红素、门静脉和脾静脉宽度、脾面积、脾/胃-肾分流的差异均有统计学意义(t=-2.830、P=0.005;t=3.576、P0.05);前腹壁静脉曲张在各分级中差异均有统计学意义(χ2=4.485,P=0.034).PVT组肠系膜上静脉血栓与肠壁水肿有一定的相关性(r=0.227,P=0.018);脾静脉与胃左静脉宽度有一定的相关性(r=0.371,P<0.001).结论:门静脉血栓形成与门脉高压症病情密切相关,可能为促进肝硬化临床病程发展的重要因素.%Objective: To investigate the effect of the portal vein thrombosis (PVT) on disease progression of liver cirrhosis (LC) portal hypertension (PH) using CT portal venography (CTPV). Methods:183 patients with LC,divided into PVT group (n = 109) and control group (n = 74) ,were performed by multi slice CT (MSCT). MIP,MPR and CPR were used to display the portal venous system and collateral circulations,and to measure the thrombosis as well as stenosis. The liver function,coagulation function,the imaging features of portal veins and PVT were compared between these two groups, then in different Child Pugh (CP) classifications. Results. There were significant differences between the two groups in total serum bilirubin,the width of main portal vein (MPV) and spleen vein (SPV),sectional area of spleen,splenic or gastric re nal shunt (t = - 2. 830,P = 0. 005 ; t=3. 576,P<0. 001;t=0. 780

  13. Portal cavernoma cholangiopathy: diagnosis, imaging, and intervention.

    Science.gov (United States)

    Moomjian, Lauren N; Winks, Sarah G

    2017-01-01

    The term portal cavernoma cholangiopathy refers to the biliary tract abnormalities that accompany extrahepatic portal vein obstruction (EHPVO) and subsequent cavernous transformation of the portal vein. EHPVO is a primary vascular disorder of the portal vein in children and adults manifested by longstanding thrombosis of the main portal vein. Nearly all patients with EHPVO have manifestations of portal cavernoma cholangiopathy, such as extrinsic indentation on the bile duct and mild bile duct narrowing, but the majority are asymptomatic. However, progressive portal cavernoma cholangiopathy may lead to severe complications, including secondary biliary cirrhosis. A spectrum of changes is seen radiologically in the setting of portal cavernoma cholangiopathy, including extrinsic indentation of the bile ducts, bile duct stricturing, bile duct wall thickening, angulation and displacement of the extrahepatic bile duct, cholelithiasis, choledocholithiasis, and hepatolithiasis. Radiologists must be aware of this disorder in order to provide appropriate imaging evaluation and interpretation, to facilitate appropriate treatment and to distinguish this entity from its potential radiologic mimics.

  14. Endotoxin and tumor necrosis factor-receptor levels in portal and hepatic vein of patients with alcoholic liver cirrhosis receiving elective transjugular intrahepatic portosystemic shunt

    DEFF Research Database (Denmark)

    Trebicka, Jonel; Krag, Aleksander; Gansweid, Stefan

    2011-01-01

    In cirrhosis portal hypertension can promote bacterial translocation and increase serum endotoxin levels. Vice versa, endotoxin aggravates portal hypertension by induction of systemic and splanchnic vasodilation, and by triggering hepatic inflammatory response via tumor necrosis factor α (TNFα......). However, the hepatic elimination of endotoxin in cirrhotic patients with severe portal hypertension, in the absence of acute complications, has not been investigated so far....

  15. Correlation between hepatic CT perfusion imaging and portal vein pressure in normal Beagles%肝脏CT灌注成像与门静脉压力相关性的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    林元为; 陈伟建; 张启瑜; 梁盼; 杨博洋

    2011-01-01

    目的:探讨正常比格犬门静脉压力与肝脏CT血流灌注参数的相关性.方法:采用螺旋CT对24只犬行肝脏灌注成像扫描,去卷积法计算肝脏血流灌注参数,包括血流量(blood flow,BF)、血容量(blood volume,BV)、平均通过时间(mean transit time,MTT)、肝动脉分数(hepatic arterial fraction,HAF)、肝动脉灌注量(hepatic arterial perfusion,HAP)、门静脉灌注量(portal venous perfusion,PVP).扫描后3 d内开腹,采用玻璃水柱法测定门静脉压力.利用直线回归与相关分析门静脉压力与肝脏CT血流灌注参数的相关性.结果:(1)正常比格犬实测门静脉压力值为(13.57±1.15)cmH2O.(2)正常比格犬门静脉压力与BF、PVP呈负相关,与HAF呈正相关,其中以PVP相关性最显著(r=-0.764,P<0.05),两者关系的直线回归方程为Y=16.507-0.037X.结论:肝脏CT灌注成像为无创、有效监测门静脉压力提供了一种新途径.%Objective To evaluate the correlation between the parameters of spiral CT perfusion imaging and portal vein pressure in normal Beagles. Methods Twenty-four normal beagles were selected to receive hepatic spiral CT perfusion imaging. The parameters of hepatic perfusion , including blood flow (BF) , blood volume (BV) ,mean transit time ( MTT) , hepatic arterial fraction ( HAF) , hepatic arterial perfusion ( HAP) , and portal venous perfusion (PVP) , were calculated hy the method of deconvolution. The portal vein pressure was measured by glass column method in laparotomy surgery three days after CT imaging. Results Portal vein pressure of the beagles were ( 13.57 ± 1.15) cmH2O. Portal vein pressure was negatively correlated with the BF and PVP , but was positively correlated with HAF. PVP was the most significant parameter that correlated with portal vein pressure (r = -0.764,P<0.05) , and their linear regression equation was Y = 16.507-0.037X. Conclusion CT perfusion imaging is a new non-invasive and eff'ective method for assessing portal vein

  16. Discussion on diagnosis and treatment in portal vein thrombosis after splenectomy%脾切除术后门静脉血栓形成的诊断及治疗策略

    Institute of Scientific and Technical Information of China (English)

    张爱民; 张涛; 李日恒; 杨季红; 陈治

    2014-01-01

    Objective To investigate the clinical characteristics of PVT in order to ifnd out effective approaches on its diagnosis and treatment.Methods The clinical data of 135 consecutive patients with non-neoplastic liver cirrhosis who had undergone splenectomy from January 2010 to January 2013 in our institution were collected. Clinical and surgical characteristics of the patients who developed PVT postoperatively and those who did not develop PVT were compared.Results 135 patients after splenectomy in 16 cases (11.85%) occurred in PVT, all patients were conifrmed by color Doppler ultrasound or contrast-enhanced CT examination. The comparison of preoperative, postoperative width of portal vein(1.53±0.19) cm vs (0.91±0.19) cm, splenic vein diameter (1.36±0.27) cm vs (0.75±0.19) cm, portal vein blood flow velocity (10.33±1.98) cm/s vs (13.65±2.31) cm/s were thrombus group than in non portal thrombosis group had signiifcant difference. In 15 cases with thrombus dissolving anticoagulant therapy in whole or in part, of which 5 cases underwent percutaneous portal vein puncture and catheterization thrombolysis, followed up for 1 years without recurrence.Conclusion Preoperative portal vein diameter and blood lfow velocity in predicting postoperative portal vein thrombosis has the function of guidance. Once PVT is diagnosed, timely anticoagulation therapy, interventional therapy should be considered as a good choice.%目的:探讨脾切除术后门静脉血栓(portal vein thrombosis,PVT)成因及诊断和治疗策略。方法回顾分析河北大学附属医院普外科2010年1月至2013年1月,16例脾切除术后PVT形成患者的临床及影像学资料并对其进行分析、总结。结果135例患者脾切除术后有16例(11.85%)发生PVT,所有患者均经彩色多普勒超声及增强CT检查确诊。对比术前术后门静脉直径(1.53±0.19)cm vs (0.91±0.19)cm、脾静脉直径(1.36±0.27)cm vs (0.75±0.19

  17. Three cases of digestive tract hemorrhage of portal hypertension combine portal vein wide embolism after transjugular intrahepatic portosystemic stent shunt treatment%颈静脉肝内门体分流术治疗门静脉高压并门静脉广泛栓子后消化道出血三例

    Institute of Scientific and Technical Information of China (English)

    张军华; 张金龙; 张弢; 张素静; 徐慧军; 李玉

    2013-01-01

    目的 探讨经颈静脉肝内门体分流术(TIPS)治疗门静脉高压并门静脉内栓子广泛形成后消化道出血的治疗效果.方法 3例急性上消化道出血患者,均经CT明确诊断为门静脉、肠系膜上静脉内(含1例脾静脉内栓子形成)广泛栓子形成,行TIPS止血治疗,将支架放置于造影所见栓子的远端.结果 TIPS治疗后,随访4~6周3例患者均未再发生出血,不适症状消失.结论 TIPS治疗门静脉高压并门静脉内广泛栓子形成后消化道出血,安全可行,疗效可靠,值得推广.%Objective To investigate the effect of transjugular intrahepatic portosystemic stent shunt (TIPS) on gastrointestinal bleeding after portal hypertension and portal vein wide embolism.Methods Three patients with acute upper gastrointestinal bleeding were diagnosed by CT with wide embolus formation in portal vein and superior mesenteric vein,of which,1 case was with spleen vein embolism formation.TIPS hemostatic treatment was applied to stop bleeding,and stents was placed where distal embolus can be observed by angiography.Results After TIPS treatment,no patients were re-bleeding during following-up periods (4-6 weeks).Uncomfortable symptoms of 3 cases were disappeared.Conclusion TIPS was a safe and effective way to treat gastrointestinal bleeding caused by portal hypertension and wide embolus formation.

  18. Effects of Medium-Chain Triglycerides, Long-Chain Triglycerides, or 2-Monododecanoin on Fatty Acid Composition in the Portal Vein, Intestinal Lymph, and Systemic Circulation in Rats

    Science.gov (United States)

    Nancy You, Yi-Qian; Ling, Pei-Ra; Qu, Jason Zhensheng; Bistrian, Bruce R.

    2011-01-01

    Background Fatty acid absorption patterns can have a major impact on the fatty acid composition in the portal, intestinal lymph, and systemic circulation. This study sought to determine the effects of long-chain triglycerides (LCT), medium-chain triglycerides (MCT), and 2-monododecanoin (2mono) on intestinal fatty acid composition during continuous feeding over a brief period. Methods The lipid sources were 100% LCT, 100% MCT, a 50:50 mixture of LCT and MCT (LCT/MCT), and a 50:50 mixture of LCT and 2mono (LCT/2mono). A total of 27 rats were randomly given 1 of the 4 diets at 200 kcal/kg/d, with 30% of total calories from lipids over 3 hours. Results MCT significantly increased each of the medium-chain fatty acids (C6:0, C8:0, and C10:0) as free fatty acids in the portal vein and about 10%/mol of C10:0 as triglycerides in the lymph compared with the other groups. There was significantly less C10:0 in lymphatic triglycerides with LCT/MCT than with MCT, but more than in the LCT and LCT/2mono diets. MCT also significantly increased the contents of C16:0, C18:0, C18:1, and C20:4 in the lymphatic triglycerides compared with all other groups including LCT/MCT. The amount of linoleic acid (C18:2) in lymphatic triglycerides followed the relative amounts of this fatty acid in the diet, with the greatest in LCT followed by LCT/MCT and LCT/2mono and least in MCT. A so-called structured lipid composed of the medium-chain fatty acid dodecanoic acid on the 2 position and long-chain fatty acids on the 1 and 3 positions appeared to be endogenously synthesized in response to the LCT/2mono diet. Conclusions The original differences in MCT and LCT content in the diets were preserved in the fatty acid composition in the intestinal free fatty acids and triglycerides during feeding. In addition, the duration of lipid administration can play a role in altering fatty acid composition in the intestine. PMID:18407910

  19. Efficacy of thrombolytic therapy on superior mesenteric vein thrombosis by percutaneous transhepatic portal vein catheterization%选择性门静脉系统置管溶栓治疗肠系膜上静脉血栓疗效观察

    Institute of Scientific and Technical Information of China (English)

    杨涛; 陈俊卯; 陈建立; 张国志

    2012-01-01

    Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on superior mesenteric vein thrombosis.Methods The treatment and therapeutic efficacy of 15 cases of patients with superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis from January 2000 to April 2011 were retrospectively analyzed.Results Percutaneous transhepatic portal vein catheterization was performed successfully in 15patients,without pneumothorax,bile leakage and intra-abdominal hemorrhage after catheterization.Eleven patients had good thrombolytic effect,with majority or complete recanalization on superior mesenteric vein,portal vein and splenic vein.The rate of recanalization Was 73.3%,total mortality was 13.3%.The total amount of urokinase was not more than 500 million U,and there was no cases with systemic bleeding.From 6 months to 36months follow-up,there was no increased portal vein system thrombosis and recurrent cases.Conclnsion Thrombolysis technique of percutaneous transhepatic portal vein catheterization is easy to master,and with good effect of local infusion thrombolytic therapy and lower complication rate.It's a selectable treatment for superior mesenteric vein thrombosis.%目的 探讨经皮经肝穿刺门静脉-肠系膜上静脉置管溶栓治疗肠系膜上静脉血栓(MVT)的临床效果.方法 回顾性分析2000年1月至2011年4月通过经皮肝穿门静脉置管溶栓对15例MVT患者的治疗情况及疗效.结果 15例患者均成功经皮肝穿门静脉置管,置管后无气胸、胆漏及腹腔内出血.11例患者溶栓效果佳,肠系膜上静脉、门静脉及脾静脉大部分或完全再通,再通率73.3% (11/15),病死率为13.3%.尿激酶总量未超过500万U,未出现全身各系统出血病例.随访6~36个月,无门静脉系统血栓加重和复发病例.结论 经皮经肝穿刺门静脉系统置管溶栓技术容易掌握,局

  20. 原位肝移植术后门静脉狭窄内支架植入治疗的随访观察%Follow-up study of percutaneous transhepatic portal vein angioplasty and stent placement after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    王欣; 王剑锋; 黄强; 高堃; 翟仁友; 杨伟利

    2013-01-01

    Objective To evaluate the efifcacy of the stent implantation in treatment of portal vein stenosis or thrombosis after liver transplantation. Methods From November 2004 to August 2012, 31 patients with portal vein stenosis after liver transplantation were referred for angiographic analysis and stent placement treatment successfully. After percutaneous transheptic balloon angioplasty, stents were deployed. Thrombolytic therapy for patients with portal vein thrombosis. Embolization was performed in patients with varices or portal vein lfow changes. The therapeutic results were monitored by the follow-up on clinical symptoms and imaging examinationsin inorder to know about the stent and complications. Results Thirty-nine stents were deployed subsequently. Four patients were given thrombolytic therapy, and 5 patients were given collateral embolization included. All the portal vein recanalized and the symptoms were relieved. Besides, 2 patients with portal vein stenosis and cavernous transformation were given stent placement successfully. Portal vein patency was all maintained in 29 patients for 6-99 months. The cumulative patency rate was 100%. In the follow-up study , the splenic vein thrombosis raised again in one case of portal vein thrombosis (PVT) after 17 months therapy. The short-time severe complication related to interventional therapy is thoracic cavity hemorrhage in 1 cases (3.2%);and the long-term complication is the blood lfown down in the other branch of portal vein in 1 cases (3.2%). Conclusions Interventional therapy is an effective method for the treatment of portal vein stenosis after liver transplantation and has low stent restenosis rate. For the patient with PVT, it still has the risk of thrombosis again in the long-term study. And we should be vigilant for possible complications.%目的:评价肝移植术后门静脉狭窄或伴血栓形成者内支架植入治疗的疗效。方法回顾性分析2004年11月至2012年8月,北

  1. 原位肝移植后门脉高压和脾功能亢进的恢复过程%Recovery of portal vein hypertension and hypersplenism after orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    陈大志; 刘爱武; 陈嘉薇; 张新宇; 杨致富; 胡占良; 韩德恩; 陈昭民

    1998-01-01

    By using color Doppler ultrasonography and blood cell counter, the recovery of blood cell counts and hypersplenism in 2 patients, undergoing orthotopic liver transplantation, who were diagnosed having hepatocirrhosis with portal vein hypertension and congestive splenomegaly before the transplantation were clinically observed.It was found that one month af-ter the transplantation, the RBC count gradually returned to normal.13 days after transplanta-tion, WBC count and the platelet count returned to normal.Before transplantation, dilated portal and splenic veins with slow blood flow, and increased spleen volume were observed, while hepatic vein was smaller than normal with recurred blood flow.After transplantation, the size of both portal and splenic veins was reduced gradually, but the size of hepatic vein increased and the veloc-ity of blood flow in these veins increased by more than 200%.One month after transplantation, the size and the blood flow of these veins were close to normal, but there was no significant change in the spleen volume which was still higher than normal.%采用全血细胞计数监测和彩色多普勒超声断层的方法对两例因肝硬化合并门脉高压脾功能亢进而行同种异体原位肝移植术的患者进行了临床观察.全血细胞计数监测显示:与术前相比,红细胞计数在术后一个月之内未见明显改善,一个月之后逐渐恢复近于正常.术后13天白细胞计数和血小板计数恢复至正常范围.彩色多普勒超声断层检查结果表明:术前门、脾静脉口径显著扩张,血流速度缓慢,肝静脉口径相应缩小,血流量减少,脾脏体积显著增大.术后门、脾静脉口径逐渐缩小,肝静脉扩张,各血管的血流速度显著加快(两倍以上),1个月后各血管口径和血流速度虽然近于正常,但脾脏体积仍持续高值.

  2. 肠系膜上静脉-门静脉血栓动物模型的建立%Establishment of animal model of superior mesenteric vein-portal vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    宋鹏; 王茂强; 段留新; 李强; 段峰; 刘凤永; 王志军; 李方广

    2009-01-01

    Objective To assess the feasibility of interventional techniques in the establishment of animal model of superior mesenteric vein-portal vein (SMV-PV) thrombosis. Methods Nine miniature pigs were involved in the study including one for preliminary experiment. After general anesthesia, a balloon catheter was placed in the main trunk of PV to block the portal flow and then thrombin or autologous blood clot was injected to the SMV. Venography was performed to confirm the thrombosis 30 minutes later. Changes in the imaging before and after the thrombosis were observed. Pigs died during the experiment were anatomized to analyze the causes, and pathological examination was performed when necessary. Results The model of SMV-PV thrombosis was successfully established in all the pigs. One pig died of diffuse intravascular coagulation 10 minutes after model establishment in the preliminary experiment. Two pigs died of hepatorrhexis and over dose of anesthetics respec-tively 3 hours after model establishment, and the rest 6 pigs were fed for 14 days. Conclusion Interventional techniques are effective in the establishment of SMV-PV thrombosis model.%目的 探讨血管内介入技术建立肠系膜上静脉-门静脉血栓动物模型的可行性.方法 小型猪9头,选用1头行预实验,8头用于正式实验.全麻下经皮经肝门静脉穿刺,用球囊导管阻塞门静脉主干并注入凝血酶或自体血栓,30 min后行门静脉造影证实肠系膜上静脉-门静脉血栓形成,并比较血栓形成前后影像学变化.对术中死亡动物进行解剖,分析死亡原因,必要时取组织行病理学检查.结果 9头猪均成功建立肠系膜上静脉-门静脉血栓模型.第1头预实验猪模型建立后10 min死亡,病理证实死亡原因为DIC.正式实验8头猪,6头肠系膜上静脉-门静脉血栓形成后饲养14 d,其余2头术后3 h内死亡,死亡原因分别为肝破裂和麻醉药物过量.结论 应用血管内介入技术可以建立肠系膜

  3. Propensity Score Matching Analysis of Changes in Alpha-Fetoprotein Levels after Combined Radiotherapy and Transarterial Chemoembolization for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus.

    Directory of Open Access Journals (Sweden)

    Yuri Jeong

    Full Text Available To investigate the value of changes in alpha-fetoprotein (AFP levels for the prediction of radiologic response and survival outcomes in hepatocellular carcinoma (HCC patients with portal vein tumor thrombus (PVTT who received combined treatment of 3-dimensional conformal radiotherapy (3D-CRT and transarterial chemoembolization (TACE.A database of 154 HCC patients with PVTT and elevated AFP levels (>20 ng/mL treated with 3D-CRT and TACE as an initial treatment between August 2002 and August 2008 was retrospectively reviewed. AFP levels were determined 1 month after radiotherapy, and AFP response was defined as an AFP level reduction of >20% from the initial level. Radiologic response, overall survival (OS, and progression-free survival (PFS rates were compared between AFP responders and non-responders. Propensity-score based matching analysis was performed to minimize the effect of potential confounding bias.The median follow-up period was 11.1 months (range, 3.1-82.7 months. In the propensity-score matching cohort (92 pairs, a best radiologic response of CR or PR occurred in more AFP responders than AFP non-responders (41.3% vs. 10.9%, p < 0.001. OS and PFS were also longer in AFP responders than in non-responders (median OS 13.2 months vs. 5.6 months, p < 0.001; median PFS 8.7 months vs. 3.5 months, p < 0.001.AFP response is a significant predictive factor for radiologic response. Furthermore, AFP response is significant for OS and PFS outcomes. AFP evaluation after combined radiotherapy and TACE appears to be a useful predictor of clinical outcomes in HCC patients with PVTT.

  4. Action of niflumic acid on evoked and spontaneous calcium-activated chloride and potassium currents in smooth muscle cells from rabbit portal vein.

    Science.gov (United States)

    Hogg, R. C.; Wang, Q.; Large, W. A.

    1994-01-01

    1. The action of niflumic acid was studied on spontaneous and evoked calcium-activated chloride (ICl(Ca)) and potassium (IK(Ca)) currents in rabbit isolated portal vein cells. 2. With the nystatin perforated patch technique in potassium-containing solutions at a holding potential of -77 mV (the potassium equilibrium potential), niflumic acid produced a concentration-dependent inhibition of spontaneous transient inward current (STIC, calcium-activated chloride current) amplitude. The concentration to reduce the STIC amplitude by 50% (IC50) was 3.6 x 10(-6) M. 3. At -77 mV holding potential, niflumic acid converted the STIC decay from a single exponential to 2 exponential components. In niflumic acid the fast component of decay was faster, and the slow component was slower than the control decay time constant. Increasing the concentration of niflumic acid enhanced the decay rate of the fast component and reduced the decay rate of the slow component. 4. The effect of niflumic acid on STIC amplitude was voltage-dependent and at -50 and +50 mV the IC50 values were 2.3 x 10(-6) M and 1.1 x 10(-6) M respectively (cf. 3.6 x 10(-6) M at -77 mV). 5. In K-free solutions at potentials of -50 mV and +50 mV, niflumic acid did not induce a dual exponential STIC decay but just increased the decay time constant at both potentials in a concentration-dependent manner. 6. Niflumic acid, in concentrations up to 5 x 10(-5) M, had no effect on spontaneous calcium-activated potassium currents.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7921628

  5. First Left Hepatic Trisectionectomy Including Segment One with New Associated Liver Partition and Portal Vein Ligation with Staged Hepatectomy (ALPPS) Modification: How To Do It?

    Science.gov (United States)

    Obed, Aiman; Jarrad, Anwar; Bashir, Abdalla

    2016-01-01

    Patient: Female, 36 Final Diagnosis: Synchronic CRLM Symptoms: Abdominal pain • abnormal finding in abdominal-pelvic CT scan Medication: — Clinical Procedure: Extended left hepatectomy with left hemicolectomy Specialty: Surgery Objective: Unusual clinical course Background: Associated Liver Partition and Portal vein ligation with Staged hepatectomy (ALPPS) leads to rapid hepatic hypertrophy and decreases incidence of post-hepatectomy liver failure in patients with a marginal future liver remnant. Various procedural ALPPS modifications were previously described. Here, we present the first case of a new ALPPS modification, carrying out a left hepatic trisectionectomy with segment 1. Case Report: We present the case of a 36-year-old woman with locally advanced sigmoid adeno-carcinoma and extensive left liver metastases extending to segment V and VIII, who received state-of-the-art systemic conversion chemotherapy. Preoperative CT volumetric scan demonstrated a FLR/TLV (Future Liver Remnant/Total Liver Volume) of 22%. A left hepatic trisectionectomy procedure was conducted using our new ALPPS modification. Sufficient hepatic hypertrophy of FLR was reached with a volume increase of 100%. The period between the 2 stages was 7 days. The patient underwent left trisectionectomy and left colectomy with tumor-free margins. All dissected lymph nodes were tumor-negative. The surgical intra- and postoperative course was uneventful. Medically, the patient acquired an Acinetobacter infection, with severe sepsis and acute renal injury. After 3 dialysis sessions, the renal function recovered completely. Afterwards, the patient recovered slowly, and reintroduction ambulation and oral feeding was prolonged. Later on, the patient received Xeloda 1500 mg twice daily as adjuvant chemotherapy. Conclusions: The new ALPPS modification leads to a sufficient hypertrophy of FRL within 1 week, allowing left hepatic trisectionectomy with tumor-free FRL. Despite the challenging complications

  6. Preoperative Estimation of Future Remnant Liver Function Following Portal Vein Embolization Using Relative Enhancement on Gadoxetic Acid Disodium-Enhanced Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Sato, Yozo [Department of Radiology, Aichi Medical University, Aichi 480-1195 (Japan); Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Matsushima, Shigeru; Inaba, Yoshitaka [Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Sano, Tsuyoshi [Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Yamaura, Hidekazu; Kato, Mina [Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Shimizu, Yasuhiro; Senda, Yoshiki [Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Ishiguchi, Tsuneo [Department of Radiology, Aichi Medical University, Aichi 480-1195 (Japan)

    2015-11-01

    To retrospectively evaluate relative enhancement (RE) in the hepatobiliary phase of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging as a preoperative estimation of future remnant liver (FRL) function in a patients who underwent portal vein embolization (PVE). In 53 patients, the correlation between the indocyanine green clearance (ICG-K) and RE imaging was analyzed before hepatectomy (first analysis). Twenty-three of the 53 patients underwent PVE followed by a repeat RE imaging and ICG test before an extended hepatectomy and their results were further analyzed (second analysis). Whole liver function and FRL function were calculated on the MR imaging as follows: RE x total liver volume (RE Index) and FRL-RE x FRL volume (Rem RE Index), respectively. Regarding clinical outcome, posthepatectomy liver failure (PHLF) was evaluated in patients undergoing PVE. Indocyanine green clearance correlated with the RE Index (r = 0.365, p = 0.007), and ICG-K of FRL (ICG-Krem) strongly correlated with the Rem RE Index (r = 0.738, p < 0.001) in the first analysis. Both the ICG-Krem and the Rem RE Index were significantly correlated after PVE (r = 0.508, p = 0.013) at the second analysis. The rate of improvement of the Rem RE Index from before PVE to after PVE was significantly higher than that of ICG-Krem (p = 0.014). Patients with PHLF had a significantly lower Rem RE Index than patients without PHLF (p = 0.023). Relative enhancement imaging can be used to estimate FRL function after PVE.

  7. Distúrbios trombofílicos em crianças e adolescentes com trombose da veia porta Thrombophilic disorders in children and adolescents with portal vein thrombosis

    Directory of Open Access Journals (Sweden)

    Raquel B. Pinto

    2003-04-01

    Full Text Available OBJETIVO: determinar a freqüência de deficiência da proteína C (PC, proteína S (PS e antitrombina (AT e das mutações fator V Leiden (FVL, G20210A, no gene da protrombina (PTR, e C677T da metileno-tetraidrofolato redutase (MTFR em crianças e adolescentes com trombose da veia porta (TVP, e definir o padrão hereditário de uma eventual deficiência. MÉTODOS: durante o período de dois anos, foi investigada a presença de distúrbios trombofílicos em 14 crianças e adolescentes (grupo 1 com TVP, seus pais (grupo 2, n = 25 e dois grupos controles constituídos, o primeiro, por crianças e adolescentes sem hepatopatia, pareados por idade com as crianças do grupo 1 (n = 28, e o outro, por pacientes com cirrose (n = 24. Os pacientes com TVP foram investigados do ponto de vista clínico, laboratorial, endoscópico e com biópsia de fígado. O diagnóstico da trombose foi realizado por ultra-sonografia abdominal com Doppler e/ou estudo angiográfico. RESULTADOS: a freqüência da deficiência de PC, PS e AT nos pacientes com TVP foi de 6/14 (42,9% (p 0,05 e 1/14 (7,1% (p > 0,05, respectivamente. Nos pacientes com cirrose, a freqüência da deficiência de PC, PS e AT foi de 14/24 (58,3%, 7/24 (29,2% e 11/24 (45,8%, respectivamente (p OBJECTIVE: to determine the frequency of protein C, protein S and antithrombin deficiency, and factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations in children and adolescents with portal vein thrombosis, as well as assessing the hereditary character of this disorders. METHODS: a two-year study was carried out to determine the frequency of thrombophilic disorders in children and adolescents with portal vein thrombosis (n = 14, their parents (n = 24, and two control groups, one age-matched children and adolescents free of liver disease (n = 28 and another group with cirrhosis (n = 24. The portal vein thrombosis patients were investigated by clinical and laboratory means

  8. 门静脉海绵样变性的血管造影表现及评价%Angiography imagings findings and evaluation of the carvernous transformation of portal vein

    Institute of Scientific and Technical Information of China (English)

    孟庆建; 付强; 马磊; 陈明

    2016-01-01

    Objective:To discuss angiography imaging findings of the carvernous transformation of portal vein(CTPV) and the diagnosis value of angiography,ultrasonography,CT,MRI,to CTPV. Methods:Using Seldinger’s technology all 23 patients were punctured from femora artery. Then selectively insert a catheter into celiac trunk or superior mesenteric arter-y,and make the arterial portography. Results:23 patients’angiograms did not find the normal portal vein trunk instead the disorderly vein group shadow. These angiograms also show the varicosity degree of fundic vein and distal esophageal veins, and may be clear about the origin of those expansive vein groups. 15 cases originate from superior mesenteric vein. Another 8 cases originate from splenic vein. Conclusions:Digital Subtracted Angiography(DSA)may clearly show the diseased por-tal vein trunk and the origin of the compensatory circulation,also may show the varicosity degree of fundic vein and distal e-sophageal veins. The diagnosis rate is 100℅. DSA is the most valuable diagonisis method to CTPV,is other image examina-tions substitutes with difficulty.%目的:探讨门脉海绵样变性(CTPV)的血管造影表现及超声、CT、MRI 等影像学对 CTPV 的诊断价值。方法23例患者,男14例,女9例,年龄17~68岁,平均年龄42.9岁。应用 Seldinger’s 技术经股动脉穿刺选择性插管于腹腔动脉及肠系膜上动脉做门静脉造影术。结果23例患者造影均未见明显的门静脉主干显影,代之以杂乱的静脉团影,还可以显示胃底及食管静脉曲张程度,并可以明确提示病变的门静脉处扩张静脉团的静脉来源,起源于胰头区的肠系膜上静脉15例,起源于脾静脉的8例。结论 DSA 可清楚显示呈海绵样改变的门静脉主干及侧支循环的来源,还可显示胃底及食管静脉曲张程度,诊断率100℅。DSA 是 CTPV 最有价值的诊断手段,是其它影像学检查难以替代的。

  9. Research progress of vasculopathy in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Tao Li; Zhen Yang

    2005-01-01

    Portal hypertension, one of the vascular diseases, not only has lesions in liver, but also changes in vascular structures and functions of extrahepatic portal system, systemic system and pulmonary circulation. The pathological changes of vasculopathy in portal hypertension include remodeling of arterialized visceral veins, intimal injury of visceral veins and destruction of contractile structure in visceral arterial wall. The mechanisms of vasculopathy in portal hypertension may be attributed to the changes of hemodynamics in portal system, immune response, gene modulation, vasoactive substances, and intrahepatic blood flow resistance. Portal hypertension can cause visceral hyperdynamic circulation, and the development and progression of visceral vasculopathy,while visceral vasculopathy can promote the development and progression of portal hypertension and visceral hyperdynamic circulation in turn. The aforementioned three factors interact in the pathogenesis of hepatic cirrhosisinduced portal hypertension and are involved in hemorrhage due to varicose vein rupture.

  10. Portal hypertension due to portal venous thrombosis: Etiology, clinical outcomes

    Institute of Scientific and Technical Information of China (English)

    Ozgur Harmanci; Yusuf Bayraktar

    2007-01-01

    The thrombophilia in adult life has major implications in the hepatic vessels. The resulting portal vein thrombosis has various outcomes and complications. Esophageal varices, portal gastropathy, ascites, severe hypersplenism and liver failure needing liver transplantation are known well. The newly formed collateral venous circulation showing itself as pseudocholangicarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of portal vein thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we present and discuss the portal vein thrombosis, etiology and the resulting clinical pictures. There are controversial issues in nomenclature,management (including anticoagulation problems), follow up strategies and liver transplantation. In the light of the current knowledge, we discuss some controversial issues in literature and present our experience and our proposals about this group of patients.

  11. 超声检查在门静脉栓塞病因诊断中的临床价值研究%Clinical Value of Ultrasonography in the Etiological Diagnosis of Portal Vein Thrombosis

    Institute of Scientific and Technical Information of China (English)

    蒋瑶; 印淑均

    2015-01-01

    目的 对门静脉栓塞病变原因进行调查,同时对门静脉栓塞的超声表现进行研究.方法 选取我院2013年7月至2014年8月50例门静脉栓塞患者,患者入院后均进行超声检查,对患者的超声表现进行研究,了解疾病的病因、性质以及发生部位;同时收集患者既往史调查患者发病原因.结果 对栓子内血流信号进行检查发现有5例栓子内部发现血流信号.对此5例患者血管内血流状态进行探测后发现,所有患者均显示为高速动脉频谱,确诊为癌栓,但我院50例患者经病理证实有41例为癌栓患者.50例患者中有7例患者门静脉周围存在蜂窝样结构,3例患者门静脉周围出现条纤曲管道结构;上述10例患者的影像资料均显示为网格状红、蓝相间的彩色血流信号,多普勒提示门静脉样血流41例;发生于门静脉和脾静脉的有2例;发生于门静脉和肠系膜上静脉的共2例;发生于所有静脉的共5例.其中原发性肝癌患者36例;其余疾病14例.结论 原发性肝癌是本病最常见的病因,超声诊断虽然能够起到一定的鉴别作用,但其对栓子性质敏感度的诊断率较低.%Objective Investigate the cause of portal vein thrombosis lesion, and study the portal vein thrombosis sonographic.Methods Our hospital, between July 2013 and 2014 August, 50 cases of portal vein thrombosis in patients after admission in patients underwent ultrasound examination, ultrasonography of patients studied to understand the etiology of the disease, the nature and occurrence site; at the same time collecting patient medical history investigate causes patients.Results Emboli lfow signals within the inspection found that there are ifve cases emboli found inside blood lfow.This state of the patient's blood lfow after ifve cases were detected was found that all patients showed a high-speed arterial spectrum diagnosed thrombus, but our hospital 50 patients with pathologically conifrmed 41 cases of

  12. Color Doppler sonography features of patent paraumbilical veins and abdominal varicose veins in portal hypertension classification%超声检查附脐静脉开放腹壁静脉曲张在门静脉高压临床分型的意义

    Institute of Scientific and Technical Information of China (English)

    陈勇刚; 王迎; 何文献; 李锐; 朱淑兰; 林巧端

    2011-01-01

    目的 应用彩色多普勒超声对门静脉高压附脐静脉开放和腹壁静脉曲张门腔之间侧支循环进行研究,确定门脉高压分型.方法 超声检查86例肝硬化门静脉高压、13例布加综合征及6例门静脉主干、脾静脉血栓3组门静脉高压患者的腹壁静脉曲张门腔之间侧支循环吻合情况及血流方向.结果 肝硬化门静脉高压组腹壁静脉曲张在脐以上血流流向头端,而脐以下血流流向腹端.布加综合征合并下腔静脉阻塞组,血流均流向上胸端.门静脉主干、脾静脉血栓未见脐静脉开放及腹壁静脉曲张.结论 应用彩色多普勒超声判断附脐静脉开放和腹壁静脉曲张门腔之间侧支循环的情况,可明确血管阻塞部位、程度、范围,为肝前、肝内及肝后门静脉高压分型的诊断提供有效依据,对临床制定合理治疗方案具有指导意义.%Objective To study the patent paraumbilical veins and abdominal varicose vems in portal hypertension hy color Doppler ultrasound. and to establish the classification of portal hypertension. Methods Three groups of patients with portal hypertension, including 86 cases of liver cirrhosis, 13 cases of Budd-Chiari syndrome and 6 cases of portal vein trunk or splenic vein thrombosis were examined by color Doppler ultrasound, abdominal varicose veins of portacaval collateral circulation and blood flow direction were observed. Results In liver cirrhosis group, the blood flow direction of abdominal varicose vems was towards the head above the navel, while towards the feet below the navel. In Budd - Chiari syndrome combined with IVC obstruction group, blood flow direction was toward the upper chest area. In portal trunk or splenic vein thrombosis group, the patent umbilical vein and abdominal varicose vems weren't seen. Conclusion Determination of patent paraumbilical veins and abdominal varicose veins by ultrasound can help to identify the location, degree and scope of vascular

  13. El Portal Latino Alzheimer's Project: Model Program for Latino Caregivers of Alzheimer's Disease-Affected People.

    Science.gov (United States)

    Aranda, Maria P.; Villa, Valentine M.; Trejo, Laura; Ramirez, Rosa; Ranney, Martha

    2003-01-01

    Describes the El Portal Latino Alzheimer's Project--a dementia-specific outreach and services program targeting Latino caregivers in the Los Angeles area. Results of an evaluation of service utilization indicate a reduction in barriers to care and an increase in services utilization. Implications for social work practice are discussed. (Contains…

  14. Neonatal vitelline vein aneurysm with thrombosis: prompt treatment should be needed

    Science.gov (United States)

    Kim, Soo-Hong; Yu, Hyeong Won; Jo, Heui Seung

    2015-01-01

    Vitelline veins are a pair of embryonic structures. The veins develop the portal vein system. Serious problems occur if the vitelline vein does not regress and becomes an aneurysm. Thrombus formation in the vitelline vein aneurysm could lead to portal vein thrombosis and portal hypertension unless promptly and correctly treated. Though vitelline vein aneurysm is an extremely rare anomaly, it rapidly progresses to portal vein thrombosis that requires prompt diagnosis and treatment. We reported a case of neonatal vitelline vein aneurysm and thrombosis that was cured by prompt operation. PMID:26665130

  15. Multiple abdominal veins thrombosis secondary to protein s deficiency - a case report.

    Science.gov (United States)

    Kodali, Venkata Umakant; Borra, Seshulakshmi; Mandarapu, Surendra Babu; Sanda, Mallikarjuna Rao; Bolla, Srinivasa Rao

    2014-06-01

    Abdominal venous thrombosis may present either as Budd-Chiari syndrome (BCS) caused by hepatic vein or proximal inferior vena cava (IVC) obstruction or as an extra hepatic portal obstruction (EHPVO) caused by Portal vein thrombosis or mesenteric vein thrombosis, but a mixed involvement is uncommon. Multiple abdominal venous obstructions presenting with thrombosis of hepatic vein, IVC, portal vein and renal vein are very rarely seen . We are reporting a rare case with thrombosis of IVC, hepatic vein, portal vein and renal vein, with protein S and protein C deficiencies, which was managed by giving anticoagulant therapy.

  16. Effect of portal vein thrombosis on the course of liver cirrhosis%门静脉血栓形成对肝硬化病程发展影响

    Institute of Scientific and Technical Information of China (English)

    刘继友; 孔丽韫

    2011-01-01

    Objective To investigate the effect of portal vein thrombosis (PVT) on nature course of liver cirrhosis ( LC ) . Methods Patients with LC during 2003 ~ 2011 were reviewed , eighteen cases of LC with PVT, nineteen cases of LC patients without PVT were chosen. The average diameter of main portal vein ( MPV) , spleen thickness, the stomach esophagus varicosity, ascites etc were compared between the two groups. Results Width of the portal vein and spleen thickness were greater in study group than those in the control group (P<0.05). Compared with control group, more severe esophageal varies, higher rate of sever variceal haemorrhage and larger volume of ascites after portal vein thrombosis were shown in the study group (P<0. 05). Conclusion The splenomegaly and broadening of portal vein are the main risk factors caused PVT, which further increase portal hypertension and the risk of gastrointestinal bleeding.%目的 探讨门静脉血栓(PVT)形成对肝硬化病程的影响.方法 回顾我院2003年~2011年肝硬化伴PVT形成的患者资料.18例肝硬化伴PVT形成患者入选血栓组;随机选择同阶段肝硬化门静脉高压症的无门 静脉血栓形成患者19例作为对照组,比较两组患者的门静脉宽度、脾脏厚度、食管胃底静脉曲张、腹水及上消化道大出血发生等情况.结果血栓组的门静脉宽度及脾脏厚度大于对照组,差异有统计学意义(P<0.05).血栓组食管胃底重度静脉曲张、上消化道大出血和大量腹水比例两组比较,差异有统计学意义(P<0.05).结论 脾肿大和门静脉增宽是PVT形成的主要危险因素,PVT形成加重门静脉高压的程度,从而增加上消化道出血几率,使腹水难以消退,增加相关并发症发生率并使相关症状加重,预防门静脉血栓形成有助于延缓肝硬化病情发展.

  17. The useful values on the findings of contrast-enhancement MRI, diffusion-weighted imaging and apparent diffusion coef-ficient in portal vein tumor thrombus and portal vein blood thrombus%门静脉癌栓和血栓MRI增强、DWI和ADC表现应用价值

    Institute of Scientific and Technical Information of China (English)

    张名忠; 丁汇清; 杨杰; 李长城; 黄克勇; 李春阳

    2016-01-01

    Objective To explore the usfull values of the findings of diffusion-weighted imaging ( DWI) and apparent diffusion coefficient (ADC) in the portal vein tumor thrombus (PVTT) and portal vein blood thrombus (PVBT).Methods 27 cases with PVTT and 10 cases with PVBT were reported .The cases in two groups were made by non-enhancement , DWI, ADC and MRI multi-phase or dynamic contrast-enhanced MRI scan .Results x2-test of number of within the branches of PVTT and that of PVBT in arterial phase enhancement were taken& x2 =228.6 ( P <0.01).The Kappa tests were made in the numenhancement within PVTT vesus high singal in DWI and low singal in ADC and Kappa values were 0.4871 and 0.4876, respectively.The Kap-pa tests were made in the noenhancement within PVBT vesus mild high singal in DWI and mild high or iso singal in ADC and Kap -pa values were 0.6610 &0.6610, respectively.The overall average ADC value of PVTT and that of PVBT were (1.052 ±0.220) ×10-3 mm2/s and (1.439 ±0.356) ×10-3 mm2/s, respectively.Conclusion The portal venous thrombus enhanced of contrast-enhancement MRI was a vital sign in diagnoses of PVTT in different from diagnoses in the PVBT and between the findings of DWI and ADC of PVTT and PVBT had a certain reference value for the diagnosis and differential diagnosis .%目的 探讨PVTT和PVBT的MRI增强、DWI和ADC表现临床应用价值. 方法 报道27例门静脉癌栓和10例血栓患者. 本组患者均作肝脏MRI平扫、DWI和ADC成像、多期或动态增强扫描. 结果 PVTT和PVBT动脉期强化情况经x2 检验,x2 =33.0( P <0.01). PVTT动脉期强化与其DWI高信号和ADC低信号表现kappa检验,kappa值分别为:0.4871、0.4876;PVBT动脉期无强化与其DWI稍高或等信号、与ADC等或稍高信号情况的kappa检验,kappa值分别为:0.6610、0.6610. PVTT 和PVBT的ADC总体均值分别为(1.052 ±0.220) ×10-3 mm2/s和(1.439 ±0.356) ×10-3 mm2/s. 结论 MRI增强时门静脉栓子强化是诊断PVTT和鉴别PVBT的重要征

  18. Portal vene-embolisering før leverkirurgi

    DEFF Research Database (Denmark)

    Andersen, Poul Erik; Mahdi, Bassam; Nielsen, Henning Overgaard

    2013-01-01

    Portal vein embolization is performed with the intention to occlude the portal veins to liver segments with malignancies and direct the portal flow to the healthy part (usually the left lobe) of the liver. Thus, hyperperfusion through the non-embolized part of the liver will create hyperplasia...

  19. Portal vene-embolisering før leverkirurgi

    DEFF Research Database (Denmark)

    Andersen, Poul Erik; Mahdi, Bassam; Nielsen, Henning Overgaard

    2013-01-01

    Portal vein embolization is performed with the intention to occlude the portal veins to liver segments with malignancies and direct the portal flow to the healthy part (usually the left lobe) of the liver. Thus, hyperperfusion through the non-embolized part of the liver will create hyperplasia...

  20. 肝硬化脾切除术后门静脉血栓形成相关因素的Meta分析%Risk factors of portal vein thrombosis after splenectomy in cirrhotic patients: a Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    王满才; 田斌; 王根年; 倪睿; 张亚武; 徐小东; 张有成

    2014-01-01

    Objective To study the perioperative predictors of portal vein thrombosis (PVT) after splenectomy in cirrhotic patients.Methods We searched the Web of Science,PubMed,EMBASE,Science Direct,CNKI,VIP,CSCD,and Wan Fang Databases up to April 2014.Only case-controlled studies which evaluated predictive factors of portal vein thrombosis (PVT) after splenectomy in cirrhotic patients were included.The Stata 12 software was used to perform the meta-analysis.Results Twenty-four casecontrolled studies were included.The sample size was 4 335,and the incidence rate of PVT was 25.0%.The risk factors of PVT included splenic volume (WMD =13.75,95% CI:6.47 ~21.00),splenic vein diameter (WMD =1.34,95% CI:0.39 ~ 2.30),portal vein diameter (WMD =1.54,95 % CI:0.56 ~ 2.52 ;WMD=2.09,95%CI:0.55 ~3.64),portal venous flow (WMD =-5.78,95% CI:-10.46 ~-1.10;WMD =-5.57,95 % CI:-5.92 ~-5.22),difference in portal venous pressure (WMD =1.90,95 % CI:1.29~2.50) and ascites (OR =1.83,95% CI:1.19,2.82).There were no significant differences between patients with and without PVT in terms of sex,age,Child-Pugh classification,prothrombin time,PLT,D-dimer,operating time.Conclusion The risk factors of portal vein thrombosis after splenectomy in cirrhotic patients were splenic volume,splenic vein diameter,portal vein diameter,portal venous flow,difference in portal venous pressure and ascites.%目的 评价肝硬化脾切除术后门静脉血栓形成的相关因素,为脾切除术后血栓的预防提供参考.方法 计算机检索Web of Science、PubMed、EMBASE、Science Direct、CNKI、VIP、CSCD、万方等数据库,检索时间截止2014年4月.并辅以手工检索、文献追溯等方法.纳入有关肝硬化脾切除术后门静脉血栓形成相关因素的病例对照研究,并进行文献质量评价.由两位研究者独立提取数据并采用Stata 12软件进行Meta分析.结果 共纳入24项符合标准的病例对照研究,病例数为4 335例.其中脾切

  1. Esophagogastric variceal bleeding in cirrhotic portal hypertension:consensus on prevention and management(2008)

    Institute of Scientific and Technical Information of China (English)

    Task Force for the Prevention and Management of Esophagogastric Variceal Bleeding of the Chinese Society of Gastroenterology,Chinese Society of Hepatology,and Chinese Society of Digestive Endoscopy

    2009-01-01

    @@ Portal hypertension is a clinical syndrome which is a consequence of a pathological increase in portal vein pressure due to various causes,liver cirrhosis being the most common.The basic pathophysioiogical characteristic of portal hypertension is resistance to portal vein flow or an increase in portal vein flow,which results in elevation of ressure in the portal vein and its tributaries and the formation of collateral circulation.Portal hypertension is manifested as a clinical syndrome including ascites,hepatoencephalopathy,esophagogastric variceal bleeding (EVB),etc.Among these manifestations,EVB has the highest mortality which is also one of the most common emergencies of the digestive system.

  2. Evaluating acute or chronic portal vein system thrombosis using multiple slice spiral computer tomography%CT增强扫描评价急慢性门静脉系统血栓

    Institute of Scientific and Technical Information of China (English)

    张青; 鲜军舫; 燕飞; 刘中林; 郭鹏德; 史旭波

    2014-01-01

    目的:采用多排螺旋CT增强扫描及三维重建技术评价急慢性门静脉系统血栓(PVT)。方法回顾性分析已证实的住院患者PVT的增强螺旋CT表现。根据症状发作时间将PVT分为急性期、慢性期,根据形态将血栓分为Ⅰ型完全型和Ⅱ型偏心型,分别评价门静脉直径、血栓位置、形态、密度、强化及伴随征象。结果 PVT形成患者19例。急性期3例,均为完全型;2例同时累及门静脉主干、左右分支、肠系膜上静脉及脾静脉,1例累及除门静脉主干外的其他3支血管。血栓CT值平均为(39±19)Hu,2例在血栓内部或边缘可见轻度强化。均有肠壁增厚、肠腔扩张积液、肠系膜水肿、腹水及侧支循环形成。慢性期16例,3例累及4支血管,4例累及3支,7例累及2支,2例累及1支。5例为完全型,11例为偏心型(68.8%),其中8例(72.7%)血栓宽径小于门脉宽径的50%。血栓 CT值平均为(41±12)Hu,3例强化。腹水15例,肠系膜水肿10例,侧支循环形成14例。结论 MSCT增强扫描可对急慢性PVT的累及范围及形态特点做出准确评价。%Objective To evaluate acute or chronic portal vein system thrombosis(PVT)using multiple slice spiral computer tomography(MSCT).Enhancement MSCT and three-dimensional CT reconstruction technique were applied in all patients.Methods Findings from inpatients proved portal vein system thrombosis were retrospectively reviewed.The portal venous system thrombosis was divided into acute or chronic stages according to the time from the onset of symptoms.The form of the blood clots fell into Ⅰ complete type and Ⅱ eccentric type.The diameter of the portal vein(DPV)was measured,and the location,shape,density,enhancement of the thrombi and the accompanying signs were assessed.Results Nineteen inpatients with portal vein system thrombosis were enrolled.Three cases were acute PVT and all were type Ⅰ.There were

  3. The effects of portal vein arterialization and party hepatectomy to the hepatocirrhosis%门静脉动脉化及部分肝切除术对肝硬化的影响

    Institute of Scientific and Technical Information of China (English)

    周强; 彭御冰

    2010-01-01

    目的 研究行部分肝切除术后PVA对肝硬化的影响,证实PVA能促进部分肝切除术后肝细胞再生,改善肝硬化.方法 肝硬化模型犬随机分三组,A组肝脏42%切除+门静脉动脉化;B组肝脏42%切除;C组对照组.实验中按计划行多普勒超声检查,血化验研究肝功能变化,检测血管内皮细胞标记抗原CD34.结果 A组肝重显著高于B组(P<0.01);A组肝功能的改善亦加快;血流动力学改变在术后A组高于其余二组;免疫组化检测血管内皮细胞标记抗原CD34计数A组高于其余二组.结论 ①门静脉动脉化有助于部分肝切除术后肝功能的改善;②门静脉动脉化增加肝细胞再生及改善肝硬化.%Objective To investigate the effects of portal vein arterializations(PVA) on hepatocirrhosis after party hepatectomy, proved that the PVA can increase the regeneration after party hepatectomy, and improve the hepatocirrhosis. Methods The cirrhosis model dogs were allocated randomly into three groups, dogs in group A received PVA after 42% liver resection, in group B underwent 42% liver resection only, group C was control group. During the experiment, Before operation, we used the color Doppler senograph to measure the hemodynamic change, the blood was taken to study the alteration of liver function and we use the immunohistochemical technique to exam CD34 of specimens. Results In group A liver weight is significant higher than group B(P<0.01).The improvement of liver function was also faster in group A. The blood flew of group A was higher than other two groups in 2 ds(P<0.05). In group A the vascular area defined by endothelial cells that stained for CD34 was higher than two groups. Conclusion ①The portal vein arterializations improve the cirrhosis liver function after partyhepatectomy. ②The portal vein erializations increase the liver regeneration and improve the epatocirrhosis.

  4. Endovascular interventions for traumatic portal venous hemorrhage complicated by portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Dinesh; Kumar; Sundarakumar; Crysela; Mirta; Smith; Jorge; Enrique; Lopera; Matthew; Kogut; Rajeev; Suri

    2013-01-01

    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.

  5. Portal Hypertension

    Science.gov (United States)

    ... Obesity to Liver Cancer Additional Content Medical News Portal Hypertension By Steven K. Herrine, MD, Thomas Jefferson ... Liver Hepatic Encephalopathy Jaundice in Adults Liver Failure Portal Hypertension (See also Overview of Liver Disease .) Portal ...

  6. Sumatriptan does not affect arteriovenous oxygen differences in jugular and cubital veins in normal human subjects

    DEFF Research Database (Denmark)

    Wienecke, T.; Hansen, J.M.; Petersen, J.;

    2008-01-01

    Arteriovenous anastomoses (AVAs) may open up during migraine attacks. In studies with anaesthetized and bilaterally vagosympatectomized pigs, triptans reduce AVA blood flow and increase the arteriovenous O-2 difference (AVDO(2)). To investigate whether subcutaneous sumatriptan 6 mg could induce...... changes in the AVDO(2), we measured the AVDO(2) in the external jugular vein in healthy subjects. We also measured the AVDO(2) in the internal jugular and cubital veins. There were no changes in AVDO(2) after subcutaneous sumatriptan, probably because AVA blood flow is limited in humans with an intact...

  7. TH 胶胃冠状静脉栓塞治疗门脉高压上消化道出血%Clinical analysis of gastric coronary vein embolization with medical TH tissue adhesive for the treatment of portal hypertention

    Institute of Scientific and Technical Information of China (English)

    张蕾

    2015-01-01

    Objective:To discuss the clinical methods and short - term effects of gastric coronary veins embolization with medical TH tissue adhesive for the treatment of portal hypertention and gastric - esophageal varices. Methods:Retro - anal-ysis of 36 cases underwent embolization and splenctomy. Results:Condition of gastric - esophageal vein varices was im-proved after the operations. Postoperative rehemorhage rate for 1 years was 5. 6%(2 / 36). The rate was decreased signifi-cantly compared with those of conventional surgical methods. Conclusion:Operation of gastric - esophageal embolization with medical TH tissue adhesive for the treatment of portal hypertention is safe with less injury and the effects are satisfacto-ry.%目的:探讨应用 TH 胶(含显影剂的α-氰基丙烯酸正辛酯)行胃冠状静脉栓塞治疗门脉高压食管胃底静脉曲张的方法,评价其近期疗效。方法对我院行该术式治疗的36例门脉高压症患者作回顾性分析。结果栓塞术后食管胃底静脉曲张减轻,术后1年再出血率5.6%(2/36),与传统断流术相比有显著下降(P <0.01)。结论应用 TH 胶胃冠状静脉栓塞治疗门脉高压消化道出血,手术较安全,创伤小,止血彻底,再出血率低,临床疗效满意。

  8. Effect of hydrogen sulfide on cell proliferation and portal vein pressure of cirrhosis rat%硫化氢对肝硬化大鼠门静脉压力及肝细胞增殖的影响

    Institute of Scientific and Technical Information of China (English)

    陈卫刚; 郑勇; 张宁; 阎继攀; 刘浩; 李睿; 齐翠花; 宋丽秀

    2013-01-01

    Objective To observe the effect of endogenous hydrogen sulfide (H2S) on cell proliferation and portal vein pressure in cirrhosis rat. Methods A total of 48 female SD rats were randomly divided into 6 groups. Rats in group H, group SH and group PH were made cirrhosis model by injecting carbon tetrachloride ( CCl4). Rats in group S and group SH were injected sodium hydrosulfide NaHS and rats in group P and group PH were injected propargylglycine (PPG) to change the content of H2S in the liver. Rats in group N and group H were injected physiological brine with the same volume. After a intervene of 7 days, laparotomy was performed in all rats to observe the portal vein pressure by method of intubation. The expression of cystathionine γ lyase( CSE)and proliferating cell nuclear antigen( PCNA)in the liver were detected by methods of immunohistochemistry and real time PCR. Results Compared with NF group, the portal vein pressure in HF group increased, the expression of CSE decreased, the expression of PCNA increased (all P <0.01). Compared with HF group, the portal vein pressure in PHF group increased, the expression of CSE decreased, the expression of PCNA increased (all P<0.01). Compared with HF group, the portal vein pressure in SHF group decreased, the expression of CSE increased, the expression of PCNA decreased (all P <0.01). Conclusion The H2S can regulate the portal vein pressure. The possible mechanism may associated with the effect of H2S on the regulation of cell proliferation.%目的 探讨硫化氢(H2S)调节肝硬化大鼠门静脉压力及肝组织细胞增殖的作用及机制.方法 将48只雌性SD大鼠随机分为六组.肝硬化对照组、肝硬化H2S减少组、肝硬化H2S增加组采用四氯化碳复合因素法制作肝硬化模型;正常H2S增加组和肝硬化H2S增加组腹腔注射H2S供体硫氢化钠(NaHS)以增加体内H2S;正常硫化氢减少组和肝硬化H2S增加组腹腔注射H2S代谢酶抑制剂PPG,以减少体内H2S;正常

  9. 自体骨髓干细胞移植术后门静脉血流动力学变化的研究%The study of portal vein hemodynamics changes after autologous bone marrow stem cell transplantation

    Institute of Scientific and Technical Information of China (English)

    何春萍; 刘黎

    2011-01-01

    Objective To study portal vein hemodynamics changes after autoiogous bone marrow stem cell transplantation in patients with liver cirrhosis. Methods The hemodynamic parameters, including portal vein diameter, average portal blood flow velocity and spleen size, were determined by Colour Doppler Ultrasonography in 50 patients after autologous bone marrow stem cell transplantation and all cases were followed for up to 6 months. Results (1) After autologous marrow stem cell transplantation, the portal vein diameter reduced significantly at different timepoints compared to before the treatment ([1.41 ± 0. 15] cm, [1. 38 ± 0. 11]cm,[1.36±0. 17] cm vs. [1. 53 ±0. 18] cm,t = 1. 987,1.994,1. 976, Ps 0.05). (2) After autologous marrow stem cell transplantation, the average portal blood flow velocity increased significantly at different timepoints compared to before the treatment ([15. 7 ± 3. 6] cm/s, [16. 1 ± 2.4] cm/s, [15. 9 ± 3.0] cm/s vs.[11.4 ± 3. 3] cm/s ,t = 2. 345, 2.460,2. 381, Ps 0.05) . (3) After autologous marrow stem cell transplantation,the spleen size reduced significantly at different timepoints compared to before the treatment ([4.8±0.3]cm,[4.7±0.6]cm,[4.8±0.5]cm vs. [5. 2 ±0. 7]cm,t =2. 289,2. 390,2.425,Ps 0.05) .Conclusion The autologous bone marrow stem cell transplantation can effectively improve the portal vein blood flow,reduce the spleen size,alleviate portal hypertension in patients with liver cirrhosis.%目的 观察肝硬化患者自体骨髓干细胞移植术后门静脉血流动力学的变化.方法 应用彩色多普勒超声测量50例自体骨髓干细胞移植术后门静脉血流动力学指标,自术前至术后6个月进行定期随访.记录门静脉内径、门静脉平均血流速度及脾脏厚度,比较自体骨髓干细胞移植前后三者的变化情况.结果 (1)术后1、3、6个月各时段门静脉内径分别为(1.41±0.15)、(1.38±0.11)、(1.36±0.17)cm,与术前(1.53±0.18)cm比较明显减小,差异均有

  10. Standard Imaging Techniques for Assessment of Portal Venous System and its Tributaries by Linear Endoscopic Ultrasound: A Pictorial Essay

    Science.gov (United States)

    Rameshbabu, C. S.; Wani, Zeeshn Ahamad; Rai, Praveer; Abdulqader, Almessabi; Garg, Shubham; Sharma, Malay

    2013-01-01

    Linear Endosonography has been used to image the Portal Venous System but no established standard guidelines exist. This article presents techniques to visualize the portal venous system and its tributaries by linear endosonography. Attempt has been made to show most of the first order tributaries and some second order tributaries of splenic vein, superior mesenteric vein and portal vein. PMID:24949362

  11. Segmentation method for the portal vein and aorta based on pyramid model and Mean Shift algorithm%基于金字塔模型和Mean Shift算法的门静脉和主动脉分割方法

    Institute of Scientific and Technical Information of China (English)

    郑建立; 于颖; 陈兆学; 聂生东

    2011-01-01

    目的 基于目前临床在绘制肝门静脉和主动脉的时间-密度曲线方面存在的问题,提出一种准确分割肝脏CT灌注成像(CTPI)图中肝脏门静脉和主动脉的方法.方法 采用金字塔模型,结合Mean Shift分割算法对肝脏CTPI图像中的门静脉和主动脉进行分割,并在此基础上计算时间一密度曲线.结果 此方法能实现对肝脏CTPI图像中门静脉和主动脉的有效分割,绘制出准确、平滑而无毛刺的门静脉和主动脉的时间-密度曲线.结论 此方法有助于临床客观、准确地评估肝功能和诊断病变.%Objective To develop a method for accurate segmentation of the portal vein and aorta parts in CT perfusion imaging (CTPI) of liver, and to solve problems existing in drawing of clinic time-density curve of the portal vein and aorta.Methods Combining the pyramid model and the Mean Shift algorithm to segment the portal vein and aorta from the liver CT PI, the time-density curve (TDC) of portal vein and aorta were drawn based on the obtained segmentation results.Results The experiment results showed that the portal vein and aorta were segmented correctly from liver CT perfusion images with the presented method.TDC of the portal vein and aorta were drawn accurately and smoothly without burrs.Conclusion The presented method is of great sense and application value for accurate evaluation on liver function and diagnosis of liver pathology.

  12. Atividade mioelétrica do intestino delgado de cães submetidos à oclusão parcial da veia porta Myoelectric activity of the small bowel of dogs submitted to partial occlusion of the portal vein

    Directory of Open Access Journals (Sweden)

    Álvaro Antônio Bandeira Ferraz

    2011-03-01

    Full Text Available RACIONAL: A oclusão temporária da veia porta causa estase esplâncnica e pode causar dismotilidade intestinal. OBJETIVO: Avaliar as alterações da atividade mioelétrica e da histologia do intestino delgado, além da pressão arterial média (PAM, frequência cardíaca (FC, pressão venosa central (PVC e press��o portal (PP, na fase de pré-oclusão e de oclusão portal. MÉTODO: Realizou-se anestesia geral em seis cães, seguido de monitorização da PAM, FC e PVC, laparotomia, aferição da PP, fixação de três pares de eletrodos na parede intestinal, biópsias jejunais e oclusão parcial da veia porta, sendo programado aumento da PP entre 2,5 e 3 vezes. Os eletrodos foram conectados a um microcomputador com software de aquisição para armazenamento e análise da atividade mioelétrica, cujo registro ocorreu nos 30 minutos da fase de pré-oclusão e nos 60 minutos de oclusão. Determinouse a variância e a média do RMS (root mean square da atividade mioelétrica. RESULTADOS: Na fase de oclusão, houve diminuição significativa da média do RMS e aumento da frequência de hemorragia da lâmina própria, sendo proporcional ao tempo de estase.Infiltrado inflamatório, dilatação vascular e desprendimento epitelial não apresentaram diferença entre as duas fases. Durante a estase, PAM, FC e PVC diminuíram (p=0,326; 0,375 e 0,008; respectivamente, e PP aumentou (p=0,015. CONCLUSÃO: A oclusão parcial da veia porta de cães promoveu diminuição da atividade mioelétrica e aumento da frequência percentual da hemorragia da lâmina própria, além de queda da PVCBACKGROUND: Temporary occlusion of the portal vein causes splancnic venous stasis and intestinal disfunction, that can produce alterations in the motility, and this fact is not vastly known. AIM: To evaluate the small bowel myoelectric activity and histology in the six dogs, also covering mean arterial blood pressure (AP, pulse rate (PR, central venous pressure (CVP e portal

  13. Relevant factors affecting the outcome of ultrasound guided foam sclerotherapy of the great saphenous vein

    Directory of Open Access Journals (Sweden)

    Giorgio Falaschi

    2013-09-01

    Full Text Available Ultrasound guided foam sclerotherapy (UGFS constitutes a valid ablative treatment for superficial vein diseases for the great saphenous vein (GSV, but no standardized protocol for its execution has yet been defined. Different variable factors involved in this procedure influence the final outcome and clinical results. The aim of our study was to analyze the respective influence on efficacy and side effects of three variable factors (foam volume, foam concentration, and contact time between the foam and the endothelium for UGFS procedures for GSV insufficiency in order to select the best protocol for treatment. A retrospective analysis was made of UGFS procedures (190 patients, 201 legs performed for GSV insufficiency in our institute from January 2007 to January 2010. All great saphenous veins included in our study exhibited a trans-ostial reflux and caliber range was 7-11 mm. In all cases, foam was prepared according to the Tessari method, using polidocanol (POL and a gas mixture of CO2 (70% and filtered room air (30%, in a proportion of 1:4. A single injection procedure in the GSV was performed under Doppler ultrasound guidance at mid to lower third of the thigh. Legs were randomly assigned to one of three different treatment protocols: - Group A (71 legs: POL 3%, mean foam volume 4.5 cc, intermittent groin pressure 5 min, supine bed rest 10 min; - Group B (61 legs: POL 2%, mean foam volume 9 cc, intermittent groin pressure 5 min, supine bed rest 10 min; - Group C (69 legs: POL 2%, mean foam volume 9 cc, continuous groin pressure 5 min followed by intermittent groin pressure 5 min, continuous leg compression 5 min, supine bed rest 10 min. Efficacy of treatment and occurrence of side effects were evaluated in each group at two weeks and again at two years after the procedure and the cumulative results compared. Analysis of outcomes did not show any significant difference between the complete obliteration rate (P=0.825 or occurrence of local

  14. COLOR DOPPLER EVALUA TION OF HEPATIC VESS ELS AND PORTAL VENOUS SYSTEM IN LIV ER DISEASES WITH PAT HOLOGICAL CPRRELATION

    Directory of Open Access Journals (Sweden)

    Sanjeev

    2015-10-01

    pathological correlation. INCLUSION CRITERIA: All patients ( M/F of all age group having liver diseases ( Medical or Surgical as diagnosed on various investigations, using curvilinear and linear probe of machine ( Wipro GE ( Logic 3 Expert - Ay15CUK and Siemens ( Sonoline G - 50. First 2D sonography was conducted and then color Doppler assessment of various vessels including Portal vein, hepatic artery and hepatic vein, inferior vena cava was done. RESULTS : Li ver pathology was evaluated by 5 and 10 MHz electronically focused curvilinear and linear transducer with patient in supine position with direct contact method. The age ranges from 8 to 73 years. Most common age group affected was between 50 to 60 years. I n this study 26 ( 57.7% cases were male and rest of 19 ( 42.2% cases was female. out of these 45 cases, 29 ( 64.4% cases were from rural area and rest of 16 ( 35.5% cases belonged to urban area. In our study 11 ( 24.4% cases had positive history of various type s of addiction. Most common presenting complaint was abdominal pain which is found in 35 ( 76% cases. In present study out of 45 cases, on USG 15 ( 33.33% cases were detected as having liver mets, 15 ( 33.33 had cirrhosis with portal hypertension, 5 ( 11.1% patient had hepatocellular carcinoma and 3 ( 6.6 patients had liver hydatid cyst and 3 ( 6.6% other had abscess while 1 ( 2.2% had liver hemangioma and 1 ( 2.2% had fatty infiltration in liver. Final diagnosis was confirmed by histopathology in all these pati ents. CONCLUSION: Color Doppler study in liver hemangioma has not any added advantages over 2D sonography. Color Doppler study in infra hepatic liver cyst has not yield any extra information and vascular changes were seen in large size liver due to compres sion of adjacent vessels.

  15. 贲门周围血管离断术后门静脉系统血栓形成与预防%Portal vein thrombosis after devascularization operation and its prevention

    Institute of Scientific and Technical Information of China (English)

    周光文

    2013-01-01

    Objective To explore the pathogenesis,diagnosis,therapy and prevention of portal vein thrombosis (PVT) after devascularization.Methods Data of 56 patients who underwent devascularization because of cirrhotic portal hypertension between Jan.2008 and Dec.2011 were retrospectively analyzed.Patients were divided into two groups according to whether or not to receive prophylactic anticoagulant therapy.There were 28 cases in each group.The causes of PVT was analyzed by Logit regression.Results Among all patients,9 patients developed PVT after operation (16%).The occurrence of PVT was 11% in preventive anticoagulant treatment group,and that was 21% in nonpreventive anticoagulant treatment group.Logit regression showed that there was no relationship in PVT with sex,age,preoperative platelet count and intraoperative ligation of splenic artery beforehand.There were apparent correlation in PVT with centrifugal-flow of portal vein and peak value of platelet count over ≥300 ×109/L.All patients discharged uneventfully after anticoagulant treatment.Conclusions The definite cause of PVT after devascularization is centrifugal-flow of portal vein and the peak value of platelet count over ≥300 × 109/L is a pivotal risk factor.The key point of therapy is early diagnosis and early anticoagulant treatment.%目的 探讨乙肝肝硬化门静脉高压症患者行贲门周围血管离断术后门静脉系统血栓形成(portal vein thrombosis,PVT)的原因及诊治.方法 回顾性分析从2008年1月至2011年12月56例接受贲门周围血管离断术治疗的门静脉高压症患者的临床资料.按是否采用预防性抗凝治疗将患者分为两组,每组28例.运用Logit分析PVT形成的因素.结果 本组有9例患者发生PVT,发生率为16%,其中预防性抗凝组PVT发生率为11%,未预防性抗凝组发生率为21%.Logit回归分析:患者年龄、性别、术前血小板值和术中是否结扎脾动脉均与患者并发PVT无明显关系;

  16. PORTAL-HYPERTENSION AS PRESENTING FEATURE OF A MYELOPROLIFERATIVE DISORDER - DIAGNOSIS AND THERAPEUTIC DILEMMAS

    NARCIS (Netherlands)

    MULLER, EW; DEWOLF, JTM; HAAGSMA, EB

    1993-01-01

    In some patients presenting with complications of portal hypertension, thrombosis of hepatic or portal veins is identified as the cause. Hepatic or portal vein thrombosis may be secondary to recognized etiologies like infection or malignancy. When no etiology for the thrombosis is found, it is

  17. PORTAL-HYPERTENSION AS PRESENTING FEATURE OF A MYELOPROLIFERATIVE DISORDER - DIAGNOSIS AND THERAPEUTIC DILEMMAS

    NARCIS (Netherlands)

    MULLER, EW; DEWOLF, JTM; HAAGSMA, EB

    1993-01-01

    In some patients presenting with complications of portal hypertension, thrombosis of hepatic or portal veins is identified as the cause. Hepatic or portal vein thrombosis may be secondary to recognized etiologies like infection or malignancy. When no etiology for the thrombosis is found, it is likel

  18. Varicose Veins

    Science.gov (United States)

    Varicose veins are swollen, twisted veins that you can see just under the skin. They usually occur in ... of the body. Hemorrhoids are a type of varicose vein. Your veins have one-way valves that help ...

  19. Summary of the surgical procedures of Rex shunt and Warren shunt in 8 cases of cavernous transfor-mation of portal vein%分流手术治疗门脉海绵样变8例临床分析

    Institute of Scientific and Technical Information of China (English)

    孔艳霞; 张大; 杨合英; 王家祥; 贾佳; 赵鸽; 岳铭

    2015-01-01

    Objetive the outcomes and possible complications of surgical procedures of Rex shunt and Warren shunt in 8 cases of cavernous transformation of portal vein. Methods 8 cases who underwent the shunt surgery for cavernous transformation of portal vein from December 2012 to January 2015 were reviewed, including 5 patients having Rex shunt (2 cases of them had recurrent bleeding after devascularization proce-dures),and 3 having Warren shunt.All cases had recurrent upper gastrointestinal hemorrhage(more than twice per year).Upper gastrointestinal contrast studies helped delineate the extent of esophageal and gastric varices and cavernous transformation of portal vein was confirmed by color Doppler ultrasound and CT.In Rex proce-dures,the isolated coronary veins were sewn to the intrahepatic portalvein in the recessus of Rex,meanwhile, the portal vein pressures were measured during vascular anastomosis to assure the relief of portal hypertension after the process.While in Warren shunt,the varices were decompressed by allowing them to drain via the splenic vein into the left renal vein,the portal vein pressures were obtained as well. Results Patients were followed up for 6 to 31 months.Growth and development was the same for all patients within the same age group,and no cases present with encephalopathy;1 case had recurrent bleeding after 16 months of the opera-tions;mesenteric venous thrombosis occurred in one case and was cured through thrombolysis and anticoagula-tion therapy;1 case with infraction of spleen had fever for one month.Conclusions Shunt precedures are effec-tive to treat cavernous transformation of portal vein and prevent the gastrointestinal bleeding while with limited complications.%目的:总结 Rex 分流术及 Warren 分流术治疗8例门静脉海绵样变的效果及并发症。方法2012年12月至2015年1月作者采用分流手术治疗门静脉海绵样变8例,其中 Rex 分流手术5例(2例为断流手术后出血复发),Warren

  20. Diagnosis of portal hypertension caused by splenic vein thrombosis%脾静脉血栓形成导致门静脉高压症的诊断

    Institute of Scientific and Technical Information of China (English)

    王燕颖; 朱雅琪

    2005-01-01

    脾静脉血栓形成(splenic vein thrombosis,SVT)引起的门静脉高压症(PH),只局限于胃脾区,故称区域性PH,又称左侧或左区PH。SVT大多数有孤立性胃静脉曲张(isolated gastric va