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Sample records for intrahepatic portosystemic shunt

  1. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... What are the limitations of TIPS? What is a Transjugular Intrahepatic Portosystemic Shunt (TIPS)? A transjugular intrahepatic ... taking our brief survey: Survey Do you have a personal story about radiology? Share your patient story ...

  2. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... Videos About Us News Physician Resources Professions Site Index A-Z Transjugular Intrahepatic Portosystemic Shunt (TIPS) Transjugular ... in the portal vein system. This pressure buildup can cause blood to flow backward from the liver ...

  3. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... story about radiology? Share your patient story here Images × Image Gallery Radiologist and patient consultation. View full size ... X-Ray and CT Exams Contrast Materials Venography Images related to Transjugular Intrahepatic Portosystemic Shunt (TIPS) Sponsored ...

  4. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... vs. risks? What are the limitations of TIPS? What is a Transjugular Intrahepatic Portosystemic Shunt (TIPS)? A ... likely to require a TIPS. top of page What are some common uses of the procedure? A ...

  5. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... bear denotes child-specific content. Related Articles and Media Radiation Dose in X-Ray and CT Exams Contrast Materials Venography Images related to Transjugular Intrahepatic Portosystemic Shunt (TIPS) Sponsored ...

  6. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Transjugular Intrahepatic Portosystemic Shunt ( ...

  7. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... Plan to stay overnight at the hospital for one or more days. What is Transjugular Intrahepatic Portosystemic ... from the digestive organs to the liver) to one of the hepatic veins (three veins that carry ...

  8. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... bear denotes child-specific content. Related Articles and Media Radiation Dose in X-Ray and CT Exams Contrast Materials Venography Images related to Transjugular Intrahepatic Portosystemic ...

  9. Embolization of nonvariceal portosystemic collaterals in transjugular intrahepatic portosystemic shunts

    International Nuclear Information System (INIS)

    Bilbao, Jose Ignacio; Arias, Mercedes; Longo, Jesus Maria; Alejandre, Pedro Luis; Betes, Maria Teresa; Elizalde, Arlette Maria

    1997-01-01

    Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy

  10. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

    Medline Plus

    Full Text Available ... the liver using x-ray guidance to connect two veins within the liver. The shunt is kept ... examination consists of a radiographic table, one or two x-ray tubes and a television-like monitor ...

  11. An unusual case of intrahepatic portosystemic venous shunt

    African Journals Online (AJOL)

    vena cava (IVC) (most common). Intrahepatic portosystemic venous shunts are rare vascular anomalies that may be detected in asymptomatic patients, given the recent advances in radiological imaging techniques. Accurate shunt evaluation and classification can be performed with ultrasound and multi-detector computed.

  12. Prevention and treatment of complications after transjugular intrahepatic portosystemic shunt

    Directory of Open Access Journals (Sweden)

    XUE Hui

    2016-02-01

    Full Text Available The application of transjugular intrahepatic portosystemic shunt (TIPS in the treatment of cirrhotic portal hypertension has been widely accepted both at home and abroad. This article focuses on the fatal complications of TIPS (including intraperitoneal bleeding and acute pulmonary embolism, shunt failure, and recurrent portosystemic hepatic encephalopathy, and elaborates on the reasons for such conditions and related preventive measures, in order to improve the accuracy and safety of intraoperative puncture, reduce common complications such as shunt failure and hepatic encephalopathy, and improve the clinical effect of TIPS in the treatment of cirrhotic portal hypertension.

  13. Clotting activation after transjugular intrahepatic portosystemic stent shunt.

    Science.gov (United States)

    Basili, S; Merli, M; Ferro, D; Lionetti, R; Rossi, E; Riggio, O; Valeriano, V; Capocaccia, L; Violi, F

    1999-05-01

    Aim of the study was to investigate the behaviour of clotting system in peripheral circulation of cirrhotic patients undergoing transjugular intrahepatic portosystemic stent shunt (TIPS). Clotting variables and endotoxemia were measured 48 h and 30 days after TIPS in patients randomised to receive heparin or not. Forty-eight hours after TIPS, a significant increase of prothrombin fragment F1+2 was observed; such increase was less evident in patients given heparin. Similar findings were observed for endotoxemia, which, however, was not affected by heparin treatment. Thirty days after TIPS procedure prothrombin fragment F1+2 and endotoxemia returned to baseline values independently of the treatment given. This study shows that TIPS is associated with an increase of clotting activation which might contribute to acute thrombosis observed after this procedure.

  14. Intrahepatic portosystemic venous shunts: diagnosis by Doppler ultrasound; Cortocircuitos venosos portosistemicos intrahepaticos: diagnostico mediante ecografia Doppler

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    Garofano, M. P.; Medina, A.; Lopez, G.; Garrido, C. [Hospital Universitario Virgen de las Nieves. Granada (Spain)

    2001-07-01

    Intrahepatic portosystemic venous shunts are venous vascular lesions that allow intrahepatic portal vessels to communicate with hepatic veins. They may present in patients with portal hypertension or b discovered incidentally; it is considered that the latter may be congenital or acquired. A noninvasive methods. Doppler ultrasound aids in the diagnosis of these anomalous communications by providing images of the vessels and the direction, velocity and volume of the blood flow through the shunt. We present four cases of intrahepatic portosystemic venous shunt. (Author) 8 refs.

  15. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + beta-blocker for prevention of variceal rebleeding

    NARCIS (Netherlands)

    Holster, I.L.; Tjwa, E.T.; Moelker, A.; Wils, A.; Hansen, B.E.; Vermeijden, J.R.; Scholten, P.; Hoek, B. van; Nicolai, J.J.; Kuipers, E.J.; Pattynama, P.M.; Buuren, H.R. van

    2016-01-01

    Gastroesophageal variceal bleeding in patients with cirrhosis is associated with significant morbidity and mortality, as well as a high rebleeding risk. Limited data are available on the role of transjugular intrahepatic portosystemic shunt (TIPS) with covered stents in patients receiving standard

  16. Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation

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    Miraglia, Roberto, E-mail: rmiraglia@ismett.edu; Maruzzelli, Luigi, E-mail: lmaruzzelli@ismett.edu; Cortis, Kelvin, E-mail: kelvincortis@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); D’Amico, Mario, E-mail: mdamico@ismett.edu [University of Palermo, Department of Radiology (Italy); Floridia, Gaetano, E-mail: gfloridia@ismett.edu; Gallo, Giuseppe, E-mail: ggallo@ismett.edu; Tafaro, Corrado, E-mail: ctafaro@ismett.edu; Luca, Angelo, E-mail: aluca@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy)

    2016-02-15

    PurposeTransjugular intrahepatic portosystemic shunt (TIPS) creation is considered as being one of the most complex procedures in abdominal interventional radiology. Our aim was twofold: quantification of TIPS-related patient radiation exposure in our center and identification of factors leading to reduced radiation exposure.Materials and methodsThree hundred and forty seven consecutive patients underwent TIPS in our center between 2007 and 2014. Three main procedure categories were identified: Group I (n = 88)—fluoroscopic-guided portal vein targeting, procedure done in an image intensifier-based angiographic system (IIDS); Group II (n = 48)—ultrasound-guided portal vein puncture, procedure done in an IIDS; and Group III (n = 211)—ultrasound-guided portal vein puncture, procedure done in a flat panel detector-based system (FPDS). Radiation exposure (dose-area product [DAP], in Gy cm{sup 2} and fluoroscopy time [FT] in minutes) was retrospectively analyzed.ResultsDAP was significantly higher in Group I (mean ± SD 360 ± 298; median 287; 75th percentile 389 Gy cm{sup 2}) as compared to Group II (217 ± 130; 178; 276 Gy cm{sup 2}; p = 0.002) and Group III (129 ± 117; 70; 150 Gy cm{sup 2}p < 0.001). The difference in DAP between Groups II and III was also significant (p < 0.001). Group I had significantly longer FT (25.78 ± 13.52 min) as compared to Group II (20.45 ± 10.87 min; p = 0.02) and Group III (19.76 ± 13.34; p < 0.001). FT was not significantly different between Groups II and III (p = 0.73).ConclusionsReal-time ultrasound-guided targeting of the portal venous system during TIPS creation results in a significantly lower radiation exposure and reduced FT. Further reduction in radiation exposure can be achieved through the use of modern angiographic units with FPDS.

  17. Pathological Predictors of Shunt Stenosis and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt

    Directory of Open Access Journals (Sweden)

    Fuliang He

    2016-01-01

    Full Text Available Background. Transjugular intrahepatic portosystemic shunt (TIPS is an artificial channel from the portal vein to the hepatic vein or vena cava for controlling portal vein hypertension. The major drawbacks of TIPS are shunt stenosis and hepatic encephalopathy (HE; previous studies showed that post-TIPS shunt stenosis and HE might be correlated with the pathological features of the liver tissues. Therefore, we analyzed the pathological predictors for clinical outcome, to determine the risk factors for shunt stenosis and HE after TIPS. Methods. We recruited 361 patients who suffered from portal hypertension symptoms and were treated with TIPS from January 2009 to December 2012. Results. Multivariate logistic regression analysis showed that the risk of shunt stenosis was increased with more severe inflammation in the liver tissue (OR, 2.864; 95% CI: 1.466–5.592; P=0.002, HE comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P<0.001, or higher MELD score (95% CI, 1.298–1.731; P<0.001. Higher risk of HE was associated with shunt stenosis comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P<0.001, higher stage of the liver fibrosis (OR, 2.431; 95% CI, 1.355–4.359; P=0.003, and higher MELD score (95% CI, 1.711–2.406; P<0.001. Conclusion. The pathological features can predict individual susceptibility to shunt stenosis and HE.

  18. Irreversible Electroporation of a Hepatocellular Carcinoma Lesion Adjacent to a Transjugular Intrahepatic Portosystemic Shunt Stent Graft

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    Niessen, Christoph; Jung, Ernst Michael; Wohlgemuth, Walter A. [Department of Radiology, University Medical Center Regensburg, Regensburg D-93053 (Germany); Trabold, Benedikt [Department of Anaesthesia, University Medical Center Regensburg, Regensburg D-93053 (Germany); Haimerl, Michael; Schreyer, Andreas; Stroszczynski, Christian; Wiggermann, Philipp [Department of Radiology, University Medical Center Regensburg, Regensburg D-93053 (Germany)

    2013-07-01

    We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.

  19. Transjugular Intrahepatic Portosystemic Shunt (TIPS): Current Status and Future Possibilities

    International Nuclear Information System (INIS)

    Bilbao, Jose Ignacio; Quiroga, Jorge; Herrero, Jose Ignacio; Benito, Alberto

    2002-01-01

    Since the insertion of the first TIPS in 1989 much has been learned about this therapeutic procedure. It has an established role for the treatment of some complications of portal hypertension: prevention of recurrent variceal bleeding and rescue of patients with acute uncontrollable variceal bleeding. In addition TIPS is useful for Budd-Chiari syndrome, refractory ascites and hepatorenal syndrome, although its specific role in these indications remains to be definitively established. However, the decrease in sinusoidal blood flow induced by TIPS can lead to the patient developing hepatic encephalopathy and liver failure in some cases. Therefore, TIPS should be used with caution in patients with very poor liver function. From a technical point of view, successful placement of TIPS is achieved in more than 98% of cases by experienced groups. At present, evaluation of TIPS dysfunction based on morphology probably leads to an overdiagnosis of this complication since most of these cases are not associated with clinical manifestations (recurrent bleeding or refractory ascites). The major disadvantage of TIPS remains its poor long-term patency requiring a mandatory surveillance program. The indicator for shunt function/malfunction should be the portosystemic pressure gradient, which is best assessed by intravascular measurements. Shunt obstructions may be prevented or reduced by the use of stent-grafts in the future

  20. Transjugular Intrahepatic Portosystemic Shunts in Children with Biliary Atresia

    International Nuclear Information System (INIS)

    Huppert, Peter E.; Goffette, Pierre; Astfalk, Wolfgang; Sokal, Emil M.; Brambs, Hans-Juergen; Schott, Ullrich; Duda, Stephan H.; Schweizer, Paul; Claussen, Claus D.

    2002-01-01

    Purpose: We retrospectively evaluated the technical and long-term clinical results of transjugularintrahepatic portosystemic shunts (TIPS) in children with portal hypertension and biliary atresia (BA). Methods: Nine children with BA and recurrent bleeding from esophagogastric and/or intestinal varices were treated by TIPS at the age of 34-156 months and followed-up in two centers. Different types of stents were used. Results: Shunt insertion succeeded in all patients, but in two a second procedure was necessary. Seven procedures lasted more than 3 hr, mainly due to difficult portal vein puncture.Variceal bleeding ceased in all patients; however, 16 reinterventions were performed in eight patients for clinical reasons (n =11) and sonographically suspected restenosis (n =5). Four patients underwent successful liver transplantation 4-51 months after TIPS and five are in good clinical conditions 64-75 months after TIPS. Conclusions: TIPS in children with BA is technically difficult, mainly due to periportal fibrosis and small portal veins. Frequency of reinterventions seems to be higher compared with adults

  1. Usefulness of a balloon-expandable, covered stent for the transjugular intrahepatic portosystemic shunt

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    Rössle M

    2018-01-01

    Full Text Available The availability of polytetrafluoroethylene (PTFE covered, self-expandable nitinol stents in 2001 considerably improved the patency, response rates and survival of the transjugular intrahepatic portosystemic shunt (TIPS. Side effects of portosystemic shunting such as hepatic encephalopathy (HE and worsening of hepatic function, however, remained a problem. To reduce HE, underdilatation of nitinol stents has been practiced for many years. However, as shown recently, underdilatation was a flop since, due to their intrinsic memory, nitinol stents always expanded to reach their nominal diameter of 8 or 10 mm. To overcome this problem and to be able to perform permanent shunts with a smaller diameter of < 8 mm, we studied the usefulness of a balloon-expandable, covered, metallic stent which allowed adjustment to any diameter between 5 and 12 mm. Methods: 30 patients with cirrhosis and symptomatic portal hypertension were included. The mean Child-Pugh score was 8 ± 2.17 patients had refractory ascites, 9 patients variceal bleeding and four patients other indications for the TIPS. Results: The TIPS was successfully implanted in all patients within 69.6 ± 21.8 min. The shunt reduced the portosystemic pressure gradient by 57.5 ± 14.2% with a mean stent diameter of 7.4 ± 1.0 mm (5 -10.3 mm. During a mean follow-up of 330 ± 249 days, shunt revision was necessary in 5 patients (17%, four of them had insufficient response and received stent dilatation and one patient had stent misplacement requiring a parallel shunt. Three patients (10% developed HE. Conclusions: The covered, balloon-expandable stent could be placed accurately and allowed creation of adapted shunts with smaller diameters as usual. This resulted in a comparatively low rate of HE.

  2. RE: Endovascular Treatment of Congenital Intrahepatic Portosystemic Shunts with Amplatzer Plugs

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    Sierre, Sergio; Alonso, Jose; Lipsich, Jose [Hospital Nacional de Pediatria ' JP Garrahan' , Combate de los Pozos, Buenos (Argentina)

    2012-01-15

    In our paper entitled 'Endovascular treatment of congenital portal vein fistulas with the Amplatzer occlusion device' published in the Journal of Vascular and Interventional Radiology in 2004, we already reported the use of the AVP in the treatment of an intrahepatic portosystemic venous shunt. This situation does not undervalue the quality of the reported case, but for didactic purposes, we believe it is important to state that the work of Dr. Lee confirms, as was previously reported, that these devices are useful and safe for these rare situations.

  3. Technical note: Reduction of radiation dose using ultrasound guidance during transjugular intrahepatic portosystemic shunt procedure

    Directory of Open Access Journals (Sweden)

    Roshan S Livingstone

    2011-01-01

    Full Text Available The transjugular intrahepatic portosystemic shunt (TIPS procedure for decompression of the portal venous system generally performed under fluoroscopic guidance has undergone continuous technical modifications recently. Due to the length of the procedure, the fluoroscopy times are reasonably high, thus increasing the risk from ionizing radiation. Radiation doses were measured for 19 patients using dose area product (DAP meter. The average DAP value for the TIPS procedure was 63.86 Gy cm 2 (21.12-117.07. Radiation doses to patients can be reduced with the use of USG guidance and intermittent fluoroscopy screening.

  4. Hepatic Veins and Inferior Vena Cava Thrombosis in a Child Treated by Transjugular Intrahepatic Portosystemic Shunt

    International Nuclear Information System (INIS)

    Carnevale, Francisco Cesar; Santos, Aline Cristine Barbosa; Tannuri, Uenis; Cerri, Giovanni Guido

    2010-01-01

    We report the case of a 9-year-old boy with portal hypertension, due to Budd-Chiari syndrome, and retrohepatic inferior vena cava thrombosis, submitted to a transjugular intrahepatic portosystemic shunt (TIPS) by connecting the suprahepatic segment of the inferior vena cava directly to the portal vein. After 3 months, the withdrawal of anticoagulants promoted the thrombosis of the TIPS. At TIPS revision, thrombosis of the TIPS and the main portal vein and clots at the splenic and the superior mesenteric veins were found. Successful angiography treatment was performed by thrombolysis and balloon angioplasty of a severe stenosis at the distal edge of the stent.

  5. Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

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    Shinsuke Takenaga

    2016-11-01

    Full Text Available Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL, and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS.

  6. Minilaparotomy-Assisted Transmesenteric-Transjugular Intrahepatic Portosystemic Shunt: Comparison with Conventional Transjugular Approach

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    Jalaeian, Hamed, E-mail: hjalaeia@umn.edu; Talaie, Reza; D’Souza, Donna; Taleb, Shayandokht [University of Minnesota, Division of Interventional Radiology, Department of Radiology (United States); Noorbaloochi, Siamak [University of Minnesota, School of Medicine (United States); Flanagan, Siobhan; Hunter, David; Golzarian, Jafar [University of Minnesota, Division of Interventional Radiology, Department of Radiology (United States)

    2016-10-15

    PurposeThis study was performed to compare the intrahepatic shunt function outcome and procedural complications of minilaparotomy-assisted transmesenteric (MAT)-transjugular intrahepatic portosystemic shunt (TIPS) placement with the conventional transjugular method.MethodsThis is a retrospective review of all patients who had a MAT or conventional TIPS procedure over a 6-year period at our institute. The primary patency rate, fluoroscopy time, technical success, major procedure-related complications, and mortality data were compared between two treatment groups.ResultsWe included 49 patients with MAT-TIPS, and 63 with conventional TIPS, with an average follow-up of 21.43 months. The primary patency rates at 6 and 12 months were 82.9 and 66.7 % in the conventional TIPS group, and 81.0 and 76.5 % in the MAT-TIPS group (p = 1.000, and 0.529), respectively. There was no significant difference in technical success rate, post-procedure portosystemic pressure gradient, fluoroscopy time, and peri-procedural mortality rate between treatment groups. Major procedural-related complications were seen more frequently among MAT-TIPS patients (p = 0.012). In the MAT-TIPS group, 5 (10.2 %) patients developed post-procedure minilaparotomy, wound-related complications, and 5 (10.2 %) developed bacterial peritonitis; whereas, none of patients with conventional TIPS had either of these complications (p = 0.014).ConclusionWhile both MAT-TIPS and conventional TIPS had similar shunt primary patency rate and technical success rate, the MAT approach was associated with a significantly higher rate of minilaparotomy-related wound complications or infectious complications. These complications maybe prevented by a change in post-procedure monitoring and therapy.

  7. Transjugular Intrahepatic Portosystemic Shunt for Maintenance of Portal Venous Patency in Liver Transplant Candidates

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    Ron Charles Gaba

    2013-01-01

    Full Text Available Maintenance of portal venous patency is vital to liver transplant candidates, as the presence of portal vein thrombosis (PVT adversely impacts clinical outcomes by increasing surgical complexity and decreasing postoperative survival. By enhancing portal venous blood flow, transjugular intrahepatic portosystemic shunt (TIPS creation may enable clearance of PVT and preservation of portal venous patency in cirrhotic patients. Herein, we describe four cases in which TIPS produced and sustained an open portal venous system in liver transplant candidates with partial PVT. All patients demonstrated rapid and effective flow-enabled clearance of clot and intermediate to long-term preservation of portal venous flow. On this basis, we propose that maintenance of portal venous patency in liver transplant candidates with partial PVT represents a developing indication for TIPS.

  8. Experimental study of an endothelial progenitor cell coated stent in transjugular intrahepatic portosystemic shunt

    International Nuclear Information System (INIS)

    Shi Hongjian; Teng Gaojun; Cao Aihong; Chen Jun; Deng Gang

    2009-01-01

    Objective: To evaluate the efficacy of a self-expandable metal stent coated with autologous endothelial progenitor cells (EPCs) for prevention of restenosis in transjugular intrahepatic portosystemic shunt (TIPS) in a swine model. Methods: EPCs were coated on the metal stents using fibrin gel before TIPS procedure. TIPS was performed in 15 young adult pigs, using an autologous EPC-seeded stent (treatment group, n=9) or a conventional bare metal stent (control group, n=6). All pigs were sacrificed at 2 weeks after TIPS procedure. Portography was performed immediately before the euthanasia. Gross and microscopic pathological exams and immunohistochemical exams of the TIPS track specimens were performed. Fisher test and t test were used to analyse the data. Results: TIPS was performed successfully in all the 15 swine. On day 14 of follow-up, direct portography and necropsy demonstrated that 5 shunts remained patent, 2 shunts stenosed, and the remaining 2 shunts occluded in the treatment group (n=9); while 5 shunts were occluded and one shunt was stenotic in the control group (n=6). The patency rate was 56% vs 0 (P=0.03) between the two groups. Histological analyses showed a greater pseudo-intimal hyperplasia in the TIPS track of the control group than that of the treatment group (pseudointimal thickness at hepatic vein, hepatic parenchyma and portal vein site was (1.2±0.4), (1.3±0.5), (1.5±0.4) mm vs (1.0±0.6), (0.9±0.5), (1.0±0.4) mm respectively (P<0.05). Conclusion: The EPC-coated metal stent is feasibly constructed in vitro and improves the patency in TIPS in a porcine model. (authors)

  9. Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts: experimental results in swine.

    Science.gov (United States)

    Nishimine, K; Saxon, R R; Kichikawa, K; Mendel-Hartvig, J; Timmermans, H A; Shim, H J; Uchida, B T; Barton, R E; Keller, F S; Rösch, J

    1995-08-01

    To evaluate the ability of stent-grafts made with polytetrafluoroethylene (PTFE) graft material to improve transjugular intrahepatic portosystemic shunt (TIPS) patency. TIPS were created in 13 swine by using PTFE-covered stent-grafts. Uncovered TIPS were placed in 13 other swine. Twenty-one of 26 animals were followed up with portal venography for 3 months or until the shunt became severely stenotic. Five animals without severe stenosis were sacrificed before 3 months because of illness. At 4 weeks after TIPS placement, nine of 13 stent-graft TIPS were patent (late shunt malfunction in selected cases.

  10. Transjugular Intrahepatic Portosystemic Shunt After Previous Recanalization of a Chronically Thrombosed Portal Vein via a Transmesenteric Approach

    International Nuclear Information System (INIS)

    Matsui, Osamu; Yoshikawa, Jun; Kadoya, Masumi; Gabata, Tosifumi; Takashima, Tsutomu; Urabe, Takeshi; Unoura, Masasi; Kobayashi, Kenichi

    1996-01-01

    We report a cirrhotic patient with complete occlusion of the portal vein with marked cavernous transformation due to chronic thrombosis in whom a transjugular intrahepatic portosystemic shunt (TIPS) was successfully created after direct minilaparotomy mesenteric vein catheterization, lysis and aspiration of the thrombus, and stenting in the portal vein. The methods used, we believe, provide a new technique for performing TIPS in chronically thrombosed portal veins in which previously no effective surgical therapeutic options were available

  11. The Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Portal Hypertension: Current Status

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    Gilles Pomier-Layrargues

    2012-01-01

    Full Text Available The transjugular intrahepatic portosystemic shunt (TIPS represents a major advance in the treatment of complications of portal hypertension. Technical improvements and increased experience over the past 24 years led to improved clinical results and a better definition of the indications for TIPS. Randomized clinical trials indicate that the TIPS procedure is not a first-line therapy for variceal bleeding, but can be used when medical treatment fails, both in the acute situation or to prevent variceal rebleeding. The role of TIPS to treat refractory ascites is probably more justified to improve the quality of life rather than to improve survival, except for patients with preserved liver function. It can be helpful for hepatic hydrothorax and can reverse hepatorenal syndrome in selected cases. It is a good treatment for Budd Chiari syndrome uncontrollable by medical treatment. Careful selection of patients is mandatory before TIPS, and clinical followup is essential to detect and treat complications that may result from TIPS stenosis (which can be prevented by using covered stents and chronic encephalopathy (which may in severe cases justify reduction or occlusion of the shunt. A multidisciplinary approach, including the resources for liver transplantation, is always required to treat these patients.

  12. Transjugular intrahepatic portosystemic shunt for the treatment of portal vein thrombus:its current status

    International Nuclear Information System (INIS)

    Qi Xingshun; Han Guohong; Fan Daiming

    2010-01-01

    The prevalence of portal vein thrombosis in the general population is about 1.1%, while it is about 10%-25% in the cirrhotic patients. The severe clinical complication in patients with acute portal vein thrombosis is ischemic intestinal infarction when the thrombus extends to the mesenteric venous arch. The complications include bleeding due to gastroesophageal varices, ascites and deterioration of live function in the patients with chronic portal vein thrombosis. The recently-published Practice Guidelines indicate that the treatment of portal vein thrombosis includes anticoagulation,thrombolysis, transjugular intrahepatic portosystemic shunt (TIPS) and surgical thrombectomy. TIPS has some advantages in treating portal vein thrombus. It can directly and effectively re-canalize the occluded portal vein. Moreover, it can accelerate portal flow and prevent recurrent thrombosis after the shunt is well-established. The disadvantages of TIPS include technical difficulties and potential complications. However, percutaneous transhepatic, transsplenic and transmesenteric approaches well facilitate the TIPS procedure. Additionally, preoperative evaluation of portal vein anatomy can provide a safe and effective choice in treating patients with portal cavernoua caver who are going to receive TIPS. Nevertheless, in the absence of relevant prospective studies, the application of TIPS for the management of portal vein thrombosis is still limited. (authors)

  13. Modifications of cardiac function in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS).

    Science.gov (United States)

    Merli, Manuela; Valeriano, Valentina; Funaro, Stefania; Attili, Adolfo Francesco; Masini, Andrea; Efrati, Cesare; De, Castro Stefano; Riggio, Oliviero

    2002-01-01

    The implantation of a transjugular intrahepatic portosystemic shunt (TIPS) has been shown to exacerbate the hyperdynamic circulation and might induce a significant cardiac overload. We investigated cardiac function before and 1, 3, 6, and 12 months after the TIPS procedure in cirrhotic patients. Eleven patients with nonalcoholic cirrhosis were evaluated. Cardiovascular parameters were assessed by two-dimensional Doppler echocardiography. After TIPS, the left ventricular diastolic diameter increased from 26.5 +/- 1.8 mm (basal) to 30.0 +/- 2.8 mm (6 months) (p < 0.05), whereas the ejection fraction showed a slight increase (basal, 64.5 +/- 3.3; 6 months, 68.1 +/- 3.2). The left ventricular pre-ejection period and the isovolumetric relaxation time decreased transiently at 1 month (p < 0.05). An increased velocity in all of the components of pulmonary venous flow (systolic, diastolic, and atrial) documented the accelerated fluxes induced by the procedure. The estimated pulmonary systolic arterial pressure also increased at 1 month (29.5 +/- 1.4 vs 44.1 +/- 1.4 mm Hg, p < 0.05). All of these modifications reverted after 6 months. Our study demonstrates that nonalcoholic cirrhotic patients, without cardiovascular pathologies, show transient modifications in cardiac dimension and function for 3-6 months after TIPS caused by the increased volume load shunted to the heart.

  14. Usefulness of Transjugular Intrahepatic Portosystemic Shunt in the Management of Bleeding Ectopic Varices in Cirrhotic Patients

    International Nuclear Information System (INIS)

    Vidal, V.; Joly, L.; Perreault, P.; Bouchard, L.; Lafortune, M.; Pomier-Layrargues, G.

    2006-01-01

    Purpose. To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the control of bleeding from ectopic varices. Methods. From 1995 to 2004, 24 cirrhotic patients, bleeding from ectopic varices, mean age 54.5 years (range 15-76 years), were treated by TIPS. The etiology of cirrhosis was alcoholic in 13 patients and nonalcoholic in 11 patients. The location of the varices was duodenal (n = 5), stomal (n = 8), ileocolic (n = 6), anorectal (n = 3), umbilical (n = 1), and peritoneal (n 1). Results. TIPS controlled the bleeding in all patients and induced a decrease in the portacaval gradient from 19.7 ± 5.4 to 6.4 ± 3.1 mmHg. Postoperative complications included self-limited intra-abdominal bleeding (n = 2), self-limited hemobilia (n = 1), acute thrombosis of the shunt (n = 1), and bile leak treated by a covered stent (n = 1). Median follow-up was 592 days (range 28-2482 days). Rebleeding occurred in 6 patients. In 2 cases rebleeding was observed despite a post-TIPS portacaval gradient lower than 12 mmHg and was controlled by variceal embolization; 1 patient underwent surgical portacaval shunt and never rebled; in 3 patients rebleeding was related to TIPS stenosis and treated with shunt dilatation with addition of a new stent. The cumulative rate of rebleeding was 23% and 31% at 1 and 2 years, respectively. One- and 2-year survival rates were 80% and 76%, respectively. Conclusion. The present series demonstrates that bleeding from ectopic varices, a challenging clinical problem, can be managed safely by TIPS placement with low rebleeding and good survival rates

  15. ePTFE-covered stent-grafts for revision of obstructed transjugular intrahepatic portosystemic shunt.

    Science.gov (United States)

    Cejna, Manfred; Peck-Radosavljevic, Markus; Thurnher, Siegfried; Schoder, Maria; Rand, Thomas; Angermayr, Bernhard; Lammer, Johannes

    2002-01-01

    To determine whether transjugular intrahepatic portosystemic shunt (TIPS) revisions with the Hemobahn stent-graft or the Viatorr endoprosthesis increase secondary patency rates. Between 1998 and June 1999, Hemobahn endoprostheses (W.L. Gore, Flagstaff, AZ, USA) were used for the revision of obstructed TIPS in seven patients, 51-67 years of age (mean 59 years). From June 1999 to 2000, the Viatorr endoprosthesis (W.L. Gore, Flagstaff, AZ, USA) was used for revision of obstructed TIPS in nine patients, 33-64 years of age (mean 49 years). Follow-up included duplex ultrasound, clinical assessment and venous portography. The technical success rate of TIPS revision with the Hemobahn stent-graft was 100%. The pressure gradient decreased from a mean of 20 mmHg to 10 mmHg. The mean follow-up was 407 days (range 81-868 days). In two patients TIPS occlusion occurred at 62 and 529 days after stent-graft placement, respectively; in another two patients outflow tract stenosis occurred at 275 and 393 days, respectively. The technical success rate of TIPS revision with the Viatorr endoprosthesis was also 100%. The pressure gradient decreased from a mean of 27 mmHg to 11 mmHg. At a mean follow-up of 201 days (range 9-426 days), all Viatorr endoprostheses are still patent without in-graft stenosis, but angioplasty was required in two patients to treat a portosystemic pressure gradient > 15 mmHg. Four of the nine patients in the Viatorr group suffered from new encephalopathy after TIPS revision. The Viatorr endoprosthesis yielded optimal results with 100% in-graft patency rates at follow-up but had a high incidence of new encephalopathy, whereas the use of Hemobahn stent-graft for TIPS revision did not appear to improve the secondary patency rates in our series.

  16. Transjugular intrahepatic portosystemic shunt: results and prognostic factors in patients with post-necrotic liver cirrhosis

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Han, Man Chung; Kim, Yong Joo

    1997-01-01

    To evaluate the effectiveness of transjugular intrahepatic portosystemic shunt(TIPS) in the management of gastroesophageal variceal bleeding and predictive factors for long-term survival in patients with post-necrotic liver cirrhosis. A total of 49 patients with post-necrotic liver cirrhosis underwent TIPS over a recent three-year period. Forty-five had a history of hepatitis B viral infection, and four, of hepatitis C viral infection. In all patients, the indication for the procedure was variceal bleeding. Child-Pugh class was A in seven patients, B in 16 and C in 26 patients at the time of the last bleeding. The effectiveness of portal decompression and bleeding control was evaluated. Long-term survival was calculated by the Kaplan-Meier method and predictive factors were analyzed using the Wilcoxon test. The procedure was technically successful in all cases. The portosystemic pressure gradient decreased significantly from 21.4 ± 6.4 mmHg to 12.0 ± 5.1 mmHg(N=45). Active variceal bleeding was controlled in 34 of the 37 emergency patients. The total length of follow-up was from one day to three and a half years(mean : 383 ± 357 days). Rebleeding developed in 17 patients (35%). Hepatic encephalopathy, either newly developed or aggravated, occurred in 16 (32.7%). The thirty-day mortality rate was 20.4%, and the one-year survival rate was 63.8%. The significant predictive factors for poor prognosis were Child-Pugh class C and post-TIPS hepatic encephalopathy. TIPS is effective in portal decompression in the patients with variceal bleeding due to post-necrotic liver cirrhosis. The Child-Pugh classification and hepatic encephalopathy after TIPS are considered to be significant predictive factors for long-term survival

  17. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ingraham, Christopher R., E-mail: cringra@uw.edu; Padia, Siddharth A., E-mail: spadia@uw.edu; Johnson, Guy E., E-mail: gej@uw.edu [University of Washington, Department of Interventional Radiology (United States); Easterling, Thomas R., E-mail: easter@uw.edu [University of Washington, Department of Obstetrics and Gynecology (United States); Liou, Iris W., E-mail: irisl@medicine.washington.edu [University of Washington, Department of Medicine (United States); Kanal, Kalpana M., E-mail: kkanal@uw.edu [University of Washington, Physics Section, Department of Radiology (United States); Valji, Karim, E-mail: kvalji@uw.edu [University of Washington, Department of Interventional Radiology (United States)

    2015-10-15

    Background and AimsComplications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.MethodsFive pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.ResultsAll five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.ConclusionsThis series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.

  18. Transjugular intrahepatic portosystemic shunt for severe jaundice in patients with acute Budd-Chiari syndrome.

    Science.gov (United States)

    He, Fu-Liang; Wang, Lei; Zhao, Hong-Wei; Fan, Zhen-Hua; Zhao, Meng-Fei; Dai, Shan; Yue, Zhen-Dong; Liu, Fu-Quan

    2015-02-28

    To evaluate the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) for severe jaundice secondary to acute Budd-Chiari syndrome (BCS). From February 2009 to March 2013, 37 patients with severe jaundice secondary to acute BCS were treated. Sixteen patients without hepatic venule, hepatic veins (HV) obstruction underwent percutaneous angioplasty of the inferior vena cava (IVC) and/or HVs. Twenty-one patients with HV occlusion underwent TIPS. Serum bilirubin, liver function, demographic data and operative data of the two groups of patients were analyzed. Twenty-one patients underwent TIPS and the technical success rate was 100%, with no technical complications. Sixteen patients underwent recanalization of the IVC and/or HVs and the technical success rate was 100%. The mean procedure time for TIPS was 84.0±12.11 min and angioplasty was 44.11±5.12 min (Pjaundice in either group. Severe jaundice is not a contraindication for TIPS in patients with acute BCS and TIPS is appropriate for severe jaundice due to BCS.

  19. Portal vein thrombosis before and after transjugular intrahepatic portosystemic shunt placement: An observational study (STROBE compliant).

    Science.gov (United States)

    Wan, Yue-Meng; Li, Yu-Hua; Wu, Hua-Mei; Xu, Zhi-Yuan; Xu, Ying; Yang, Li-Hong; Wu, Xi-Nan; Yang, Jin-Hui

    2017-11-01

    Portal vein thrombosis (PVT) is common in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS). This study had 3-fold aims: to assess risk factors for PVT; to determine the efficacy of anticoagulant therapy; to investigate the impact of PVT on clinical outcomes in TIPS-treated cirrhosis.Between June 2012 and February 2016, 126 TIPS-treated patients with cirrhosis were enrolled and studied prospectively. Enrolled patients were screened for PVT before TIPS and at 3, 6, 12, and 24 months post-TIPS. All patients received warfarin (1.5-3.0 mg/day) or aspirin (100 mg/day) or clopidogrel (75 mg/day) post-TIPS. Results of patients with and without PVT (baseline and de novo) were compared.White blood cell (WBC) counts (odds ratio (OR): 0.430, 95% confidence interval (CI): 0.251-0.739, P = .002) and Child-Turcotte-Pugh (CTP) score (OR: 2.377, 95% CI: 1.045-5.409, P = .039) were significant baseline predictors for PVT in TIPS-treated patients with cirrhosis. Warfarin resulted in markedly greater rates of complete recanalization than aspirin or clopidogrel (P < .05) in patients with PVT. Patients with PVT had markedly higher 2-year cumulative rates of variceal rebleeding, shunt dysfunction, hepatic encephalopathy, and hepatocellular carcinoma, and prominently lower overall survival than those without PVT (P < .05).In TIPS-treated patients with cirrhosis, lower WBC count and higher CTP score were independent baseline predictors for PVT; patients with PVT had worse clinical outcomes than those without; warfarin may be more effective in recanalizing PVT than aspirin or clopidogrel.

  20. A case of pancreatic arteriovenous malformation with portal hypertension: treatment with transjuguIar intrahepatic portosystemic shunt

    International Nuclear Information System (INIS)

    Kim, Seong Hoon; Kim, Young Whan; Kim, Yong Joo

    2004-01-01

    Arteriovenous malformation of the pancreas is a rare disease, and it is manifested by gastrointestinal bleeding and/or portal hypertension. Surgery is definitely the treatment of choice at the early stage of the disease, and a transcatheter embolization is an alternative treatment for the control of bleeding and if the lesion is surgically inaccessible. We describe a 62-year-old man who had refractory ascites and esophageal variceal bleeding caused by a pancreatic arteriovenous malformation associated with portal hypertension; this was successfully treated by a transjugular intrahepatic portosystemic shunt

  1. The genetic background of congenital portosystemic shunts in dogs

    NARCIS (Netherlands)

    van Steenbeek, F.G.|info:eu-repo/dai/nl/314417958

    2013-01-01

    Congenital disorders of the hepatic portal vasculature are rare in man, but occur frequently in certain dog breeds. Congenital portosystemic shunts (CPSS) is the collective term for two subtypes; extrahepatic portosystemic shunts (EHPSS) and intrahepatic portosystemic shunts (IHPSS). The dog is very

  2. Experimental comparison study of the tissue characteristics in transjugular intrahepatic portosystemic shunt and vascular stent

    International Nuclear Information System (INIS)

    Lu Qin; An Yanli; Deng Gang; Fang Wen; Zhu Guangyu; Niu Huanzhang; Yu Hui; Li Guozhao; Teng Gaojun; Wang Zhen; Wei Xiaoying

    2009-01-01

    Objective: To investigate the tissue characteristics within vascular stent and transjugular intrahepatic portosystemic shunt(TIPS) on swine and to provide more information for the understanding and prevention of vascular stent and TIPS restenosis. Methods: Animal models for TIPS were built in 6 swine and vascular stents were implanted in iliac veins simultaneously. 14-28 days after the operation, the 6 swine were killed to remove the TIPS and vascular stent and the pathological examinations were performed on the tissues within the shunt and stent. The similarities and differences of the tissues within the shunt and stent were analyzed with Krttskal Wallis test. Results: Restenosis of TIPS occurred in 4 models and complete occlusion were seen in 2, while all vascular stents were patent and coated with a thin layer of intimal tissue. Electron microscopic results showed that the tissues in restenotic TIPS were loose and with more extra matrix and fibers, and less smooth muscle, fibroblastic and myofibroblastic cells with different and irregular shape and rich secretory granules. The tissues in patent TIPS contained more extra fibers, smooth muscle and fibroblastic cells with normal organelle. The intimal tissues in vascular stent contained more fibers and fibroblasts cells, less smooth muscle cells. On immunohistochemical staining, the tissues in restenotic and patent TIPS as well as the intimal tissues in vascular stent had strong positive expression for anti-SMC- actin-α, the expression were gradually weakened for PCNA, the intimal tissues in vascular stent had a strong positive expression for vimentin, while the expression of the tissues in restenotic and patent TIPS were weakened gradually. For myoglobulin, the tissues in restenotic TIPS had weakly positive expression, the expression in patent TIPS and vascular stent were almost negative. Western blot results for TGF-β showed that the absorbance ratios of the intima tissues in vascular stent, normal vascular

  3. Radiation dose reduction during transjugular intrahepatic portosystemic shunt implantation using a new imaging technology

    Energy Technology Data Exchange (ETDEWEB)

    Spink, C., E-mail: c.spink@uke.de [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Avanesov, M. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Schmidt, T. [Philips Healthcare, Hamburg (Germany); Grass, M. [Philips Research, Hamburg (Germany); Schoen, G. [Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Adam, G.; Bannas, P.; Koops, A. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

    2017-01-15

    Highlights: • The new imaging technology halved the radiation exposure. • DSA image quality observed was not decreased after technology upgrade. • Radiation time and contrast consumption not significantly increased using the new technology. - Abstract: Objective: To compare patient radiation dose in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation before and after an imaging-processing technology upgrade. Methods: In our retrospective single-center-study, cumulative air kerma (AK), cumulative dose area product (DAP), total fluoroscopy time and contrast agent were collected from an age- and BMI-matched collective of 108 patients undergoing TIPS implantation. 54 procedures were performed before and 54 after the technology upgrade. Mean values were calculated and compared using two-tailed t-tests. Two blinded, independent readers assessed DSA image quality using a four-rank likert scale and the Wilcoxcon test. Results: The new technology demonstrated a significant reduction of 57% of mean DAP (402.8 vs. 173.3 Gycm{sup 2}, p < 0.001) and a significant reduction of 58% of mean AK (1.7 vs. 0.7 Gy, p < 0.001) compared to the precursor technology. Time of fluoroscopy (26.4 vs. 27.8 min, p = 0.45) and amount of contrast agent (109.4 vs. 114.9 ml, p = 0.62) did not differ significantly between the two groups. The DSA image quality of the new technology was not inferior (2.66 vs. 2.77, p = 0.56). Conclusions: In our study the new imaging technology halved radiation dose in patients undergoing TIPS maintaining sufficient image quality without a significant increase in radiation time or contrast consumption.

  4. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + β-blocker for prevention of variceal rebleeding.

    Science.gov (United States)

    Holster, I Lisanne; Tjwa, Eric T T L; Moelker, Adriaan; Wils, Alexandra; Hansen, Bettina E; Vermeijden, J Reinoud; Scholten, Pieter; van Hoek, Bart; Nicolai, Jan J; Kuipers, Ernst J; Pattynama, Peter M T; van Buuren, Henk R

    2016-02-01

    Gastroesophageal variceal bleeding in patients with cirrhosis is associated with significant morbidity and mortality, as well as a high rebleeding risk. Limited data are available on the role of transjugular intrahepatic portosystemic shunt (TIPS) with covered stents in patients receiving standard endoscopic, vasoactive, and antibiotic treatment. In this multicenter randomized trial, long-term endoscopic variceal ligation (EVL) or glue injection + β-blocker treatment was compared with TIPS placement in 72 patients with a first or second episode of gastric and/or esophageal variceal bleeding, after hemodynamic stabilization upon endoscopic, vasoactive, and antibiotic treatment. Randomization was stratified according to Child-Pugh score. Kaplan-Meier (event-free) survival estimates were used for the endpoints rebleeding, death, treatment failure, and hepatic encephalopathy. During a median follow-up of 23 months, 10 (29%) of 35 patients in the endoscopy + β-blocker group, as compared to 0 of 37 (0%) patients in the TIPS group, developed variceal rebleeding (P = 0.001). Mortality (TIPS 32% vs. endoscopy 26%; P = 0.418) and treatment failure (TIPS 38% vs. endoscopy 34%; P = 0.685) did not differ between groups. Early hepatic encephalopathy (within 1 year) was significantly more frequent in the TIPS group (35% vs. 14%; P = 0.035), but during long-term follow-up this difference diminished (38% vs. 23%; P = 0.121). In unselected patients with cirrhosis, who underwent successful endoscopic hemostasis for variceal bleeding, covered TIPS was superior to EVL + β-blocker for reduction of variceal rebleeding, but did not improve survival. TIPS was associated with higher rates of early hepatic encephalopathy. © 2015 by the American Association for the Study of Liver Diseases.

  5. Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts

    International Nuclear Information System (INIS)

    Park, Jonathan K.; Al-Tariq, Quazi Z.; Zaw, Taryar M.; Raman, Steven S.; Lu, David S.K.

    2015-01-01

    PurposeTo assess radiofrequency (RF) ablation efficacy, as well as the patency of transjugular intrahepatic portosystemic shunts (TIPSs), in patients with hepatocellular carcinoma (HCC).Materials and MethodsRetrospective database review of patients with pre-existing TIPS undergoing RF ablation of HCC was conducted over a 159-month period ending in November 2013. TIPS patency pre- and post-RF ablation was assessed by ultrasound, angiography, and/or contrast-enhanced CT or MRI. Patient demographics and immediate post-RF ablation outcomes and complications were also reviewed.Results19 patients with 21 lesions undergoing 25 RF ablation sessions were included. Child-Pugh class A, B, and C scores were seen in 1, 13, and 5 patients, respectively. Eleven patients (58 %) ultimately underwent liver transplantation. Immediate technical success was seen in all ablation sessions without residual tumor enhancement (100 %). No patients (0 %) suffered liver failure within 1 month of ablation. Pre-ablation TIPS patency was demonstrated in 22/25 sessions (88 %). Of 22 cases with patent TIPS prior to ablation, post-ablation patency was demonstrated in 22/22 (100 %) at immediate post-ablation imaging and in 21/22 (95 %) at last follow-up (1 patient was incidentally noted to have occlusion 31 months later). No immediate complications were observed.ConclusionAblation efficacy was similar to the cited literature values for patients without TIPS. Furthermore, TIPS patency was preserved in the majority of cases. Patients with both portal hypertension and HCC are not uncommonly encountered, and a pre-existing TIPS does not appear to be a definite contraindication for RF ablation

  6. Sarcopenia Is Risk Factor for Development of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement.

    Science.gov (United States)

    Nardelli, Silvia; Lattanzi, Barbara; Torrisi, Sabrina; Greco, Francesca; Farcomeni, Alessio; Gioia, Stefania; Merli, Manuela; Riggio, Oliviero

    2017-06-01

    Hepatic encephalopathy (HE) is an important complication in patients with cirrhosis who received transjugular intrahepatic portosystemic shunts (TIPS). We investigated whether a decrease in muscle mass was associated independently with the occurrence of HE after TIPS. We performed a prospective study of 46 consecutive patients with cirrhosis (mean age, 58.6 ± 9.1 y; mean model for end-stage liver disease score, 11.3 ± 3.3; mean Child-Pugh score, 7.6 ± 1.5) who received TIPS from January 2013 through December 2014 at a tertiary center in Rome, Italy. All patients underwent computed tomography analysis at the level of the third lumbar vertebrae to determine the skeletal muscle index; sarcopenia was defined by sex-specific cut-off values. We estimated the incidence of the first episode of HE after TIPS, taking into account the competing risk nature of the data (death or liver transplantation). Twenty-six patients (57%) were found to have sarcopenia. Twenty-one patients (46%) developed overt HE in the 7 ± 9 months after TIPS placement; all of these patients were sarcopenic, according to the skeletal muscle index. Of the 25 patients without HE after TIPS, only 5 had sarcopenia. In multivariate analysis, model for end-stage liver disease score (subdistribution hazard ratio, 1.16; 95% confidence interval, 1.01-1.34; P = .043) and sarcopenia (subdistribution hazard ratio, 31.3; 95% confidence interval, 4.5-218.07; P Sarcopenia should be considered in selecting patients for TIPS therapy. Nutritional status should be evaluated in patients with sarcopenia before TIPS placement, which might reduce the incidence of HE. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  7. Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

    Energy Technology Data Exchange (ETDEWEB)

    Padia, Siddharth A., E-mail: spadia@uw.edu; Chewning, Rush H., E-mail: rchewnin@uw.edu; Kogut, Matthew J., E-mail: kogutm@uw.edu; Ingraham, Christopher R., E-mail: cringa@uw.edu; Johnson, Guy E., E-mail: gej@uw.edu [University of Washington Medical Center, Section of Interventional Radiology, Department of Radiology (United States); Bhattacharya, Renuka, E-mail: renuka@uw.edu [University of Washington Medical Center, Division of Gastroenterology and Hepatology, Department of Medicine (United States); Kwan, Sharon W., E-mail: shakwan@uw.edu; Monsky, Wayne L., E-mail: wmonsky@uw.edu; Vaidya, Sandeep, E-mail: svaidya@uw.edu [University of Washington Medical Center, Section of Interventional Radiology, Department of Radiology (United States); Hippe, Daniel S., E-mail: dhippe@uw.edu [University of Washington Medical Center, Department of Radiology (United States); Valji, Karim, E-mail: kvalji@uw.edu [University of Washington Medical Center, Section of Interventional Radiology, Department of Radiology (United States)

    2015-08-15

    PurposeLocoregional therapy for hepatocellular carcinoma (HCC) can be challenging in patients with a transjugular intrahepatic portosystemic shunt (TIPS). This study compares safety and imaging response of ablation, chemoembolization, radioembolization, and supportive care in patients with both TIPS and HCC.MethodsThis retrospective study included 48 patients who had both a TIPS and a diagnosis of HCC. Twenty-nine of 48 (60 %) underwent treatment for HCC, and 19/48 (40 %) received best supportive care (i.e., symptomatic management only). While etiology of cirrhosis and indication for TIPS were similar between the two groups, treated patients had better baseline liver function (34 vs. 67 % Child-Pugh class C). Tumor characteristics were similar between the two groups. A total of 39 ablations, 17 chemoembolizations, and 10 yttrium-90 radioembolizations were performed on 29 patients.ResultsAblation procedures resulted in low rates of hepatotoxicity and clinical toxicity. Post-embolization/ablation syndrome occurred more frequently in patients undergoing chemoembolization than ablation (47 vs. 15 %). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the ablation group. Follow-up imaging response showed objective response in 100 % of ablation procedures, 67 % of radioembolization procedures, and 50 % of chemoembolization procedures (p = 0.001). When censored for OLT, patients undergoing treatment survived longer than patients receiving supportive care (2273 v. 439 days, p = 0.001).ConclusionsAblation appears to be safe and efficacious for HCC in patients with TIPS. Catheter-based approaches are associated with potential increased toxicity in this patient population. Chemoembolization appears to be associated with increased toxicity compared to radioembolization.

  8. Inpatient Cost Assessment of Transjugular Intrahepatic Portosystemic Shunt in the USA from 2001 to 2012.

    Science.gov (United States)

    Kuei, Andrew; Lee, Edward Wolfgang; Saab, Sammy; Busuttil, Ronald W; Durazo, Francisco; Han, Steven-Huy; ElKabany, Mohamed; McWilliams, Justin P; Kee, Stephen T

    2016-10-01

    Despite widespread use of transjugular intrahepatic portosystemic shunt (TIPS) for treatment of portal hypertension, a paucity of nationwide data exists on predictors of the economic impact related to TIPS. Using the National Inpatient Sample (NIS) database from 2001 to 2012, we aimed to evaluate factors contributing to hospital cost of patients admitted to US hospitals for TIPS. Using the NIS, we identified a discharge-weighted national estimate of 61,004 TIPS procedures from 2001 to 2012. Through independent sample analysis, we determined profile factors related to increases in hospital costs. Of all TIPS cases, the mean charge adjusted for inflation to the year 2012 is $125,044 ± $160,115. The mean hospital cost adjusted for inflation is $44,901 ± $54,565. Comparing pre- and post-2005, mean charges and cost have increased considerably ($98,154 vs. $142,652, p < 0.001 and $41,656 vs. $46,453, p < 0.001, respectively). Patients transferred from a different hospital, weekend admissions, Asian/Pacific Islander patients, and hospitals in the Northeastern and Western region had higher cost. Number of diagnoses and number of procedures show positive correlations with hospital cost, with number of procedures exhibiting stronger relationships (Pearson 0.613). Comorbidity measures with highest increases in cost were pulmonary circulation disorders ($32,157 increase, p < 0.001). The cost of the TIPS procedure is gradually rising for hospitals. Alongside recent healthcare reform through the Affordable Care Act, measures to reduce the economic burden of TIPS are of increasing importance. Data from this study are intended to aid physicians and hospitals in identifying improvements that could reduce hospital costs.

  9. The natural history of parallel transjugular intrahepatic portosystemic stent shunts using uncovered stent: the role of host-related factors.

    Science.gov (United States)

    Helmy, Ahmed; Redhead, Doris N; Stanley, Adrian J; Hayes, Peter C

    2006-06-01

    Parallel shunts (PS) are used in the management of transjugular intrahepatic portosystemic stent-shunt (TIPS) insufficiency, a major limitation of the technique. This study describes the natural history of PS, and uses them as a model to assess the role of host factors in the development of primary shunt insufficiency. Out of 338 patients with TIPS, 40 (11.8%) patients required insertion of a PS. Baseline and follow-up data of these patients were collected. Regular shunt surveillance involved biannual clinic visits and transjugular portography. The non-PS group (group 1; n = 298) and the PS group (group 2; n = 40) had similar baseline demographic and disease characteristics. Index shunts of both groups and the PS produced a significant portal pressure gradient drop (P < 0.001), which was less in the index shunts of Group 2 (P < 0.02 for both). PS had similar cumulative shunt patency rates to those of the index shunts of Group 1, and both were greater than those of index shunts in Group 2 (P < 0.001 for both). The intervention rate (number of interventions/number of check portograms x 100) was similar for PS and the index shunts of Group 1 (38.7% and 43% respectively), but was significantly higher in the index shunts of Group 2 (85.6%; P < 0.01 for both). In Group 1 and Group 2, 144 patients (48.3%) and 21 patients (52.5%) died during follow-up after a median period of 23.4 and 8.9 months respectively. These findings do not support the hypothesis that shunt insufficiency is related to host factors.

  10. Portal hypertensive enteropathy diagnosed by capsule endoscopy and demonstration of the ileal changes after transjugular intrahepatic portosystemic shunt placement: a case report

    Directory of Open Access Journals (Sweden)

    Carella Alessandra

    2011-03-01

    Full Text Available Abstract Introduction Recent data suggest that mucosal abnormalities can occur even in the duodenum, jejunum, and distal ileum of cirrhosis patients. We present a case of portal hypertensive enteropathy in a cirrhosis patient shown by capsule endoscopy and the effect of transjugular intrahepatic portosystemic shunt on the ileal pictures. Case presentation An 83-year-old Caucasian woman was admitted to our hospital for anemia and a positive fecal occult blood test. An upper gastrointestinal endoscopy revealed small varices without bleeding signs and hypertensive gastropathy. Colonoscopy was negative. To rule out any other cause of bleeding, capsule endoscopy was performed; capsule endoscopy revealed severe hyperemia of the jejunum-ileal mucosa with active bleeding. Because of the persistence of anemia and the frequent blood transfusions, not responding to β-blocker drugs or octreotide infusion, a transjugular intrahepatic portosystemic shunt was performed. Anemia improved quickly after the transjugular intrahepatic portosystemic shunt, and no further blood transfusion was necessary in the follow-up. The patient developed portal encephalopathy two months later and was readmitted to our department. We repeated the capsule endoscopy that showed a significant improvement of the gastric and ileal mucosa without any signs of bleeding. Conclusion Hypertensive enteropathy is a rare condition, but it seems more common with the introduction of capsule endoscopy in clinical practice. This case shows that the jejunum can be a source of bleeding in cirrhosis patients, and this is the first demonstration of its resolution after transjugular intrahepatic portosystemic shunt placement.

  11. Efficacy of a paclitaxel-eluting nitinol stent on the inhibition of pseudointimal hyperplasia in a transjugular intrahepatic portosystemic shunt: an experimental study in a swine model

    International Nuclear Information System (INIS)

    Seo, Tae Seok; Oh, Joo Hyeong; Kwon, Se Hwan; Park, Young Koo; Song, Ho Young; Yuk, Sun Hong

    2007-01-01

    To evaluate the efficacy of a paclitaxel-eluting nitinol stent on the inhibition of pseudointimal hyperplasia in a transjugular intrahepatic portosystemic shunt. Twelve pigs were used in this study. Two types of 10-mm diameter and 60-mm long nitinol stents were made for a transjugular intrahepatic portosystemic shunt by coating them with a polyurethane solution, with and without paclitaxel. Each transjugular intrahepatic portosystemic shunt was created successfully in the 12 swine with 7 paclitaxel-eluting stents and 5 polyurethane stents. Five swine in each group were followed-up for 14 days due to the death of 2 swine given the paclitaxel-eluting stents. The proliferation of the pseudointima was evaluated on both follow-up portograms and histopathology examinations. The mean maximum pseudointimal hyperplasia is expressed as the percentage of the stent radius. On the portograms, all the transjugular intrahepatic portosystemic shunts using the paclitaxel-eluting stents maintained patency despite there being a complete occlusion of the polyurethane stents in all the animals. The histopathology analysis revealed the mean maximum pseudointimal hyperplasia to be 25% and 76% in the paclitaxel-eluting and control stents, respectively

  12. Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

    Energy Technology Data Exchange (ETDEWEB)

    Gong, Ying; Chen, Jun; Chen, Qi; Ji, Min; Pa, Mier; Qiao, Zhongwei [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Zhu, Hui [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Zheng, Shan [Children' s Hospital of Fudan University, Department of Surgery, Shanghai (China)

    2015-12-15

    The clinical presentation of congenital portosystemic shunt is variable and gastrointestinal bleeding is an uncommon presentation. To describe the imaging features of congenital portosystemic shunt as it presented in 11 children with (n = 6) and without gastrointestinal bleeding (n = 5). We performed a retrospective study on a clinical and imaging dataset of 11 children diagnosed with congenital portosystemic shunt. A total of 11 children with congenital portosystemic shunt were included in this study, 7 with extrahepatic portosystemic shunts and 4 with intrahepatic portosystemic shunts. Six patients with gastrointestinal bleeding had an extrahepatic portosystemic shunt, and the imaging results showed that the shunts originated from the splenomesenteric junction (n = 5) or splenic vein (n = 1) and connected to the internal iliac vein. Among the five cases of congenital portosystemic shunt without gastrointestinal bleeding, one case was an extrahepatic portosystemic shunt and the other four were intrahepatic portosystemic shunts. Most congenital portosystemic shunt patients with gastrointestinal bleeding had a shunt that drained portal blood into the iliac vein via an inferior mesenteric vein. This type of shunt was uncommon, but the concomitant rate of gastrointestinal bleeding with this type of shunt was high. (orig.)

  13. A multimodality imaging approach for guiding a modified endovascular coil embolization of a single intrahepatic portosystemic shunt in dogs.

    Science.gov (United States)

    Knapp, Teja; Navalòn, Iolanda; Medda, Massimo; Pradelli, Danitza; Borgonovo, Simone; Crosta, Cristina; Bussadori, Claudio Maria

    2015-12-01

    Intrahepatic portosystemic shunts (IHPSS) in dogs are aberrant vascular anomalies that connect the portal and the systemic venous vessels. In most of the patients, the surgical approach is unfavourable due to the difficulties in isolating the IHPSS, making the option of a percutaneous transvenous coil embolization (PTCE) one of the safer occlusive procedures. This study describes the treatment of eight dogs with a single IHPSS using a multimodality imaging approach to guide the modified PTCE procedure. This new technique results in a decrease of 71% of the time of the entire procedure with the reduction of 91% in the time required involved the IHPSS identification and in the fluoroscopy exposure time avoiding the need for iodinated contrast agents during the procedure. Moreover, the placement of the catheter before the caval stent ensures its greater stability, enhancing the procedural safety in the phase when the coils are released and avoiding the risk of their dislocation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Outcomes of transjugular intrahepatic portosystemic shunt creation for flow-enabled dissolution of spleno-mesenterico-portal venous thrombosis.

    Science.gov (United States)

    Lakhoo, J; Gaba, R C

    2016-11-01

    To evaluate the outcomes of transjugular intrahepatic portosystemic shunt (TIPS) for flow-enabled clearance of portal (PVT), splenic (SVT) and/or superior mesenteric (MVT) vein thrombosis. In this single-center study, 12 patients underwent TIPS using Viatorr covered stent-grafts (W.L. Gore & Associates, Flagstaff, AZ, USA) from 2008-2014 for PVT as a primary (n=8) or secondary (n=4) indication. TIPS were not accompanied by pharmacomechanical clot disruption; rather, shunts served to increase portal blood flow to allow flow-mediated physiologic clot dissolution. Pre- and post-TIPS cross-sectional imaging were used to assess clot location, size, and clearance, defined by resolution (vessel patency with no clot), reduction (decrease in clot size), stability (no change in clot size), or extension (increase in clot size). The cohort included 5 men and 7 women (median age 63 years, range 45-73 years, median MELD score 15) with 30 non-occlusive and asymptomatic thrombi spanning main or intrahepatic PVT (n=15/30, 50%), SVT (n=6/30, 20%), and MVT (n=9/30, 30%). TIPS were generally created with 10mm covered stent-grafts; mean final portosystemic pressure gradient was 8mmHg. At mean 190 days post-TIPS, 58% (n=7/12) had clot resolution, 33% (n=4/12) had clot reduction, and 8% (n=1/12) had stable clot; there were no cases of clot extension. Resolution rate was 67% for PVT (10/15), SVT (4/6), and MVT (6/9). Two of 12 (17%) patients underwent successful liver transplant post-TIPS. TIPS prompts dissolution of or decrease in PVT, SVT, and MVT in cirrhotic patients. This may be a useful approach notwithstanding omission of pharmacomechanical methods. Copyright © 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  15. Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Keith, E-mail: keithjppereira@gmail.com [Jackson Memorial Hospital/University of Miami Hospital, Department of Interventional Radiology (United States); Carrion, Andres F., E-mail: andres.carrionmonsa@jhsmiami.org [Jackson Memorial Hospital/University of Miami Hospital, Department of Hepatology (United States); Salsamendi, Jason, E-mail: JSalsamendi@med.miami.edu; Doshi, Mehul, E-mail: MDoshi@med.miami.edu; Baker, Reginald, E-mail: RBaker@med.miami.edu; Kably, Issam, E-mail: ikably@med.miami.edu [Jackson Memorial Hospital/University of Miami Hospital, Department of Interventional Radiology (United States)

    2016-02-15

    Transjugular intrahepatic portosystemic shunt (TIPS) has evolved as an effective intervention for treatment of complications of portal hypertension. The use of polytetrafluoroethylene-covered stents have improved the patency of the shunts and diminished the incidence of TIPS dysfunction. However, TIPS-related refractory hepatic encephalopathy (rHE) poses a significant challenge. Approximately 3–7 % of patients with TIPS develop rHE. Refractory hepatic encephalopathy is defined as a recurrent or persistent encephalopathy despite appropriate medical treatment. Hepatic encephalopathy can be an extremely debilitating complication that profoundly affects quality of life. The approach to management of patients with rHE is complex and typically requires collaboration between different specialties. Liver transplantation is the ultimate treatment for rHE; however, the ongoing shortage of organ donation markedly limits this treatment option. Alternative therapies such as shunt occlusion or reduction can control symptoms and serve as a ‘bridge’ therapy to liver transplantation. Therefore, interventional radiologists play a key role in the management of these patients by offering a variety of endovascular techniques. The purpose of this review is to highlight some of these endovascular techniques and to develop a therapeutic algorithm that can be applied in clinical practice for the management of rHE.

  16. Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm

    International Nuclear Information System (INIS)

    Pereira, Keith; Carrion, Andres F.; Salsamendi, Jason; Doshi, Mehul; Baker, Reginald; Kably, Issam

    2016-01-01

    Transjugular intrahepatic portosystemic shunt (TIPS) has evolved as an effective intervention for treatment of complications of portal hypertension. The use of polytetrafluoroethylene-covered stents have improved the patency of the shunts and diminished the incidence of TIPS dysfunction. However, TIPS-related refractory hepatic encephalopathy (rHE) poses a significant challenge. Approximately 3–7 % of patients with TIPS develop rHE. Refractory hepatic encephalopathy is defined as a recurrent or persistent encephalopathy despite appropriate medical treatment. Hepatic encephalopathy can be an extremely debilitating complication that profoundly affects quality of life. The approach to management of patients with rHE is complex and typically requires collaboration between different specialties. Liver transplantation is the ultimate treatment for rHE; however, the ongoing shortage of organ donation markedly limits this treatment option. Alternative therapies such as shunt occlusion or reduction can control symptoms and serve as a ‘bridge’ therapy to liver transplantation. Therefore, interventional radiologists play a key role in the management of these patients by offering a variety of endovascular techniques. The purpose of this review is to highlight some of these endovascular techniques and to develop a therapeutic algorithm that can be applied in clinical practice for the management of rHE

  17. Transjugular Intrahepatic Portosystemic Shunt, Mechanical Aspiration Thrombectomy, and Direct Thrombolysis in the Treatment of Acute Portal and Superior Mesenteric Vein Thrombosis

    International Nuclear Information System (INIS)

    Ferro, Carlo; Rossi, Umberto G.; Bovio, Giulio; Dahamane, M'Hamed; Centanaro, Monica

    2007-01-01

    A patient was admitted because of severe abdominal pain, anorexia, and intestinal bleeding. Contrast-enhanced multidetector computed tomography demonstrated acute portal and superior mesenteric vein thrombosis (PSMVT). The patient was treated percutaneously with transjugular intrahepatic portosystemic shunt (TIPS), mechanical aspiration thrombectomy, and direct thrombolysis, and 1 week after the procedure, complete patency of the portal and superior mesenteric veins was demonstrated. TIPS, mechanical aspiration thrombectomy, and direct thrombolysis together are promising endovascular techniques for the treatment of symptomatic acute PSMVT

  18. Transjugular Intrahepatic Porto-Systemic Stent-Shunt for Therapy of Bleeding Esophageal Varices Due to Extramedullary Hematopoiesis in Primary Myelofibrosis: A Case Report

    OpenAIRE

    Phillip, Veit;Berger, Hermann;Straub, Melanie;Saugel, Bernd;Treiber, Matthias;Einwächter, Henrik;Schmid, Roland M.;Huber, Wolfgang

    2016-01-01

    Background: Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. Patient and Methods: We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Results: Therapy of variceal bleeding ...

  19. Comparison of shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene-covered stents for transjugular intrahepatic portosystemic shunts

    International Nuclear Information System (INIS)

    Seo, Young Woo; Weon, Young Cheol; Hwang, Jae Cheol; Kang, Byeong Seong; Kwon, Woon Jung; Shin, Shang Hun; Nam, Mi Jeong; Yang, Chi Youn; Choi, Seong Hoon

    2013-01-01

    The purpose of this study is to compare shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene (ePTFE) covered stents in patients who had undergone transjugular intrahepatic portosystemic shunt (TIPS) creation. M43 consecutive patients with active gastroesophageal variceal bleeding who had undergone de novo TIPS creation were included in this study. For TIPS creation, bare stents were placed in twenty patients (Group 1) from January 2001 to December 2003, while ePTFE-covered stents were placed in twenty-three patients (Group 2) from January 2004 to December 2007. The primary and secondary patency rates of TIPS along with the clinical outcome were assessed, and a comparison was made between the two groups. The technical success rate was 100%. Cumulative primary shunt patency rate in Group 1 was 78.5%, 55.8%, and 45.8% at 6, 12, and 24 months, respectively, and in Group 2, 91.1%, 86.0%, and 79.9%, respectively (p = 0.009). Cumulative secondary shunt patency rate in Group 1 was 86.3%, 70.7%, and 64.3%, respectively, and in Group 2, 91.1%, 91.1%, and 85.0%, respectively (p = 0.022). The use of ePTFE-covered stents particularly designed to spare the juxtacaval segment of the hepatic vein resulted in an improved patency of shunts compared to using bare stents.

  20. Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Portal Hypertension Using Memotherm Stents: A Prospective Multicenter Study

    International Nuclear Information System (INIS)

    Domagk, Dirk; Patch, David; Dick, Robert; Grosso, Maurizio; Rousseau, Herve; Otal, Philippe; Goffette, Pierre; Heinecke, Achim; Drees, Markus; Domschke, Wolfram; Menzel, Josef

    2002-01-01

    Purpose: In a prospective multicenter study, efficacy and safety of transjugular intrahepatic portosystemic shunts (TIPS) were evaluated in the treatment of the complications of portal hypertension using a new self-expanding mesh-wire stent(Memotherm). Methods: One hundred and eighty-one patients suffering from variceal bleeding (either acute or recurrent)or refractory ascites were enrolled. Post interventional follow-up lasted for 8.4 months on average. Differences were analyzed by the log-rank test (chi-square) or Wilcoxon test. Results:Shunt insertion was completed successfully in all patients(n = 181 patients, 100%). During follow-up, shunt occlusion was evident in 23 patients, and shunt stenosis was found in 33 patients (12.7% and 18.2%, respectively). Variceal rebleeding occurred in 20 of 139 patients (14.4%), with at least one episode of bleeding before TIPS treatment. The overall mortality rate of the patients treated by TIPS was 39.8%. In 51.4% of these cases (37 of 72 patients), however, the patients died within 30 days after TIPS replacement. Analysis of subgroups showed that patients who underwent emergency TIPS for acute variceal bleeding had a significantly higher early mortality compared with other patient groups (p= 0.0014). Conclusion: In the present prospective multicenter study, we were able to show that insertion of Memothermstents is an effective tool for TIPS. The occlusion rates seem to be comparable to those reported for the Palmaz stent. It could be shown that in particular, those patients who were treated for acute bleeding were at high risk of early mortality. Consequently, in such a critical condition, the indication for TIPS has to be set carefully

  1. Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis

    Directory of Open Access Journals (Sweden)

    XU Zhengguo

    2016-12-01

    Full Text Available ObjectiveTo investigate the association between portal vein pressure drop gradient in patients with cirrhotic portal hypertension treated by transjugular intrahepatic portosystemic shunt (TIPS and clinical prognosis, as well as the ideal range of portal vein pressure drop. MethodsA total of 58 patients who underwent TIPS in Xinqiao Hospital of Third Military Medical University from November 2013 to December 2015 were enrolled. All the patients underwent TIPS and embolization of the gastric coronary vein and the short gastric veins, and the change intervals of portal vein pressure gradient were monitored. The follow-up time ranged from 3 days to 2 years, and the association of portal vein pressure drop gradient with postoperative liver function, splenic function, rebleeding rate, hepatic encephalopathy, and portal hypertensive gastrointestinal diseases was analyzed. The paired t-test was used for comparison of parameters before and after treatment. ResultsThe patients had a significant reduction in liver function on day 3 after surgery. At 2 month after surgery, the levels of TBil was rised and had significant changes[(49.81±27.82μmol/L vs (31.64±17.67 μmol/L,t=5.372,P<0.001]. At 6 months after surgery, red blood cell count and platelet count had no significant changes,but,white blood cell count was reduced[(3.79±1.37)×109/L vs (4.57±2.24×109/L,t=2.835,P=0.006]. There was a 23% reduction in portal vein pressure after surgery (from 30.62±3.56 mmHg before surgery to 21.21±2.90 mmHg after surgery, t=23.318,P<0.001. All the patients had varying degrees of relief of gastrointestinal symptoms associated with portal vein hypertension, such as abdominal distension, poor appetite, and diarrhea. Of all patients, none experienced in-stent restenosis or occlusion and 13 experienced hepatic encephalopathy after surgery, which tended to occur at the time when postoperative portal vein pressure was reduced to 14.7-25.7 mmHg, i

  2. Management of transjugular intrahepatic portosystemic shunt (TIPS)-associated refractory hepatic encephalopathy by shunt reduction using the parallel technique: outcomes of a retrospective case series.

    Science.gov (United States)

    Cookson, Daniel T; Zaman, Zubayr; Gordon-Smith, James; Ireland, Hamish M; Hayes, Peter C

    2011-02-01

    To investigate the reproducibility and technical and clinical success of the parallel technique of transjugular intrahepatic portosystemic shunt (TIPS) reduction in the management of refractory hepatic encephalopathy (HE). A 10-mm-diameter self-expanding stent graft and a 5-6-mm-diameter balloon-expandable stent were placed in parallel inside the existing TIPS in 8 patients via a dual unilateral transjugular approach. Changes in portosystemic pressure gradient and HE grade were used as primary end points. TIPS reduction was technically successful in all patients. Mean ± standard deviation portosystemic pressure gradient before and after shunt reduction was 4.9 ± 3.6 mmHg (range, 0-12 mmHg) and 10.5 ± 3.9 mmHg (range, 6-18 mmHg). Duration of follow-up was 137 ± 117.8 days (range, 18-326 days). Clinical improvement of HE occurred in 5 patients (62.5%) with resolution of HE in 4 patients (50%). Single episodes of recurrent gastrointestinal hemorrhage occurred in 3 patients (37.5%). These were self-limiting in 2 cases and successfully managed in 1 case by correction of coagulopathy and blood transfusion. Two of these patients (25%) died, one each of renal failure and hepatorenal failure. The parallel technique of TIPS reduction is reproducible and has a high technical success rate. A dual unilateral transjugular approach is advantageous when performing this procedure. The parallel technique allows repeat bidirectional TIPS adjustment and may be of significant clinical benefit in the management of refractory HE.

  3. Three-dimensional C-arm CT-guided transjugular intrahepatic portosystemic shunt placement: Feasibility, technical success and procedural time

    Energy Technology Data Exchange (ETDEWEB)

    Ketelsen, Dominik; Groezinger, Gerd; Maurer, Michael; Grosse, Ulrich; Horger, Marius; Nikolaou, Konstantin; Syha, Roland [University of Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Lauer, Ulrich M. [University of Tuebingen, Internal Medicine I, Department of Gastroenterology, Hepatology and Infectious disease, Tuebingen (Germany)

    2016-12-15

    Establishment of transjugular intrahepatic portosystemic shunts (TIPS) constitutes a standard procedure in patients suffering from portal hypertension. The most difficult step in TIPS placement is blind puncture of the portal vein. This study aimed to evaluate three-dimensional mapping of portal vein branches and targeted puncture of the portal vein. Twelve consecutive patients suffering from refractory ascites by liver cirrhosis were included in this retrospective study to evaluate feasibility, technical success and procedural time of C-arm CT-targeted puncture of the portal vein. As a control, 22 patients receiving TIPS placement with fluoroscopy-guided blind puncture were included to compare procedural time. Technical success could be obtained in 100 % of the study group (targeted puncture) and in 95.5 % of the control group (blind puncture). Appropriate, three-dimensional C-arm CT-guided mapping of the portal vein branches could be achieved in all patients. The median number of punctures in the C-arm CT-guided study group was 2 ± 1.3 punctures. Procedural time was significantly lower in the study group (14.8 ± 8.2 min) compared to the control group (32.6 ± 22.7 min) (p = 0.02). C-arm CT-guided portal vein mapping is technically feasible and a promising tool for TIPS placement resulting in a significant reduction of procedural time. (orig.)

  4. Management of transjugular intrahepatic portosystemic shunt induced refractory hepatic encephalopathy with the parallel technique: results of a clinical follow-up study.

    Science.gov (United States)

    Maleux, Geert; Heye, Sam; Verslype, Chris; Nevens, Fredrik

    2007-08-01

    To retrospectively evaluate the safety, feasibility, and midterm clinical outcome of the use of the parallel technique to treat transjugular intrahepatic portosystemic shunt (TIPS)-induced hepatic encephalopathy (HE) refractory to medical treatment. Additionally, factors potentially influencing clinical results after shunt reduction are assessed. Seventeen patients (11 men and 6 women) presenting with TIPS-induced HE refractory to medical treatment underwent shunt reduction with use of the parallel technique. West Haven HE grades before shunt reduction were IV and III in seven patients each and II in three patients. Mean portosystemic pressure gradient (PSPG) before shunt reduction was 6.8 mm Hg (range, 2-16 mm Hg). Relations between change in patients' mental state and several clinical parameters were analyzed. In all patients, it was technically feasible to reduce the shunt with use of the parallel technique. PSPG after reduction increased by a mean of 5.8 mm Hg (range, 1-12 mm Hg; P parallel technique is feasible and safe. It results in an increase of PSPG, which is associated with an improvement in neuropsychiatric status in most patients.

  5. Clinical analysis of long-term outcomes of re-intervention of transjugular intrahepatic porto-systemic shunt

    International Nuclear Information System (INIS)

    Liu Fuquan; Yue Zhendong; Zhao Hongwei

    2012-01-01

    Objective: To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS). Methods: A retrospective study of safety and long-term outcomes of TIPS was made in 771 patients from August 1994 to August 2010. The 625 patients had follow-up data.The patients who received TIPS once, twice, and more than twice were divided into group 1, group 2 and group 3, respectively. Clinical symptoms, survival rate and restenosis rate of each group were analyzed. Clinical influencing factors of re-intervention effect were discussed. Results: The success rate of first intervention was 98.2% (757/771), the death rate was 0.7% (5/757) and severe complication rate was 2.5% (19/757). The success rate of re-intervention was 98.7% (457/463), no death and severe complications occurred. The restenosis rate in group 3 decreased significantly than group 1 (χ 2 =7.908, P<0.05) in the first year of TIPS. The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS (χ2 values were 27.046, 25.724, 37.002 and 19.046, respectively, P<0.05). The survival rate in group 3 was higher than group 1 (χ 2 =9.114, P<0.05)and group 2 was higher than group 1 (χ 2 =4.929, P<0.05) in the first year of TIPS, while there was no statistical difference between group 2 and group 3 (χ 2 =2.678, P>0.05). The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (χ 2 value were 41.314, 26.920, 13.692 and 6.713, respectively, P<0.05). 19.4% (79/406) of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6% (47/406) of patients had symptom recurrence with portal hypertension signs, 62.8% (255/406) had shunt stenosis or occlusion with portal hypertension signs. Conclusions: Restenosis or occlusion of TIPS, symptom recurrence and portal hypertension signs were important factors for re-intervention. Re-intervention of TIPS was

  6. Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation.

    Science.gov (United States)

    Gaba, Ron C; Couture, Patrick M; Bui, James T; Knuttinen, M Grace; Walzer, Natasha M; Kallwitz, Eric R; Berkes, Jamie L; Cotler, Scott J

    2013-03-01

    To compare the performance of various liver disease scoring systems in predicting early mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. In this single-institution retrospective study, eight scoring systems were used to grade liver disease in 211 patients (male-to-female ratio = 131:80; mean age, 54 y) before TIPS creation from 1999-2011. Scoring systems included bilirubin level, Child-Pugh (CP) score, Model for End-Stage Liver Disease (MELD) and Model for End-Stage Liver Disease sodium (MELD-Na) score, Emory score, prognostic index (PI), Acute Physiology and Chronic Health Evaluation (APACHE) 2 score, and Bonn TIPS early mortality (BOTEM) score. Medical record review was used to identify 30-day and 90-day clinical outcomes. The relationship of scoring parameters with mortality outcomes was assessed with multivariate analysis, and the relative ability of systems to predict mortality after TIPS creation was evaluated by comparing area under receiver operating characteristic (AUROC) curves. TIPS were successfully created for variceal hemorrhage (n = 121), ascites (n = 72), hepatic hydrothorax (n = 15), and portal vein thrombosis (n = 3). All scoring systems had a significant association with 30-day and 90-day mortality (P<.050 in each case) on multivariate analysis. Based on 30-day and 90-day AUROC, MELD (0.878, 0.816) and MELD-Na (0.863, 0.823) scores had the best capability to predict early mortality compared with bilirubin (0.786, 0.749), CP (0.822, 0.771), Emory (0.786, 0.681), PI (0.854, 0.760), APACHE 2 (0.836, 0.735), and BOTEM (0.798, 0.698), with statistical superiority over bilirubin, Emory, and BOTEM scores. Several liver disease scoring systems have prognostic value for early mortality after TIPS creation. MELD and MELD-Na scores most effectively predict survival after TIPS creation. Copyright © 2013. Published by Elsevier Inc.

  7. Transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis.

    Science.gov (United States)

    Klinger, Christoph; Riecken, Bettina; Schmidt, Arthur; De Gottardi, Andrea; Meier, Benjamin; Bosch, Jaime; Caca, Karel

    2018-03-01

    To determine safety and efficacy of transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis (PVT). This retrospective study includes 17 consecutive patients with chronic non-cirrhotic PVT (cavernous transformation n = 15). PVR-TIPS was indicated because of variceal bleeding (n = 13), refractory ascites (n = 2), portal biliopathy with recurrent cholangitis (n = 1), or abdominal pain (n = 1). Treatment consisted of a combination of transjugular balloon angioplasty, mechanical thrombectomy, and-depending on extent of residual thrombosis-transjugular intrahepatic portosystemic shunt and additional stenting of the portal venous system. Recanalization was successful in 76.5 % of patients despite cavernous transformation in 88.2 %. Both 1- and 2-year secondary PV and TIPS patency rates were 69.5 %. Procedure-related bleeding complications occurred in 2 patients (intraperitoneal bleeding due to capsule perforation, n = 1; liver hematoma, n = 1) and resolved spontaneously. However, 1 patient died due to subsequent nosocomial pneumonia. During follow-up, 3 patients with TIPS occlusion and PVT recurrence experienced portal hypertensive complications. PVR-TIPS is safe and effective in selected patients with chronic non-cirrhotic PVT. Due to technical complexity and possible complications, it should be performed only in specialized centers with high experience in TIPS procedures. © Georg Thieme Verlag KG Stuttgart · New York.

  8. An Approach to Endovascular and Percutaneous Management of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Dysfunction: A Pictorial Essay and Clinical Practice Algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Keith, E-mail: keithjppereira@gmail.com; Baker, Reginald, E-mail: rbaker@med.miami.edu; Salsamendi, Jason; Doshi, Mehul; Kably, Issam; Bhatia, Shivank [Jackson Memorial Hospital/University of Miami Hospital, Department of Interventional Radiology (United States)

    2016-05-15

    Transjugular intrahepatic portosystemic shunts (TIPS) have evolved as an effective and durable nonsurgical option in the treatment of portal hypertension (PH). It has been shown to improve survival in decompensated cirrhosis and may also serve as a bridge to liver transplantation. In spite of the technical improvements in the procedure, problems occur with the shunt which jeopardizes effective treatment of the PH. Appropriate management is vital to ensure the longevity of the conduit. Shunt revision techniques include endovascular revision techniques and new shunt creation or, in the appropriate patients, alternative/rescue therapies. The ability of interventional radiologists to restore adequate TIPS function has enormous implications for quality of life with palliation, morbidity/mortality related to variceal bleeding and survival if transplant candidates can live long enough to receive a new liver. As such, it is imperative that these treatment strategies are understood and employed when these patients are encountered. In this review, the restoration of appropriate shunt function using various techniques will be discussed as they apply to a variety of clinical scenarios, based on literature. In addition, illustrative case examples highlighting our experience at an academic tertiary medical center will be included. It is the intent to have this document serve as a concise and informative reference to be used by those who may encounter patients with suboptimal functioning TIPS.

  9. QT interval in patients with non-cirrhotic portal hypertension and in cirrhotic patients treated with transjugular intrahepatic porto-systemic shunt.

    Science.gov (United States)

    Trevisani, Franco; Merli, Manuela; Savelli, Francesco; Valeriano, Valentina; Zambruni, Andrea; Riggio, Oliviero; Caraceni, Paolo; Domenicali, Marco; Bernardi, Mauro

    2003-04-01

    A prolonged QT interval is frequent in chronic liver disease and its aetiology remains unsettled. The study's aim was to assess the role of portal hypertension in the pathogenesis of QT prolongation. We measured the QT interval in: (1) 10 patients with non-cirrhotic portal hypertension (NCPH) and preserved liver function; (2) 19 cirrhotic patients before, 1-3 and 6-9 months after transjugular intrahepatic porto-systemic shunt (TIPS) insertion. Baseline corrected maximum QT interval (QTcmax) was prolonged (>440 ms) in eight NCPH and 16 cirrhotic patients, and its value did not differ between the two groups (453+/-8 vs. 465+/-6 ms, P=NS). No patients showed an abnormal baseline QT dispersion. In cirrhotic individuals, QTcmax further increased 1-3 months after TIPS (P=0.042), thereafter remaining steadily elevated. QT dispersion only increased at the second post-TIPS determination (P=0.030). Such changes occurred despite no deterioration of liver function, plasma electrolytes and haemoglobin. QT interval is frequently prolonged in patient with both non-cirrhotic and cirrhotic portal hypertension and portal decompression by TIPS worsens this abnormality. These results suggest that the porto-systemic shunting is responsible for the altered ventricular repolarisation possibly through a dumping into the systemic circulation of splanchnic-derived cardioactive substances.

  10. Transjugular intrahepatic porto-systemic stent-shunt for therapy of bleeding esophageal varices due to extramedullary hematopoiesis in primary myelofibrosis: a case report.

    Science.gov (United States)

    Phillip, Veit; Berger, Hermann; Straub, Melanie; Saugel, Bernd; Treiber, Matthias; Einwächter, Henrik; Schmid, Roland M; Huber, Wolfgang

    2012-01-01

    Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Therapy of variceal bleeding by TIPS insertion was successful. During a 29-month follow-up, no hepatic failure, hepatic encephalopathy, or further variceal bleeding episode occurred. TIPS placement is a well-established procedure for the treatment of complications due to portal hypertension mainly due to liver cirrhosis. This report illustrates that TIPS placement can also be a promising treatment option in patients with primary myelofibrosis and portal hypertension due to extramedullary hematopoiesis. Copyright © 2012 S. Karger AG, Basel.

  11. Combination therapy versus pharmacotherapy, endoscopic variceal ligation, or the transjugular intrahepatic portosystemic shunt alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized controlled trials

    OpenAIRE

    Lin, Lu-Lu; Du, Shi-Ming; Fu, Yan; Gu, Hui-Yun; Wang, Lei; Jian, Zhi-Yuan; Shen, Xian-Feng; Luo, Jie; Zhang, Chao

    2017-01-01

    Patients with liver cirrhosis and variceal hemorrhage are at increased risk of rebleeding. We performed a meta-analysis toassess the clinical efficacy of combination therapy (pharmacotherapy and endoscopic variceal ligation (EVL)) compared with pharmacotherapy, EVL, or transjugular intrahepatic portosystemic shunt (TIPS) alone in the prevention of rebleeding and mortality. A literature search of MEDLINE, EMBASE, and the Cochrane Controlled Trials Register, up until November 2016, identified r...

  12. Multidetector-Row Computed Tomography in the Evaluation of Transjugular Intrahepatic Portosystemic Shunt Performed with Expanded-Polytetrafluoroethylene-Covered Stent-Graft

    International Nuclear Information System (INIS)

    Fanelli, Fabrizio; Bezzi, Mario; Bruni, Antonio; Corona, Mario; Boatta, Emanuele; Lucatelli, Pierleone; Passariello, Roberto

    2011-01-01

    We assessed, in a prospective study, the efficacy of multidetector spiral computed tomography (MDCT) in the evaluation of transjugular intrahepatic portosystemic shunt (TIPS) patency in patients treated with the Viatorr (Gore, Flagstaff, AZ) expanded-polytetrafluoroethylene (e-PTFE)-covered stent-graft. Eighty patients who underwent TIPS procedure using the Viatorr self-expanding e-PTFE stent-graft were evaluated at follow-up of 1, 3, 6, and 12 months with clinical and laboratory tests as well as ultrasound–color Doppler (USCD) imaging. In case of varices, upper gastrointestinal endoscopy was also performed. In addition, the shunt was evaluated using MDCT at 6 and 12 months. In all cases of abnormal findings and discrepancy between MDCT and USCD, invasive control venography was performed. MDCT images were acquired before and after injection of intravenous contrast media on the axial plane and after three-dimensional reconstruction using different algorithms. MDCT was successfully performed in all patients. No artefacts correlated to the Viatorr stent-graft were observed. A missing correlation between UCSD and MDCT was noticed in 20 of 80 (25%) patients. Invasive control venography confirmed shunt patency in 16 (80%) cases and shunt malfunction in 4 (20%) cases. According to these data, MDCT sensitivity was 95.2%; specificity was 96.6%; and positive (PPV) and negative predictive values (NPV) were 90.9 and 98.2%, respectively. USCD sensitivity was 90%; specificity was 75%; and PPV and NPV were 54.5 and 95.7%, respectively. A high correlation (K value = 0.85) between MDCT and invasive control venography was observed. On the basis of these results, MDCT shows superior sensitivity and specificity compared with USCD in those patients in whom TIPS was performed with the Viatorr stent-graft. MDCT can be considered a valid tool in the follow-up of these patients.

  13. Cost analysis for the prevention of variceal rebleeding: a comparison between transjugular intrahepatic portosystemic shunt and endoscopic sclerotherapy in a selected group of Italian cirrhotic patients.

    Science.gov (United States)

    Meddi, P; Merli, M; Lionetti, R; De Santis, A; Valeriano, V; Masini, A; Rossi, P; Salvatori, F; Salerno, F; de Franchis, R; Capocaccia, L; Riggio, O

    1999-04-01

    The aim of the present study was to compare the cumulative cost of the first 18-month period in a selected group of Italian cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic sclerotherapy (ES) to prevent variceal rebleeding. Thirty-eight patients enrolled in a controlled trial were considered (18 TIPS and 20 sclerotherapy). The number of days spent in the hospital for the initial treatment and during the follow-up period were defined as the costs of hospitalization. ES sessions, TIPS procedures, angioplasty or addition of a second stent to maintain the shunt patency, were defined as the costs of therapeutic procedures. The two groups were comparable for age, sex, and Child-Pugh score. During the observation period 4 patients died in the TIPS group, and 2 died and 1 was transplanted in the sclerotherapy group. The rebleeding rate was significantly higher in the sclerotherapy group. Despite this, the number of days spent in the hospital was similar in the two groups. This was because of a higher number of hospital admissions for the treatment of hepatic encephalopathy and shunt insufficiency in the TIPS group. The therapeutic procedures were more expensive for TIPS. Consequently, the cumulative cost was higher for patients treated with TIPS than for those treated with sclerotherapy. The extra cost was because of the initial higher cost of the procedure and the difference was still maintained at the end of the 18-month follow-up. When the cumulative costs were expressed per month free of rebleeding, the disadvantage of TIPS disappeared. In conclusion, a program of prevention of variceal rebleeding with TIPS, despite the longer interval free of rebleeding, is not a cost-saving strategy in comparison with sclerotherapy.

  14. Transjugular intrahepatic portosystemic shunt (TIPS) versus laparoscopic splenectomy (LS) plus preoperative endoscopic varices ligation (EVL) in the treatment of recurrent variceal bleeding.

    Science.gov (United States)

    Zhou, Jin; Wu, Zhong; Wu, Junchao; Wang, Xin; Li, Yongbin; Wang, Mingjun; Yang, Zhengguo; Peng, Bing; Zhou, Zongguang

    2013-08-01

    The aim of the present study was to compare elective transjugular intrahepatic portosystemic shunt (TIPS) and laparoscopic splenectomy (LS) plus preoperative endoscopic varices ligation (EVL) in their efficacy in preventing recurrent bleeding and improving the long-term liver function in patients with liver cirrhosis and portal hypertension. Between January 2009 and March 2012, we enrolled 83 patients (55 with TIPS, defined as the TIPS group, and 28 with LS plus preoperative EVL, defined as the LS group) with portal hypertension and a history of gastroesophageal variceal bleeding resulting from liver cirrhosis. The clinical characteristics, perioperative outcomes, and follow-up were recorded. No significant differences were observed between the two treatment groups with respect to the patients' characteristics and preoperative variables. Within 30 days after surgery, one patient in the TIPS group died of multiple organ dysfunction syndrome, whereas no patient in the LS group died. Complications occurred in 14 patients in the TIPS group, which included rebleeding, encephalopathy, ascites, bleeding from a pseudoaneurysm of the thoracoabdominal aorta, and pulmonary infection, compared with 5 patients in the LS group, which included pulmonary effusion, pancreatic leakage, and portal vein thrombosis. During a mean follow-up of 13.6 months in the TIPS group and 12.3 months in the LS group, the actuarial survival was 85.5 % in the TIPS group versus 100 % in the LS group. The long-term complications included rebleeding and encephalopathy in the TIPS group. LS plus EVL was superior to TIPS in the prevention of gastroesophageal variceal rebleeding in cirrhotic patients. This treatment was associated with a low rate of portosystemic encephalopathy and improvements in the long-term liver function.

  15. Transjugular Intrahepatic Portosystemic Shunt Flow Reduction with Adjustable Polytetrafluoroethylene-Covered Balloon-Expandable Stents Using the “Sheath Control” Technique

    Energy Technology Data Exchange (ETDEWEB)

    Blue, Robert C., E-mail: Robert.c.blue@gmail.com; Lo, Grace C.; Kim, Edward; Patel, Rahul S.; Scott Nowakowski, F.; Lookstein, Robert A.; Fischman, Aaron M. [Icahn School of Medicine at Mount Sinai, Interventional Radiology Section, Department of Radiology (United States)

    2016-06-15

    PurposeA complication of transjugular intrahepatic portosystemic shunts (TIPS) placement is refractory portosystemic encephalopathy (PSE) often requiring TIPS reduction. We report the results of a “sheath control technique” utilizing constraining sheaths during deployment of polytetrafluoroethylene (PTFE)-covered balloon-expandable stents, minimizing stent migration, and providing additional procedural control.MethodsTIPS reduction was performed in 10 consecutive patients for PSE using Atrium iCast covered stents (Atrium Maquet Getinge Group, Germany). Within the indwelling TIPS stent, a 9 mm × 59 mm iCast stent was deployed with 2 cm exposed from the sheath’s distal end and the majority of the stent within the sheath to create the distal hourglass shape. During balloon retraction, the stent was buttressed by the sheath. The proximal portion of the stent was angioplastied to complete the hourglass configuration, and the central portion of the stent was dilated to 5 mm. Demographics, pre- and post-procedure laboratory values, and outcomes were recorded.ResultsTen patients underwent TIPS reduction with 100 % technical success. There was no stent migration during stent deployment. All patients experienced initial improvement of encephalopathy. One patient ultimately required complete TIPS occlusion for refractory PSE, and another developed TIPS occlusion 36 days post-procedure. There was no significant trend toward change in patients’ MELD scores immediately post-procedure or at 30 days (p = 0.46, p = 0.47, respectively).ConclusionTIPS reduction using Atrium iCast PTFE balloon-expandable stents using the “sheath control technique” is safe and effective, and minimizes the risk of stent migration.

  16. Trans-jugular intrahepatic porto-systemic shunt placement for refractory ascites: a ‘real-world’ UK health economic evaluation

    Science.gov (United States)

    Parker, Matthew J; Guha, Neil; Stedman, Brian; Hacking, Nigel; Wright, Mark

    2013-01-01

    Objective To assess the benefit of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement for refractory ascites. Design A retrospective observational study of all patients undergoing TIPS for refractory ascites in our hospital between 2003 and 2012. Setting Secondary care. Patients Cirrhotic patients with refractory ascites. Main outcome measures We examined direct real-world (National Health Service) health related costs in the year before and after the TIPS procedure took place. Data were collected relating to the need for reintervention and hepatic encephalopathy. Results Data were available for 24 patients who underwent TIPS for refractory ascites (86% of eligible patients). TIPS was technically successful in all cases. Mean number of bed days in the year prior to TIPS was 30.3 and 14.3 in the year following (p=0.005). No patient had ascites at the end of the year after the TIPS with less requirement for paracentesis over the course of the year (p<0.001). Mean reduction in cost was £2759 per patient. TIPS was especially cost-effective in patients requiring between 6 and 12 drains per year with a mean saving of £9204 per patient. Conclusions TIPS is both a clinically effective and economically advantageous therapeutic option for selected patients with refractory ascites. PMID:28839725

  17. Efficacy of a dexamethasone-eluting nitinol stent on the inhibition of pseudointimal hyperplasia in a transjugular intrahepatic portosystemic shunt: an experimental study in a swine model

    International Nuclear Information System (INIS)

    Seo, Tae Seok; Oh, Joo Hyeogn; Park, Young Koo; Song, Ho Young; Park, Sang Joon; Yuk, Sun Hong

    2005-01-01

    We wanted to evaluate the feasibility and efficacy of using a dexamethasone (DM)-eluting nitinol stent to inhibit the pseudointimal hyperplasia following stent placement in the transjugular intrahepatic portosystemic shunt tract (TIPS) of a swine. Fifteen stents were constructed using 0.15 mm-thick nitinol wire; they were 60 mm in length and 10 mm in diameter. The metallic stents were then classified into three types; type 1 and 2 was coated with the mixture of 12% and 20%, respectively, of DM solution and polyurethane (PU), while type 3 was a bare stent that was used for control study. In fifteen swine, each type of stent was implanted in the TIPS tract of 5 swine, and each animal was sacrificed 2 weeks after TIPS creation. The proliferation of the pseudointima was evaluated both on follow-up portogram and pathologic examination. One TIPS case, using the type 1 stent, and two TIPS cases, using the type 2 stent, maintained their luminal patency while the others were all occluded. On the histopathologic analysis, the mean of the maximum pseudointimal hyperplasia was expressed as the percentage of the stent radius that was patent, and these values were 51.2%, 50% and 76% for the type 1, 2, and 3 stents, respectively. The DM-eluting stent showed a tendency to reduce the development of pseudointimal hyperplasia in the TIPS tract of a swine model with induced-portal hypertension

  18. Prediction of Mortality after Emergent Transjugular Intrahepatic Portosystemic Shunt Placement: Use of APACHE II, Child-Pugh and MELD Scores in Asian Patients with Refractory Variceal Hemorrhage

    International Nuclear Information System (INIS)

    Tzeng, Wen Sheng; Wu, Reng Hong; Lin, Ching Yih; Chen, Jyh Jou; Sheu, Ming Juen; Koay, Lok Beng; Lee, Chuan

    2009-01-01

    This study was designed to determine if existing methods of grading liver function that have been developed in non-Asian patients with cirrhosis can be used to predict mortality in Asian patients treated for refractory variceal hemorrhage by the use of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. Data for 107 consecutive patients who underwent an emergency TIPS procedure were retrospectively analyzed. Acute physiology and chronic health evaluation (APACHE II), Child-Pugh and model for end-stage liver disease (MELD) scores were calculated. Survival analyses were performed to evaluate the ability of the various models to predict 30-day, 60-day and 360-day mortality. The ability of stratified APACHE II, Child-Pugh, and MELD scores to predict survival was assessed by the use of Kaplan-Meier analysis with the log-rank test. No patient died during the TIPS procedure, but 82 patients died during the follow-up period. Thirty patients died within 30 days after the TIPS procedure; 37 patients died within 60 days and 53 patients died within 360 days. Univariate analysis indicated that hepatorenal syndrome, use of inotropic agents and mechanical ventilation were associated with elevated 30-day mortality (p 11 or an MELD score > 20 predicted increased risk of death at 30, 60 and 360 days (p 11 or an MELD score > 20 are predictive of mortality in Asian patients with refractory variceal hemorrhage treated with the TIPS procedure. An APACHE II score is not predictive of early mortality in this patient population

  19. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt.

    Science.gov (United States)

    Salerno, Francesco; Merli, Manuela; Cazzaniga, Massimo; Valeriano, Valentina; Rossi, Plinio; Lovaria, Andrea; Meregaglia, Daniele; Nicolini, Antonio; Lubatti, Lorenzo; Riggio, Oliviero

    2002-04-01

    Patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) are at risk of early death due to end-stage liver failure. The aim of this study was to compare model of end-stage liver disease (MELD) and Child-Pugh scores as predictors of survival after TIPS. We studied 140 cirrhotic patients treated with elective TIPS. Concordance (c)-statistic was used to assess the ability of MELD or Child-Pugh scores to predict 3-month survival. The prediction of overall survivals was estimated by comparing actuarial curves of subgroups of patients stratified according to either Child-Pugh scores or MELD risk scores. During a median follow-up of 23.7 months, 55 patients died, 14 underwent liver transplantation and seven were lost to follow-up. For 3-month survival, the discrimination power of MELD score was superior to Child-Pugh score (0.84 vs. 0.70, z=2.07; P=0.038). Unlike Pugh score, MELD score identified two subgroups of Child C patients with different overall survivals (P=0.027). The comparison between observed and predicted survivals showed that MELD score overrates death risk. MELD score is superior to Child-Pugh score as predictor of short-term outcome after TIPS. Its accuracy, however, decreases for long-term predictions.

  20. Transjugular Intrahepatic Portosystemic Shunts in Patients with Cirrhosis with Refractory Ascites: Comparison of Clinical Outcomes by Using 8- and 10-mm PTFE-covered Stents.

    Science.gov (United States)

    Miraglia, Roberto; Maruzzelli, Luigi; Tuzzolino, Fabio; Petridis, Ioannis; D'Amico, Mario; Luca, Angelo

    2017-07-01

    Purpose To compare the efficacy and complications of transjugular intrahepatic portosystemic shunt (TIPS) creation performed by using a 10-mm or an 8-mm-diameter polytetrafluoroethylene (PTFE)-covered stent in a consecutive series of patients with cirrhosis with refractory ascites (RA). Materials and Methods The institutional review board approved this retrospective study and informed consent was waived. One hundred seventy-one patients with RA (mean age, 58.7 years ± 10.3; 95% confidence interval [CI]: 57.2 years, 60.3 years) had undergone TIPS placement by using 10-mm (60 patients) or 8-mm (111 patients) covered stent between January 2004 and December 2012. Median follow-up time was 16.8 months (range, 3.4-84.8 months). Hemodynamic changes, incidence of hepatic encephalopathy, and long-term (>3 months) need for paracentesis after TIPS placement were evaluated and calculated by using the Kaplan-Meier method and were compared by using the log-rank test. Results Pre-TIPS demographics and clinical characteristics of the two groups were comparable. The portosystemic gradient before TIPS was 17.0 mm Hg ± 4.2 (95% CI: 15.9 mm Hg, 18.1 mm Hg) in the 10-mm group versus 16.1 mm Hg ± 3.7 (95% CI: 15.4 mm Hg, 16.8 mm Hg) in the 8-mm group (P = .164). After TIPS, the portosystemic gradient was 6.5 mm Hg ± 3.4 (95% CI: 5.7 mm Hg, 7.4 mm Hg) in the 10-mm group versus 7.5 mm Hg ± 2.6 (95% CI: 6.9 mm Hg, 7.9 mm Hg) in the 8-mm group (P = .039). The long-term need for paracentesis was greater in the 8-mm group (64 of 111 patients [58%] vs 18 of 60 patients [31%], P = .003). Overall, hepatic encephalopathy was similar in both groups (45 of 111 patients [41%] vs 26 of 60 patients [44%], P = .728). Conclusion A10-mm PTFE-covered stent leads to better control of RA secondary to portal hypertension in patients with cirrhosis, compared with an 8-mm stent, without increasing the incidence of hepatic encephalopathy. © RSNA, 2017.

  1. Congenital Portosystemic Shunt: Our Experience

    Directory of Open Access Journals (Sweden)

    Tiziana Timpanaro

    2015-01-01

    Full Text Available Introduction. Congenital portosystemic venous malformations are rare abnormalities in which the portal blood drains into a systemic vein and which are characterized by extreme clinical variability. Case Presentations. The authors present two case reports of a congenital extrahepatic portosystemic shunt (Type II. In the first patient, apparently nonspecific symptoms, such as headache and fatigue, proved to be secondary to hypoglycemic episodes related to the presence of a portosystemic shunt, later confirmed on imaging. During portal vein angiography, endovascular embolization of the portocaval fistula achieved occlusion of the anomalous venous tract. In the second patient, affected by Down’s syndrome, the diagnosis of a portosystemic malformation was made by routine ultrasonography, performed to rule out concurrent congenital anomalies. Because of the absence of symptoms, we chose to observe this patient. Conclusions. These two case reports demonstrate the clinical heterogeneity of this malformation and the need for a multidisciplinary approach. As part of a proper workup, clinical evaluation must always be followed by radiographic diagnosis.

  2. Aberrant hepatic lipid storage and metabolism in canine portosystemic shunts.

    Science.gov (United States)

    Van den Bossche, Lindsay; Schoonenberg, Vivien A C; Burgener, Iwan A; Penning, Louis C; Schrall, Ingrid M; Kruitwagen, Hedwig S; van Wolferen, Monique E; Grinwis, Guy C M; Kummeling, Anne; Rothuizen, Jan; van Velzen, Jeroen F; Stathonikos, Nikolas; Molenaar, Martijn R; Helms, Bernd J; Brouwers, Jos F H M; Spee, Bart; van Steenbeek, Frank G

    2017-01-01

    Non-alcoholic fatty liver disease (NAFLD) is a poorly understood multifactorial pandemic disorder. One of the hallmarks of NAFLD, hepatic steatosis, is a common feature in canine congenital portosystemic shunts. The aim of this study was to gain detailed insight into the pathogenesis of steatosis in this large animal model. Hepatic lipid accumulation, gene-expression analysis and HPLC-MS of neutral lipids and phospholipids in extrahepatic (EHPSS) and intrahepatic portosystemic shunts (IHPSS) was compared to healthy control dogs. Liver organoids of diseased dogs and healthy control dogs were incubated with palmitic- and oleic-acid, and lipid accumulation was quantified using LD540. In histological slides of shunt livers, a 12-fold increase of lipid content was detected compared to the control dogs (EHPSS Plipid-related genes to steatosis in portosystemic shunting was corroborated using gene-expression profiling. Lipid analysis demonstrated different triglyceride composition and a shift towards short chain and omega-3 fatty acids in shunt versus healthy dogs, with no difference in lipid species composition between shunt types. All organoids showed a similar increase in triacylglycerols after free fatty acids enrichment. This study demonstrates that steatosis is probably secondary to canine portosystemic shunts. Unravelling the pathogenesis of this hepatic steatosis might contribute to a better understanding of steatosis in NAFLD.

  3. Aberrant hepatic lipid storage and metabolism in canine portosystemic shunts.

    Directory of Open Access Journals (Sweden)

    Lindsay Van den Bossche

    Full Text Available Non-alcoholic fatty liver disease (NAFLD is a poorly understood multifactorial pandemic disorder. One of the hallmarks of NAFLD, hepatic steatosis, is a common feature in canine congenital portosystemic shunts. The aim of this study was to gain detailed insight into the pathogenesis of steatosis in this large animal model. Hepatic lipid accumulation, gene-expression analysis and HPLC-MS of neutral lipids and phospholipids in extrahepatic (EHPSS and intrahepatic portosystemic shunts (IHPSS was compared to healthy control dogs. Liver organoids of diseased dogs and healthy control dogs were incubated with palmitic- and oleic-acid, and lipid accumulation was quantified using LD540. In histological slides of shunt livers, a 12-fold increase of lipid content was detected compared to the control dogs (EHPSS P<0.01; IHPSS P = 0.042. Involvement of lipid-related genes to steatosis in portosystemic shunting was corroborated using gene-expression profiling. Lipid analysis demonstrated different triglyceride composition and a shift towards short chain and omega-3 fatty acids in shunt versus healthy dogs, with no difference in lipid species composition between shunt types. All organoids showed a similar increase in triacylglycerols after free fatty acids enrichment. This study demonstrates that steatosis is probably secondary to canine portosystemic shunts. Unravelling the pathogenesis of this hepatic steatosis might contribute to a better understanding of steatosis in NAFLD.

  4. [Recurrent enterococcal bacteremia associated with a transjugular intrahepatic protosystemic shunt].

    Science.gov (United States)

    Passeron, Amélie; Mihaïla-Amrouche, Liliana; Perreira Rocha, Elsa; Wyplosz, Benjamin; Capron, Loïc

    2004-12-01

    Transjugular intrahepatic portosystemic shunts (TIPS) are an accepted technique for controlling the complications of portal hypertension. Although the incidence of TIPS-associated bacteremia appears to be low (2%), this complication has a high mortality. We report one case of recurrent enterococcal bacteremia associated with TIPS and regression of TIPS thrombus after antibiotherapy. The antibiotic regimen is similar to that given in bacterial endocardites.

  5. Comparison of transjugular intrahepatic portosystemic shunt with covered stent and ballon-occluded retrograde transvenous obliteration in managing isolated gastric varices

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Kwon; Lee, Kristen A.; Sauk, Steven; Korenblat, Kevin [Washington University St. Louis School of Medicine, St. Louis (United States)

    2017-04-15

    Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRTO) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience. We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRTO between January 2000 and July 2013. We identified 52 consecutive patients, 27 who had received TIPS with a covered stent and 25 who had received BRTO. We compared procedural complications, re-bleeding rates, and clinical outcomes between the two groups. There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRTO (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7% [2/27]; BRTO, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRTO, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRTO (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRTO, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRTO, it was 26.6 months. BRTO is an effective method of treating isolated gastric varices with similar outcomes and complication rates to those of TIPS with a covered stent but with a lower rate of hepatic encephalopathy.

  6. Prediction of Mortality after Emergent Transjugular Intrahepatic Portosystemic Shunt Placement: Use of APACHE II, Child-Pugh and MELD Scores in Asian Patients with Refractory Variceal Hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Tzeng, Wen Sheng; Wu, Reng Hong; Lin, Ching Yih; Chen, Jyh Jou; Sheu, Ming Juen; Koay, Lok Beng; Lee, Chuan [Chi-Mei Foundation Medical Center, Tainan (China)

    2009-10-15

    This study was designed to determine if existing methods of grading liver function that have been developed in non-Asian patients with cirrhosis can be used to predict mortality in Asian patients treated for refractory variceal hemorrhage by the use of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. Data for 107 consecutive patients who underwent an emergency TIPS procedure were retrospectively analyzed. Acute physiology and chronic health evaluation (APACHE II), Child-Pugh and model for end-stage liver disease (MELD) scores were calculated. Survival analyses were performed to evaluate the ability of the various models to predict 30-day, 60-day and 360-day mortality. The ability of stratified APACHE II, Child-Pugh, and MELD scores to predict survival was assessed by the use of Kaplan-Meier analysis with the log-rank test. No patient died during the TIPS procedure, but 82 patients died during the follow-up period. Thirty patients died within 30 days after the TIPS procedure; 37 patients died within 60 days and 53 patients died within 360 days. Univariate analysis indicated that hepatorenal syndrome, use of inotropic agents and mechanical ventilation were associated with elevated 30-day mortality (p < 0.05). Multivariate analysis showed that a Child-Pugh score > 11 or an MELD score > 20 predicted increased risk of death at 30, 60 and 360 days (p < 0.05). APACHE II scores could only predict mortality at 360 days (p < 0.05). A Child-Pugh score > 11 or an MELD score > 20 are predictive of mortality in Asian patients with refractory variceal hemorrhage treated with the TIPS procedure. An APACHE II score is not predictive of early mortality in this patient population.

  7. Clinical outcomes of transcatheter selective superior mesenteric artery urokinase infusion therapy vs transjugular intrahepatic portosystemic shunt in patients with cirrhosis and acute portal vein thrombosis.

    Science.gov (United States)

    Jiang, Ting-Ting; Luo, Xiao-Ping; Sun, Jian-Ming; Gao, Jian

    2017-11-07

    To compare the outcomes of transcatheter superior mesenteric artery (SMA) urokinase infusion and transjugular intrahepatic portosystemic shunt (TIPS) for acute portal vein thrombosis (PVT) in cirrhosis. From January 2013 to December 2014, patients with liver cirrhosis and acute symptomatic PVT who met the inclusion criteria were randomly assigned to either an SMA group or a TIPS group. The two groups accepted transcatheter selective SMA urokinase infusion therapy and TIPS, respectively. The total follow-up time was 24 mo. The primary outcome measure was the change in portal vein patency status which was evaluated by angio-computed tomography or Doppler ultrasound. Secondary outcomes were rebleeding and hepatic encephalopathy. A total of 40 patients were enrolled, with 20 assigned to the SMA group and 20 to the TIPS group. The symptoms of all patients in the two groups improved within 48 h. PVT was improved in 17 (85%) patients in the SMA group and 14 (70%) patients in the TIPS group. The main portal vein (MPV) thrombosis was significantly reduced in both groups ( P mesenteric vein (SMV) thrombosis and splenic vein (SV) thrombosis were significantly reduced ( P = 0.048 and P = 0.02), which did not occur in the TIPS group. At 6-, 12-, and 24-mo follow-up, in the SMA group and the TIPS group, the cumulative rates free of the first episode of rebleeding were 80%, 65%, and 45% vs 90%, 80%, and 60%, respectively ( P = 0.320); the cumulative rates free of the first episode of hepatic encephalopathy were 85%, 80%, and 65% vs 50%, 40%, and 35%, respectively ( P = 0.022). Transcatheter selective SMA urokinase infusion and TIPS are safe and effective for acute symptomatic PVT in cirrhosis.

  8. Case report: massive lower intestinal bleeding from ileal varices. Treatment with transjugular intrahepatic portosystemic shunt (TIPSS); Fallbericht: Massive untere gastrointestinale Blutung aus ilealen Varizen. Behandlung mittels transjugulaerem intrahepatischem portosystemischem Shunt (TIPSS)

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    Lopez-Benitez, R. [Universitaetsklinikum Heidelberg (Germany). Abteilung fuer Diagnostische und Iinterventionelle Radiologie; Universitaetsklinikum, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Seidensticker, P.; Richter, G.M.; Stampfl, U.; Hallscheidt, P. [Universitaetsklinikum Heidelberg (Germany). Abteilung fuer Diagnostische und Iinterventionelle Radiologie

    2007-05-15

    Acute gastrointestinal bleeding in patients with liver cirrhosis is associated with a high mortality. Ileal varices and collaterals from ectopic vessels are extremely rare, encountered in less than 5% of the cirrhotic patients. The diagnosis is frequently delayed because the regular diagnostic methods such as gastroscopy or colonoscopy are unsuccessful in accurate the source of bleeding in the majority of the cases. We report an unusual case of massive and uncontrollable lower intestinal bleeding from ileal varices with right ovarian vein anastomosis in a 56 year-old female patient with liver cirrhosis and previous history of abdominal and pelvic surgery. The accurate angiographic and computed tomography diagnosis allowed fast decompression of the portal venous system using a transjugular intrahepatic portosystemic shunt. (orig.) [German] Akute gastrointestinale Blutungen sind bei Leberzirrhosepatienten mit einer hohen Mortalitaet verbunden. Ileale Varizen und Kollateralen aus anderen ektopen Gefaessen des Darms sind extrem selten und treten bei weniger als 5% aller Zirrhosepatienten auf. Die Diagnosestellung erfolgt oft verspaetet, da die ueblichen diagnostischen Untersuchungsmethoden wie Gastroskopie oder Koloskopie in den meisten Faellen die Blutungsquelle nicht ausreichend darstellen. Wir berichten ueber einen ungewoehnlichen Fall von massiver und unkontrollierbarer unterer gastroinstestinaler (GI-)Blutung aus ilealen Varizen mit Verbindung zur rechten V. ovarica einer 56-jaehrigen Frau, bei der anamnestisch eine Leberzirrhose und abdominelle Operationen sowie Operationen im Bereich des Beckens bekannt waren. Die genaue angiographische und computertomographische Diagnose erlaubte eine rasche Dekompression des Portalvenensystems mittels eines transjugulaeren portosystemischen Shunts. (orig.)

  9. Early and long-term clinical and radiological follow-up results of expanded-polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunt procedures

    International Nuclear Information System (INIS)

    Maleux, Geert; Heye, Sam; Thijs, Maria; Wilms, Guy; Nevens, Frederik; Verslype, Chris; Wilmer, Alexander

    2004-01-01

    The purpose of this study was to assess the therapeutic efficacy and immediate and long-term safety of expanded-tetrafluoroethylene covered stent-grafts for transjugular intrahepatic portosystemic shunts in patients with portal hypertension-related complications. A cohort of 56 patients suffering from severe portal hypertension-related complications underwent implantation of an expanded-polytetrafluoroethylene-covered stent-graft. All patients suffered from severe liver cirrhosis graded Child-Pugh A (n=8; 16%), B (n=13; 21%) or C (n=35; 63%). In 44 patients, the stent-graft was placed during the initial TIPS procedure (de novo TIPS); in the other 12 patients, the stent-graft was placed to repermeabilize the previously placed bare stent (TIPS revision). Follow-up was performed with clinical assessment, duplex ultrasound and, if abnormal or inconclusive, with invasive venography and pressure measurements. Per- en immediate post-procedural complications occurred in four patients (4/56, 7%). None of them was lethal. During follow-up, stent occlusion appeared in one patient and stenosis in two; no recurrence of bleeding was noted in all patients treated for variceal bleeding (n=28), and 24 of the 28 patients (86%) suffering from refractory ascites and/or hepatic hydrothorax were free of regular paracenteses and/or drainage of pleural effusion after shunt creation. The 30-day and global mortality for the total study population (n=56) was, respectively, 7% (n=4) and 28.5% (n=16). In the patient subgroup with variceal bleeding (n=28), 30-day mortality was 3.5% (n=1) and global mortality 14.2% (n=4). In the ascites and/or hydrothorax subgroup (n=28), 8.1% (n=3) mortality at 30 days was found and global mortality was 32.4% (n=12). In 10 patients of the 56 studied patients (18%), isolated hepatic encephalopathy occurred, which was lethal in 4 (Child C) patients (7%). Three of these four patients died within the 1st month after TIPS placement. A very high primary patency rate

  10. Early and long-term clinical and radiological follow-up results of expanded-polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunt procedures

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    Maleux, Geert; Heye, Sam; Thijs, Maria; Wilms, Guy [University Hospitals Gasthuisberg, Department of Radiology, Leuven (Belgium); Nevens, Frederik; Verslype, Chris [University Hospitals Gasthuisberg, Department of Hepatology, Leuven (Belgium); Wilmer, Alexander [University Hospitals Gasthuisberg, Department of Medical Intensive Care Unit, Leuven (Belgium)

    2004-10-01

    The purpose of this study was to assess the therapeutic efficacy and immediate and long-term safety of expanded-tetrafluoroethylene covered stent-grafts for transjugular intrahepatic portosystemic shunts in patients with portal hypertension-related complications. A cohort of 56 patients suffering from severe portal hypertension-related complications underwent implantation of an expanded-polytetrafluoroethylene-covered stent-graft. All patients suffered from severe liver cirrhosis graded Child-Pugh A (n=8; 16%), B (n=13; 21%) or C (n=35; 63%). In 44 patients, the stent-graft was placed during the initial TIPS procedure (de novo TIPS); in the other 12 patients, the stent-graft was placed to repermeabilize the previously placed bare stent (TIPS revision). Follow-up was performed with clinical assessment, duplex ultrasound and, if abnormal or inconclusive, with invasive venography and pressure measurements. Per- en immediate post-procedural complications occurred in four patients (4/56, 7%). None of them was lethal. During follow-up, stent occlusion appeared in one patient and stenosis in two; no recurrence of bleeding was noted in all patients treated for variceal bleeding (n=28), and 24 of the 28 patients (86%) suffering from refractory ascites and/or hepatic hydrothorax were free of regular paracenteses and/or drainage of pleural effusion after shunt creation. The 30-day and global mortality for the total study population (n=56) was, respectively, 7% (n=4) and 28.5% (n=16). In the patient subgroup with variceal bleeding (n=28), 30-day mortality was 3.5% (n=1) and global mortality 14.2% (n=4). In the ascites and/or hydrothorax subgroup (n=28), 8.1% (n=3) mortality at 30 days was found and global mortality was 32.4% (n=12). In 10 patients of the 56 studied patients (18%), isolated hepatic encephalopathy occurred, which was lethal in 4 (Child C) patients (7%). Three of these four patients died within the 1st month after TIPS placement. A very high primary patency rate

  11. [Hemolytic anemia secondary to the placement of a portosystemic stented shunt].

    Science.gov (United States)

    Carrillo-Esper, Raúl; Carrillo-Cortes, Ulises; Carrillo-Córdova, Jorge Raúl; Carrillo-Córdova, Luis Daniel; Carrillo-Córdova, Carlos Alberto; Carrillo-Córdova, Dulce María

    2013-01-01

    portal hypertension and variceal hemorrhage are common complications of hepatic cirrhosis, both associated with a high morbimortality. Portal system decompression by the placement of a transjugular intrahepatic portosystemic stented shunt, can reduce portal venus pressure and is effective controling complications of portal hypertension, like variceal hemorrhage and ascitis. The aim of this document is to describe a case of hemolytic anemia secondary to the placement of a transjugular intrahepatic portosystemic stented shunt. patient with portal hypertension secondary to liver cirrosis was given a transjugular intrahepatic portosystemic stented shunt for recurrent variceal hemorrhage. After the procedure, hemoglobin decreased 2 g/dL, associated with reticulocitosis, hipohaptoglobinemia, elevated lactic dehydrogenase and indirect hyperbilirrubinemia with negative Coombs test. The peripheral blood smear showed abnormal erythrocytes, with the prevalence of schistocytes. The final diagnosis was hemolytic anemia secondary to transjugular intrahepatic portosystemic stented shunt. the hemolytic anemia secondary to Transjugular Intrahepatic Portosystemic Stented Shunt is a rare complication. Usually, it has a benign prognosis, and it is self-limited once the stent is endothelialized.

  12. Influence of covered stent versus bare stent on long-term efficacy of transjugular intrahepatic portosystemic shunt: a meta-analysis

    Directory of Open Access Journals (Sweden)

    XU Lu

    2016-10-01

    Full Text Available Objective To investigate the long-term postoperative efficacy of transjugular intrahepatic portosystemic shunt (TIPS using polytetrafluoroethylene (PTFE-covered stent or bare stent, and to provide a basis of evidence-based medicine for the selection of stent in TIPS. Methods CBM, Wanfang Data, CNKI, VIP, MEDLINE, and PubMed were searched for controlled trials on TIPS in the treatment of cirrhotic portal hypertension published form 1989 to 2015; the studies which met the inclusion criteria were selected, and quality assessment was performed for these articles. RevMan 5.3 software was used to analyze the incidence rates of stent dysfunction and hepatic encephalopathy and 1-year survival rate after TIPS, and funnel plots were used to analyze publication bias. Results A total of 11 studies were included, consisting of 698 patients in PTFE-covered stent group and 1283 patients in bare stent group. The results of the meta-analysis showed that the PTFE-covered stent group showed a significantly lower incidence rate of stent dysfunction than the bare stent group (14.8% vs 47.0%, OR=0.18, 95% CI: 0.13-0.24, P<0.001. There was no significant difference in the incidence rate of hepatic encephalopathy between the two groups (23.5% vs 25.7%, OR=0.88, 95% CI: 0.66-1.17, P=0.37. The PTFE-covered stent group had a significantly higher 1-year survival rate than the bare stent group (76.9% vs 62.7%, OR=2.10, 95% CI: 1.54-2.85, P<0.001. The funnel plots which were plotted based on the incidence rates of stent dysfunction and hepatic encephalopathy and 1-year survival rate lacked symmetry, which suggested that a certain degree of publication bias might exist. Conclusion Compared with the bare stent, the PTFE-covered stent can improve stent dysfunction and 1-year survival rate after TIPS, while there is no significant change in the incidence rate of hepatic encephalopathy. Therefore, the PTFE-covered stent has certain advantages over the bare stent in TIPS. In

  13. Brain regional homogeneity changes following transjugular intrahepatic portosystemic shunt in cirrhotic patients support cerebral adaptability theory—A resting-state functional MRI study

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    Ni, Ling; Qi, Rongfeng [Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002 (China); Zhang, Long Jiang, E-mail: kevinzhlj@163.com [Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002 (China); Zhong, Jianhui [Department of Biomedical Engineering, Zhejiang University, Hangzhou, Zhejiang 310027 (China); Zheng, Gang [Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002 (China); Wu, Xingjiang; Fan, Xinxin [Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002 (China); Lu, Guang Ming, E-mail: cjr.luguangming@vip.163.com [Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002 (China)

    2014-03-15

    Purpose: The exact neuro-pathophysiological effect of transjugular intrahepatic portosystemic shunt (TIPS) on brain function remains unclear. The purpose of this study was to investigate the longitudinal brain activity changes in cirrhotic patients with TIPS insertion using resting-state functional MRI (fMRI) with regional homogeneity (ReHo) method. Methods: Fifteen cirrhotic patients without overt hepatic encephalopathy (OHE) planned for TIPS procedure and 15 age- and gender-matched healthy controls were included in this study. Eleven of the 15 patients underwent repeated fMRI examinations at median 7-day following TIPS, 8 patients in median 3-month, and 7 patients in median 1-year follow-up duration, respectively. Regional homogeneity was calculated by the Kendall's coefficient of concordance (KCC) and compared between patients before TIPS and healthy controls with two-sample t test as well as pre-and post-TIPS patients with paired t test. Correlations between the pre- and post-TIPS changes of ReHo and the changes of venous blood ammonia level and number connection test type A (NCT-A)/digit symbol test (DST) scores were calculated by crossing subjects. Results: Compared with healthy controls, 15 cirrhotic patients before TIPS procedure showed decreased ReHo in the bilateral frontal, parietal, temporal and occipital lobes and increased ReHo in the bilateral caudate. Compared with the pre-TIPS patients, 11 post-TIPS patients in the median 7-day follow-up examinations demonstrated decreased ReHo in the medial frontal gyrus (MFG), superior parietal gyrus (SPG), middle/superior temporal gyrus (M/STG), anterior cingulate cortex (ACC), caudate, and increased ReHo in the insula. Eight post-TIPS patients in the median 3-month follow-up examinations showed widespread decreased ReHo in the bilateral frontal and parietal lobes, ACC, caudate, and increased ReHo in the insula and precuneus/cuneus. In the median 1-year follow-up studies, seven post-TIPS patients displayed

  14. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... echoes from the tissues in the body. The principles are similar to sonar used by boats and ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

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    Full Text Available ... from the area within the patient that is being examined to the transducer (the device placed on ... and a different procedure may be needed to control your symptoms. They are also at risk for ...

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    Full Text Available ... the liver). Portal hypertension can also occur in children, although children are much less likely to require a TIPS. ... intentionally to solve the problem. Although extremely rare, children may also require a TIPS procedure. TIPS in ...

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    Full Text Available ... have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes ... performing this procedure while the patient is under general anesthesia, while some prefer conscious sedation for their ...

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    Full Text Available ... transducer sends out high-frequency sound waves (that the human ear cannot hear) into the body and then ... hypertension, and also to determine the severity of the condition. To help plan for the placement of the ...

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    Full Text Available ... system. This pressure buildup can cause blood to flow backward from the liver into the veins of the spleen, stomach, lower esophagus, and intestines, causing enlarged vessels, bleeding and the accumulation of fluid in the chest or abdomen. This condition is ...

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    Full Text Available ... consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located ... guide a catheter, a long, thin, hollow plastic tube into the vessel. Using real time x-ray guidance, your doctor will then guide the catheter ...

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    Full Text Available ... the TIPS. top of page Additional Information and Resources Society of Interventional Radiology (SIR) - Patient Center This ... To locate a medical imaging or radiation oncology provider in your community, you can search the ACR- ...

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    Full Text Available ... TIPS. top of page What are some common uses of the procedure? A TIPS is used to ... the scanner by a cord. Some exams may use different transducers (with different capabilities) during a single ...

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    Full Text Available ... or blood thinners for a specified period of time before your procedure. Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so ...

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    Full Text Available ... recovery. You should be able to resume your normal activities in seven to 10 days. Follow-up ... risk for encephalopathy , which is an alteration of normal brain function that can lead to confusion. This ...

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    Full Text Available ... tube, often covered with a fabric made of GORE-TEX®. Other equipment that may be used during the ... is less common with the current generation of GORE-TEX-lined stents Serious complications, reported in fewer than ...

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    Full Text Available ... prior to your procedure and instructed to not eat or drink anything after midnight the night before. ... rays. You will likely be instructed not to eat or drink anything after midnight before your procedure. ...

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    Full Text Available ... fabric lining abdominal bleeding that might require a transfusion laceration of the hepatic artery, which may result ... liver injury or bleeding that could require a transfusion or urgent intervention heart arrhythmias or congestive heart ...

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    Full Text Available ... any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred ... this procedure while the patient is under general anesthesia, while some prefer conscious sedation for their patient. ...

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    Full Text Available ... pressure. top of page How does the procedure work? A TIPS reroutes blood flow in the liver ... physician will numb an area just above your right collarbone with a local anesthetic . A very small ...

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    Full Text Available ... the contrast material used for venograms . Also, kidney failure (temporary or permanent) due to contrast material use ... or urgent intervention heart arrhythmias or congestive heart failure radiation injury to the skin is a rare ...

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    Full Text Available ... in the chest or abdomen. This condition is most commonly seen in adults, often as a result ... minimally invasive procedures such as a TIPS are most often performed by a specially trained interventional radiologist ...

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    Full Text Available ... and vascular anatomy. top of page What will I experience during and after the procedure? Devices to monitor your heart rate and blood pressure will be attached to your body. You will feel a slight pin prick when ...

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    Full Text Available ... causing enlarged vessels, bleeding and the accumulation of fluid in the chest or abdomen. This condition is ... cause severe bleeding. severe ascites (the accumulation of fluid in the abdomen) and/or hydrothorax (in the ...

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    Full Text Available ... considerably smaller than a "pencil lead", or approximately 1/8 inch in diameter. The stent used in ... treatment appears to be less than one in 1,000. There is a very slight risk of ...

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    Full Text Available ... and lengthy procedures requiring extended fluoroscopy use) death (rare) top of page What are the limitations of TIPS? Patients with more advanced liver disease are at greater risk for worsening liver failure ...

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    Full Text Available ... pitch) and time it takes for the ultrasound signal to return from the area within the patient that is being examined to the transducer (the device placed on the patient's skin to send and receive the returning sound waves), as well as the type of body ...

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    Full Text Available ... the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than ... bruising or bleeding at the puncture site, and infection. However precaution is taken to mitigate these risks. ...

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    Full Text Available ... for ultrasound. A catheter is a long, thin plastic tube that is considerably smaller than a "pencil ... and guide a catheter, a long, thin, hollow plastic tube into the vessel. Using real time x- ...

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    Full Text Available ... the hepatic vein in the liver. A small metal device called a stent is placed to keep ... open by the placement of a small, tubular metal device commonly called a stent . During a TIPS ...

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    Full Text Available ... to take in the morning. Leave jewelry at home and wear loose, comfortable clothing. You will be ... can be done electively and patients may go home the next day. However, the amount of bleeding ...

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    Full Text Available ... can be done electively and patients may go home the next day. However, the amount of bleeding that can occur can sometimes be life threatening and those patients are monitored in intensive care beforehand and during recovery. You should be able ...

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    Full Text Available ... vein (the vein that carries blood from the digestive organs to the liver) to one of the ... vein (the vein that carries blood from the digestive organs to the liver) to a hepatic vein ( ...

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    Full Text Available ... monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is ... the liver). A stent is then placed under fluoroscopy extending from the portal vein into the hepatic ...

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    Full Text Available ... tube that is considerably smaller than a "pencil lead", or approximately 1/8 inch in diameter. The ... an alteration of normal brain function that can lead to confusion. This is because toxic substances in ...

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    Full Text Available ... hepatic vein to identify the portal venous system. Access is then gained from the hepatic vein into ... depending on the complexity of the condition and vascular anatomy. top of page What will I experience ...

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    Full Text Available ... the catheter is inserted into the vein or artery. If you receive a general anesthetic, you will ... might require a transfusion laceration of the hepatic artery, which may result in severe liver injury or ...

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    Full Text Available ... while avoiding the liver. TIPS may successfully reduce internal bleeding in the stomach and esophagus in patients ... site. Using ultrasound, the doctor will identify your internal jugular vein , which is situated above your collarbone, ...

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    Full Text Available ... as to whether the procedure was a technical success when it is completed. top of page What ... the contrast material used for venograms . Also, kidney failure (temporary or permanent) due to contrast material use ...

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    Full Text Available ... or bypass, without the risks that accompany open surgery. TIPS is a minimally invasive procedure that typically has a shorter recovery time than surgery. Your TIPS should have less of an effect ...

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    Full Text Available ... scanner by a cord. Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends ... may not be the best use and a different procedure may be needed to control your symptoms. ...

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    Full Text Available ... Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a ... a video display screen that looks like a computer or television monitor. The image is created based ...

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    Full Text Available ... TIPS. top of page Additional Information and Resources Society of Interventional Radiology (SIR) - Patient Center This page ... American College of Radiology (ACR) and the Radiological Society of North America (RSNA), comprising physicians with expertise ...

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    Full Text Available ... echoes from the tissues in the body. The principles are similar to sonar used by boats and ... smaller than a "pencil lead", or approximately 1/8 inch in diameter. The stent used in this ...

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    Full Text Available ... TIPS may successfully reduce internal bleeding in the stomach and esophagus in patients with cirrhosis. Tell your ... the liver into the veins of the spleen, stomach, lower esophagus, and intestines, causing enlarged vessels, bleeding ...

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    Full Text Available ... the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines. The ultrasound image is immediately visible on a video display screen ...

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    Full Text Available ... hollow plastic tube into the vessel. Using real time x-ray guidance, your doctor will then guide the catheter toward the liver and into one of the hepatic veins. Pressures are measured in the hepatic vein and right heart to confirm ...

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    Full Text Available ... in an hour or two but may take up to several hours depending on the complexity of ... normal activities in seven to 10 days. Follow-up ultrasounds will be performed frequently after the TIPS ...

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    Full Text Available ... portal vein to the hepatic vein in the liver. A small metal device called a stent is ... bowel back to the heart while avoiding the liver. TIPS may successfully reduce internal bleeding in the ...

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    Full Text Available ... of an effect than open surgical bypass on future liver transplantation surgery because the abdomen has not ... TIPS. top of page Additional Information and Resources Society of Interventional Radiology (SIR) - Patient Center This page ...

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    Full Text Available ... blood draining from the bowel back to the heart while avoiding the liver. TIPS may successfully reduce ... blood away from the liver back to the heart). A stent is then placed in this tunnel ...

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    Full Text Available ... The teddy bear denotes child-specific content. Related Articles and Media ... note RadiologyInfo.org is not a medical facility. Please contact your physician with specific medical ...

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    Full Text Available ... Radiology (ACR) and the Radiological Society of North America (RSNA), comprising physicians with expertise in several radiologic ... Site Map Copyright © 2018 Radiological Society of North America, Inc. (RSNA). To help ensure current and accurate ...

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not ...

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    Full Text Available ... pressure. top of page How does the procedure work? A TIPS reroutes blood flow in the liver and reduces abnormally high blood pressure in the veins of the stomach, esophagus, bowel and liver, reducing the risk of bleeding from enlarged veins across the esophagus ...

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    Full Text Available ... pressure. top of page How does the procedure work? A TIPS reroutes blood flow in the liver ... have special pediatric considerations. The teddy bear denotes child-specific content. Related Articles and Media Radiation Dose ...

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    Full Text Available ... failure is severe, a TIPS may not be the best use and a different procedure may be needed to control your symptoms. They are also at risk for encephalopathy , which is an alteration of normal brain function that can lead to confusion. This is ...

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    Full Text Available ... successfully reduce internal bleeding in the stomach and esophagus in patients with cirrhosis. Tell your doctor if ... into the veins of the spleen, stomach, lower esophagus, and intestines, causing enlarged vessels, bleeding and the ...

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    Full Text Available ... discuss any recent illnesses, medical conditions, allergies and medications you’re taking. You may be advised to ... night before. Your doctor will tell you which medication to take in the morning. Leave jewelry at ...

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    Full Text Available ... seen in adults, often as a result of chronic liver problems leading to cirrhosis (scarring of the ... is a concern, particularly in patients with poor kidney function. Any procedure ... with more advanced liver disease are at greater risk for worsening liver failure ...

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    Full Text Available ... be connected to monitors that track your heart rate, blood pressure and pulse during the procedure. A ... after the procedure? Devices to monitor your heart rate and blood pressure will be attached to your ...

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    Full Text Available ... your procedure and instructed to not eat or drink anything after midnight the night before. Your doctor ... will likely be instructed not to eat or drink anything after midnight before your procedure. Your doctor ...

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    Full Text Available ... small wire mesh tube, often covered with a fabric made of GORE-TEX®. Other equipment that may ... recurrence of symptoms infection of the stent or fabric lining abdominal bleeding that might require a transfusion ...

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    Full Text Available ... to the heart while avoiding the liver. TIPS may successfully reduce internal bleeding in the stomach and ... conditions, allergies and medications you’re taking. You may be advised to stop taking aspirin, nonsteroidal anti- ...

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    Full Text Available ... liver disease are at greater risk for worsening liver failure after TIPS. If your liver failure is severe, a TIPS may not be the best use and a different procedure may be needed to control your symptoms. ... ordinarily filtered out by the liver. The TIPS may cause too much of these ...

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    Full Text Available ... liver disease are at greater risk for worsening liver failure after TIPS. If your liver failure is severe, a TIPS may not be the ... children are more likely to be performed before liver transplant in those with ascites or variceal ... 08, 2017 Send us your feedback Did you find the ...

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    Full Text Available ... risks. Other possible complications of the procedure include: fever muscle stiffness in the neck bruising on the ... filtered out by the liver. The TIPS may cause too much of these substances to bypass the ...

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    Full Text Available ... based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return from the area within the patient that ... area of your body where the catheter is to be inserted will be sterilized and covered ... an area just above your right collarbone with a local anesthetic . ...

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    Full Text Available ... then placed in this tunnel to keep the pathway open. Patients who typically need a TIPS have ... and stomach. A TIPS procedure involves creating a pathway through the liver that connects the portal vein ( ...

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    Full Text Available ... and/or hydrothorax (in the chest). Budd-Chiari syndrome , a blockage in one or more veins that ... intentionally to solve the problem. Although extremely rare, children may also require a TIPS procedure. TIPS in ...

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    Full Text Available ... avoiding the liver. TIPS may successfully reduce internal bleeding in the stomach and esophagus in patients with ... stomach, lower esophagus, and intestines, causing enlarged vessels, bleeding and the accumulation of fluid in the chest ...

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    Full Text Available ... system. This pressure buildup can cause blood to flow backward from the liver into the veins of ... does the procedure work? A TIPS reroutes blood flow in the liver and reduces abnormally high blood ...

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    Full Text Available ... sends out high-frequency sound waves (that the human ear cannot hear) into the body and then ... IV), ultrasound machine and devices that monitor your heart beat and blood pressure. top of page How ...

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    Full Text Available ... they have increased pressure in the portal vein system. This pressure buildup can cause blood to flow ... the hepatic vein to identify the portal venous system. Access is then gained from the hepatic vein ...

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    Full Text Available ... increased pressure in the portal vein system. This pressure buildup can cause blood to flow backward from the liver into the veins of the spleen, stomach, lower esophagus, and intestines, causing enlarged vessels, bleeding and the accumulation of fluid in the ...

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    Full Text Available ... should always inform their physician and x-ray technologist if there is any possibility that they are ... and pulse during the procedure. A nurse or technologist will insert an intravenous (IV) line into a ...

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    Full Text Available ... all medications that you are taking, including herbal supplements, and if you have any allergies, especially to ... can be treated with certain medications, a special diet or, by revising the stent, but sometimes the ...

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    Full Text Available ... needle (a special long needle extending from the neck into the liver). A stent is then placed ... the procedure include: fever muscle stiffness in the neck bruising on the neck at the point of ...

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    Full Text Available ... physician will numb an area just above your right collarbone with a local anesthetic . A very small ... Pressures are measured in the hepatic vein and right heart to confirm the diagnosis of portal hypertension, ...

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    Full Text Available ... balloon, you may experience discomfort. If you feel pain, you should inform your physician; you may be given extra intravenous medications. As the contrast material passes through your body, ...

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    Full Text Available ... liver back to the heart. top of page How should I prepare? You should report to your ... heart beat and blood pressure. top of page How does the procedure work? A TIPS reroutes blood ...

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    Full Text Available ... single exam. The transducer sends out high-frequency sound waves (that the human ear cannot hear) into ... patient's skin to send and receive the returning sound waves), as well as the type of body ...

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    Full Text Available ... heart while avoiding the liver. TIPS may successfully reduce internal bleeding in the stomach and esophagus in ... TIPS reroutes blood flow in the liver and reduces abnormally high blood pressure in the veins of ...

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    Full Text Available ... No Please type your comment or suggestion into the following text box: Comment: E-mail: Area code: Phone no: Thank you! Please help us improve RadiologyInfo.org by taking our brief survey: Survey ... and treatments have special pediatric considerations. The teddy bear denotes child-specific content. Related Articles ...

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    Full Text Available ... any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to ... See the Safety page for more information about pregnancy and x-rays. You ... tests and treatments have special pediatric considerations. The teddy ...

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    Full Text Available ... vascular anatomy. top of page What will I experience during and after the procedure? Devices to monitor ... pathway is expanded by the balloon, you may experience discomfort. If you feel pain, you should inform ...

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    Full Text Available ... the portal vein system. This pressure buildup can cause blood to flow backward from the liver into ... in the wall of the stomach, which can cause severe bleeding. severe ascites (the accumulation of fluid ...

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    Full Text Available ... pregnant and discuss any recent illnesses, medical conditions, allergies and medications you’re taking. You may be ... including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or ...

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    Full Text Available ... out high-frequency sound waves (that the human ear cannot hear) into the body and then listens ... to make sure that it remains open and functions properly. top of page Who interprets the results ...

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    Full Text Available ... an interventional radiology suite or occasionally in the operating room. Some interventional radiologists prefer performing this procedure ... the hepatic vein to identify the portal venous system. Access is then gained from the hepatic vein ...

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    Full Text Available ... sends out high-frequency sound waves (that the human ear cannot hear) into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and ...

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    Full Text Available ... may be connected to monitors that track your heart rate, blood pressure and pulse during the procedure. A ... and after the procedure? Devices to monitor your heart rate and blood pressure will be attached to your ...

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    Full Text Available ... You should be able to resume your normal activities in seven to 10 days. Follow-up ultrasounds ... Other possible complications of the procedure include: fever muscle stiffness in the ... bleeding that might require a transfusion laceration of ...

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    Full Text Available ... of page Who interprets the results and how do I get them? Prior to leaving the hospital, ... E-mail: Area code: Phone no: Thank you! Do you have a personal story about radiology? Share ...

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    Full Text Available ... is suspended over a table on which the patient lies. Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that ...

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    Full Text Available ... vascular anatomy. top of page What will I experience during and after the procedure? Devices to monitor ... areas. Outside links: For the convenience of our users, RadiologyInfo .org provides links to relevant websites. RadiologyInfo. ...

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    Full Text Available ... a specified period of time before your procedure. Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy ...

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    Full Text Available ... not responsible for the content contained on the web pages found at these links. About ... Inc. (RSNA). To help ensure current and accurate information, we do not permit copying but encourage linking ...

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    Full Text Available ... consist of a console containing a computer and electronics, a video display screen and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner ...

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site ...

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    Full Text Available ... you which medication to take in the morning. Leave jewelry at home and wear loose, comfortable clothing. ... of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1, ...

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    Full Text Available ... Patients who typically need a TIPS have portal hypertension , meaning they have increased pressure in the portal ... leading to cirrhosis (scarring of the liver). Portal hypertension can also occur in children, although children are ...

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    Full Text Available ... Other possible complications of the procedure include: fever muscle stiffness in the neck bruising on the neck ... can be treated with certain medications, a special diet or, by revising the stent, but sometimes the ...

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    Full Text Available ... deeply you are sedated. When the needle is advanced through the liver and the pathway is expanded ... are the limitations of TIPS? Patients with more advanced liver disease are at greater risk for worsening ...

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    Full Text Available ... in creating the TIPS. top of page Additional Information and Resources Society of Interventional Radiology (SIR) - Patient ... Send us your feedback Did you find the information you were looking for? Yes No Please type ...

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    Full Text Available ... by taking our brief survey: Survey Do you have a personal story about radiology? Share your patient ... caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy bear denotes child- ...

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    ... complex and lengthy procedures requiring extended fluoroscopy use) death (rare) top of page What are the limitations ... and treatments have special pediatric considerations. The teddy bear denotes child-specific content. Related Articles and Media ...

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    Full Text Available ... or blood thinners for a specified period of time before your procedure. Women should always inform their ... based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return ...

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    Full Text Available ... page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the American College of Radiology (ACR) and the Radiological Society of North ... with expertise in several radiologic areas. Outside links: For the ...

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    Full Text Available ... a radiologist or other physician. To locate a medical imaging or radiation oncology provider in your community, you ... not provide cost information. The costs for specific medical imaging tests, treatments and procedures may vary by geographic ...

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    Full Text Available ... including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred ...

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    Full Text Available ... consist of a console containing a computer and electronics, a video display screen and a transducer that ... suggestion into the following text box: Comment: E-mail: Area code: Phone no: Thank you! Please help ...

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    Full Text Available ... of page What are some common uses of the procedure? A TIPS is used to treat the ... during the procedure. top of page What does the equipment look like? In this procedure, x-ray ...

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    Full Text Available ... sends out high-frequency sound waves (that the human ear cannot hear) into the body and then ... in children is their tremendous variability in size, physiology, and medical diseases. This can result in significant ...

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    Full Text Available ... seen in adults, often as a result of chronic liver problems leading to cirrhosis (scarring of the liver). Portal hypertension can also occur in children, although children are much less likely to require ...

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    Full Text Available ... is completed. top of page What are the benefits vs. risks? Benefits A TIPS is designed to produce the same ... urgent intervention heart arrhythmias or congestive heart failure radiation injury to the skin is a rare complication ( ...

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    Full Text Available ... taking. You may be advised to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners ... Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners ...

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    Full Text Available ... send and receive the returning sound waves), as well as the type of body structure and composition ... full size with caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy ...

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    Full Text Available ... local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred to as "dye" or " ... the placement of the TIPS stent, a contrast material will be injected in the hepatic vein to ...

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos ... limitations of TIPS? Patients with more advanced liver disease are at greater risk for worsening liver failure ...

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    Full Text Available ... pressure. top of page How does the procedure work? A TIPS reroutes blood flow in the liver ... TIPS is a minimally invasive procedure that typically has a shorter recovery time than surgery. Your TIPS ...

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    Full Text Available ... some prefer conscious sedation for their patient. The advantage of general anesthesia is that the patient will ... us improve RadiologyInfo.org by taking our brief survey: Survey Do you have a personal story about ...

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    Full Text Available ... adults, often as a result of chronic liver problems leading to cirrhosis (scarring of the liver). Portal ... must be blocked off intentionally to solve the problem. Although extremely rare, children may also require a ...

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    Full Text Available ... flow in the liver and reduces abnormally high blood pressure in the veins of the stomach, esophagus, bowel and liver, reducing ... liver to bypass the liver entirely, reducing high blood pressure in the portal vein and the associated risk of bleeding from enlarged ...

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    Full Text Available ... then listens for the returning echoes from the tissues in the body. The principles are similar to ... type of body structure and composition of body tissue through which the sound travels. A small amount ...

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    Full Text Available ... advised to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to ... you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period ...

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    Full Text Available ... in the wall of the stomach, which can cause severe bleeding. severe ascites (the accumulation of fluid in the abdomen) and/or hydrothorax (in the chest). Budd-Chiari syndrome , a blockage in one or more veins that ...

  11. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... and/or hydrothorax (in the chest). Budd-Chiari syndrome , a blockage in one or more veins that ... hepatic vein and right heart to confirm the diagnosis of portal hypertension, and also to determine the ...

  12. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

    Medline Plus

    Full Text Available ... and devices that monitor your heart beat and blood pressure. top of page How does the procedure work? ... flow in the liver and reduces abnormally high blood pressure in the veins of the stomach, esophagus, bowel ...

  13. Congenital extrahepatic portosystemic shunt associated with heterotaxy and polysplenia

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley [Lucile Packard Children' s Hospital, Department of Radiology, Stanford University School of Medicine, Stanford, CA (United States); Feinstein, Jeffrey A. [Stanford University School of Medicine, Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children' s Hospital, Stanford (United States); Cohen, Ronald A.; Patel, Hitendra [Children' s Hospital and Research Center, Department of Diagnostic Radiology, Oakland, CA (United States); Feingold, Brian; Kreutzer, Jacqueline [Children' s Hospital of Pittsburgh, Department of Pediatrics, Division of Pediatric Cardiology, Pittsburgh, PA (United States); Chan, Fandics P. [Stanford University School of Medicine, Cardiovascular Imaging Section, Department of Radiology, Lucile Packard Children' s Hospital, Stanford, CA (United States)

    2010-07-15

    Heterotaxy with polysplenia is associated with many cardiovascular anomalies including the occasional occurrence of congenital extrahepatic portosystemic shunts (CEPS). Missing this anomaly can lead to inappropriate and ineffective therapy. To emphasize the importance and associated anatomy of CEPS in conjunction with heterotaxy with polysplenia. Review of three young children who presented with cyanosis and pulmonary hypertension without a cardiac etiology. They were known (1) or discovered (2) to have heterotaxy with polysplenia. There was absence of the intrahepatic inferior vena cava (IVC) with azygos or hemiazygos continuation in all three cases. In spite of normal liver function, they were discovered to have large portosystemic shunts, splenorenal in location, along with diffuse peripheral pulmonary arterial dilatation suggestive of CEPS (Abernethy malformation) with hepatopulmonary or, more accurately, portopulmonary syndrome. All CEPS were ipsilateral to the spleens. Patency of the portal veins in these cases allowed for percutaneous shunt closure with resolution of cyanosis. CEPS is associated with heterotaxy with polysplenia and can be symptomatic because of pulmonary arteriovenous (AV) shunting. Portal and hepatic vein patency are critical for determining feasibility of CEPS closure. (orig.)

  14. Splenophrenic portosystemic shunt in dogs with and without portal ...

    African Journals Online (AJOL)

    The possible existence of the same pattern of porto-caval connection in dogs having a single congenital portosystemic shunt (CPSS) and in dogs having multiple acquired portosystemic shunt (MAPSS) secondary to portal hypertension (PH) was evaluated. Retrospective evaluation of all CT examinations of patients having ...

  15. Combination therapy versus pharmacotherapy, endoscopic variceal ligation, or the transjugular intrahepatic portosystemic shunt alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Lin, Lu-Lu; Du, Shi-Ming; Fu, Yan; Gu, Hui-Yun; Wang, Lei; Jian, Zhi-Yuan; Shen, Xian-Feng; Luo, Jie; Zhang, Chao

    2017-08-22

    Patients with liver cirrhosis and variceal hemorrhage are at increased risk of rebleeding. We performed a meta-analysis toassess the clinical efficacy of combination therapy (pharmacotherapy and endoscopic variceal ligation (EVL)) compared with pharmacotherapy, EVL, or transjugular intrahepatic portosystemic shunt (TIPS) alone in the prevention of rebleeding and mortality. A literature search of MEDLINE, EMBASE, and the Cochrane Controlled Trials Register, up until November 2016, identified relevant randomized controlled trials. Data analysis was performed using Stata 12.0. Regarding overall mortality, combination therapy was as effective as EVL, pharmacotherapy, and TIPS (relative risk (RR) = 0.62, 95% confidence interval (CI): 0.36-1.08, RR=1.05, 95% CI: 0.68-1.63, and RR=1.39, 95% CI: 0.92-2.09, respectively). Combination therapy was as effective as EVL and pharmacotherapy alone in reducing blood-related mortality (RR=0.43, 95% CI: 0.15-1.25, and RR=0.42, 95% CI: 0.17-1.06), whereas TIPS was more effective than combination therapy (RR=5.66, 95% CI: 1.02-31.40). This was also the case for rebleeding; combination therapy was more effective than EVL and pharmacotherapy alone (RR=0.57, 95% CI: 0.41-0.79, and RR=0.65, 95% CI: 0.48-0.88), whereas TIPS was more effective than combination therapy (RR=9.42, 95% CI: 2.99-29.65). Finally, regarding rebleeding from esophageal varices, combination therapy was as effective as EVL alone (RR=0.59, 95% CI: 0.33-1.06) and was more effective than pharmacotherapy alone (RR=0.58, 95% CI: 0.40-0.85), although was less effective than TIPS (RR=2.20, 95% CI: 1.22-3.99). TIPS was recommended as the first choice of therapy in the secondary prevention of esophageal variceal bleeding.

  16. The role of MR angiography before transjugular placement of a portosystemic stent shunt (TIPS)

    International Nuclear Information System (INIS)

    Mueller, M.F.; Siewert, B.; Kim, D.; Edelman, R.R.; Stokes, K.R.; Finn, J.P.

    1994-01-01

    The authors employed magnetic resonance angiography (MRA) to guide catheter placement for transjugular intrahepatic portosystemic stent shunt (TIPS) procedures in 14 of 24 patients, and compared the results to the 10 patients who did not have prior panning based on MRA. Two-dimensional time-of-flight venography was performed during breath holding, and projection venograms were formatted in sagittal, coronal and axial planes. MRA defined venous anatomy sufficiently well to shorten the procedure and helped to minimize invasiveness. With MRA guidance, intrahepatic needle punctures were significantly fewer (without MRA guidance: mean 12.1; with MRA guidance: mean 3.5, p [de

  17. Imaging findings of unusual intra- and extrahepatic portosystemic collaterals

    Energy Technology Data Exchange (ETDEWEB)

    Ito, K. [Department of Radiology, Yamaguchi University School of Medicine, Yamaguchi (Japan)], E-mail: itokatsu@med.kawasaki-m.ac.jp; Fujita, T.; Shimizu, A.; Sasaki, K.; Tanabe, M.; Matsunaga, N. [Department of Radiology, Yamaguchi University School of Medicine, Yamaguchi (Japan)

    2009-02-15

    We describe unusual portosystemic shunts demonstrated using computed tomography (CT) and magnetic resonance imaging (MRI), including gallbladder varices, aberrant left gastric vein to left portal vein collaterals, intrahepatic and transhepatic portosystemic venous shunt, and mesenteric varices. Familiarity with the CT and MRI features of unusual portosystemic shunts will help in making the correct diagnosis for affected patients.

  18. Recanalization of an Occluded Intrahepatic Portosystemic Covered Stent via the Percutaneous Transhepatic Approach

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Chih Yang; Liang, Po Chin [National Taiwan University Hospital, Taipei (China)

    2010-08-15

    A 41-year-old woman with liver cirrhosis had recurrent portal hypertension and bleeding from esophageal varices due to complete occlusion of a previously inserted transjugular intrahepatic portosystemic shunt stent. Because recanalization of the stent by the transjugular approach was unsuccessful, ultrasound-guided entry to the splenic vein and portal vein was used. After catheter-directed intrathrombus thrombolysis, successful opening of the stent was achieved and a stent was placed. We herein report a rare case in which thrombolysis and recanalization of a TIPS stent were performed via a percutaneous transhepatic approach

  19. Haematology and coagulation profiles in cats with congenital portosystemic shunts.

    Science.gov (United States)

    Tzounos, Caitlin E; Tivers, Michael S; Adamantos, Sophie E; English, Kate; Rees, Alan L; Lipscomb, Vicky J

    2017-12-01

    Objectives The objectives of this study were, first, to report the haematological parameters and coagulation times for cats with a congenital portosystemic shunt (CPSS) and the influence of surgical shunt attenuation on these parameters; and, second, to identify any association between prolongation in coagulation profiles and incidence of perioperative haemorrhage. Methods This was a retrospective clinical study using client-owned cats with a CPSS. Signalment, shunt type (extra- or intrahepatic), degree of shunt attenuation (complete or partial), haematological parameters, prothrombin time (PT) and activated partial thromboplastin time (aPTT) test results, and occurrence of any perioperative clinical bleeding complications were recorded for cats undergoing surgical treatment of a CPSS at the Royal Veterinary College, UK, between 1994 and 2011. Results Forty-two cats were included. Thirty-six (85.7%) had an extrahepatic CPSS and six (14.3%) had an intrahepatic CPSS. Preoperatively, mean cell volume (MCV) and mean cell haemoglobin (MCH) were below the reference interval (RI) in 32 (76.2%) and 31 (73.8%) cats, respectively. Red blood cell count and mean cell haemoglobin concentration (MCHC) were above the RI in 10 (23.8%) and eight (19.1%) cats, respectively. Postoperatively, there were significant increases in haematocrit ( P = 0.044), MCV ( P = 0.008) and MCH ( P = 0.002). Despite the significant increase in MCV postoperatively, the median MCV postoperatively was below the RI, indicating persistence of microcytosis. Preoperatively, PT was above the upper RI in 14 cats (87.5%), and aPTT was above the upper RI in 11 cats (68.8%). No cat demonstrated a perioperative clinical bleeding complication. Conclusions and relevance Cats with a CPSS are likely to present with a microcytosis, but rarely present with anaemia, leukocytosis or thrombocytopenia. Surgical attenuation of the CPSS results in a significant increase in the HCT and MCV. Coagulation profiles in cats with a

  20. Anatomy of the Portal Vein Bifurcation: Implication for Transjugular Intrahepatic Portal Systemic Shunts

    International Nuclear Information System (INIS)

    Kwok, Philip Chong-hei; Ng, Wai Fu; Lam, Christine Suk-yee; Tsui, Polly Po; Faruqi, Asma

    2003-01-01

    Purpose: The relationship of the portalvein bifurcation to the liver capsule in Asians, which is an important landmark for transjugular intrahepatic portosystemic shunt, has not previously been described. Methods: The anatomy of the portal vein bifurcation was studied in 70 adult Chinese cadavers; it was characterized as intrahepatic or extrahepatic. The length of the exposed portion of the right and left portal veins was measured when the bifurcation was extrahepatic. Results: The portal vein bifurcation was intrahepatic in 37 cadavers (53%) and extrahepatic in 33 cadavers (47%). The mean length of the right and left extrahepatic portal veins was 0.96 cm and 0.85 cm respectively.Both were less than or equal to 2 cm in 94% of the cadavers with extrahepatic bifurcation. There was no correlation between the presence of cirrhosis and the location of the portal vein bifurcation(p 1.0). There was no statistically significant difference in liver mass in cadavers with either extrahepatic or intrahepatic bifurcation (p =0.40). Conclusions: These findings suggest that fortransjugular intrahepatic portosystemic shunt placement, a portal vein puncture 2 cm from the bifurcation will be safe in most cases

  1. The clinical results of balloon-occluded retrograde transvenous obliteration in treatment of gastric varices compared with transjugular intrahepatic portosystemic shunt

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nam Kyung; Kim, Chang Won; Jeon, Ung Bae; Kim, Suk; Lee, Jun Woo; Jo, Mong; Heo, Jeong [Pusan National University School of Medicine, Busan (Korea, Republic of)

    2007-03-15

    To compare the clinical results of BRTO in the gastric varices with those of TIPS. From January 2004 to March 2006, eight patients who had been followed up for more than 1 month after BRTO were enrolled in this study. This study compared the clinical efficacy of BRTO with than of TIPS in 13 patients who had undergone TIPS from January 2000 to March 2006. The change in laboratory parameters before and after each procedure and the incidence of rebleeding, encephalopathy, asictes and varices were analyzed after each procedure. In the BRTO group, the level of albumin increased, and the levels of ammonia and the Child-Pugh score decreased. The TIPS group showed no improvement in the liver function. In the BRTO group, the gastric varices were eradicated in 7 patients. Gastric variceal rebleeding and encephalopathy did not occur. However, the esophageal varices worsened in 6 patients. In the TIPS group, rebleeding (n = 4), encephalopathy (n = 7) and a worsening of the gastric (n = 5) or esophageal varices (n = 2) occurred. BRTO improves the metabolic activity of the liver and has a lower incidence of encephalopathy. Hence, BRTO is a good alternative to TIPS in the gastric varices accompanied by a gastrorenal shunt although a treatment for a worsening of the esophageal varices may be needed after BRTO.

  2. Improved Patency of Transjugular Intrahepatic Portosystemic Shunt: The Efficacy of Cilostazol for the Prevention of Pseudointimal Hyperplasia in Swine TIPS Models

    International Nuclear Information System (INIS)

    Park, Sang Woo; Cha, In Ho; Kim, Chul Hwan; Jeon, Hae Jeong; Park, Jeong Hee; Hong, Suk Joo; Lee, In Sik

    2007-01-01

    Purpose. To investigate the efficacy of oral administration of cilostazol to inhibit pseudointimal/intimal hyperplasia in swine TIPS models. Methods. Successful TIPS creation was carried out in 11 of 12 healthy young pigs (20-25 kg). In the treatment group (n = 6), both cilostazol and aspirin were administered daily, from the first day of TIPS creation. The control group (n = 5) was administered only aspirin. The animals were followed-up for 2 weeks and then killed. The specimen (including portal vein, hepatic parenchymal tract, hepatic vein, and inferior vena cava) and stents were carefully bisected in a longitudinal fashion. The control group was compared with the treatment group by means of a gross and histologic evaluation of the degree of pseudointimal/intimal hyperplasia in the shunt. Results. At the gross evaluation, the control group showed considerably more pseudointimal/intimal hyperplasia than the treatment group. Using microscopic evaluation, there was a statistically significant difference (p < 0.05) in the mean maximum pseudointimal/intimal hyperplasia thickness between the control group (2.97 ± 0.33 mm) and treatment group (0.73 ± 0.27 mm). Conclusion. Oral administration of cilostazol may have been effective in reducing pseudointimal/intimal hyperplasia in swine TIPS models

  3. The transjugular intrahepatic portosystemic stentshunt (TIPSS): A new nonoperative, transjugular percutaneous procedure

    International Nuclear Information System (INIS)

    Richter, G.M.; Noeldge, G.; Siegerstetter, V.; Franke, M.; Wenz, W.

    1989-01-01

    In a 49-year-old male patient suffering from severe symptoms of end-stage portal hypertension and Child's stage C metabolic status, an intrahepatic stent-assisted portosystemic shunt was established for the first time exclusively by means of interventional radiology. Via transjugular access, a modified Brockenbrough needle was used to puncture the right branch of the portal vein via the right liver vein. As a target, a Dormia-basket was used that had previously been exposed in the right main portal branch. After successful puncture and balloon dilation of the artificial tract, two Palmaz stents were implanted to keep the tract permanently open. The portosystemic pressure gradient dropped from 38 to 18 mm Hg. The clinical status of the patient improved substantially during the following days. However, the patient died on day 11 after the procedure because of sudden onset of acute respiratory distress arising from acute nosocomial fungus and cytomegalovirus infection worsened by his primary immunoincompetence. Autopsy demonstrated a totally patent shunt without superficial thrombus. Microscopically, a thin endothelial layer on the inner shunt surface was found to be present. (orig.) [de

  4. Aberrant hepatic lipid storage and metabolism in canine portosystemic shunts

    NARCIS (Netherlands)

    Van den Bossche, Lindsay; Schoonenberg, Vivien A C; Burgener, Iwan A; Penning, Louis C; Schrall, Ingrid M; Kruitwagen, Hedwig S; van Wolferen, Monique E; Grinwis, Guy C M; Kummeling, Anne; Rothuizen, Jan; van Velzen, Jeroen F.; Stathonikos, Nikolas; Molenaar, Martijn R; Helms, Bernd J; Brouwers, Jos F H M; Spee, Bart; van Steenbeek, Frank G

    2017-01-01

    Non-alcoholic fatty liver disease (NAFLD) is a poorly understood multifactorial pandemic disorder. One of the hallmarks of NAFLD, hepatic steatosis, is a common feature in canine congenital portosystemic shunts. The aim of this study was to gain detailed insight into the pathogenesis of steatosis in

  5. Intrahepatic arterioportal shunt: helical CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Quiroga, S.; Sebastia, M.C.; Moreiras, M.; Pallisa, E.; Rius, J.M.; Alvarez-Castells, A. [I. D. I. Hospital General i Universitari Vall d`Hebron, Barcelona (Spain). Servei de Radiodiagnostic

    1999-08-01

    The purpose of this study was to characterize the appearance of intrahepatic arterioportal shunts (APS) on two-phase helical CT, with emphasis on the importance of the hepatic arterial-dominant phase (HAP) to demonstrate perfusion disorders. We review eight cases of APS diagnosed by helical CT in our institution from January 1996 to March 1997 and describe the CT findings that established diagnosis. Five of them were confirmed by angiography. In seven (87.5 %) cases of APS we found early enhancement of the peripheral portal branches during the HAP of helical CT, whereas the superior mesenteric and splenic veins remained unenhanced. In five (62.5 %) cases of APS, transient, peripheral, triangular parenchymal enhancement was depicted during the HAP of helical CT; in four of these cases there was associated early enhancement of the portal branches. Helical CT can show perfusion alterations that might remain undiagnosed with conventional CT. An understanding of the hemodynamic changes that occur in APS can help in the interpretation of focal transient hepatic parenchymal enhancement and to differentiate APS from hypervascular tumors. We believe that the helical CT findings described herein are characteristic enough to suggest the diagnosis of APS. (orig.) With 3 figs., 1 tab., 16 refs.

  6. Use of transsplenic injection of agitated saline and heparinized blood for the ultrasonographic diagnosis of macroscopic portosystemic shunts in dogs.

    Science.gov (United States)

    Gómez-Ochoa, Pablo; Llabrés-Díaz, Francisco; Ruiz, Sergio; Corda, Andrea; Prieto, Saul; Sosa, Ivan; Gregori, Tommaso; Gascón, Manuel; Couto, Guillermo C

    2011-01-01

    We describe the use of ultrasonography-guided percutaneous splenic injection of agitated saline and heparinized blood for the diagnosis of portosystemic shunts (PSS) in 34 dogs. Agitated saline mixed with 1 ml of heparinized autologous blood was injected into the spleen of 34 sedated dogs under sonographic guidance. The transducer was then sequentially repositioned to visualize the portal vein, the caudal vena cava, and the right atrium through different acoustic windows. It was possible to differentiate between intrahepatic and extrahepatic shunts depending on the entry point of the microbubbles into the caudal vena cava. Portoazygos shunts and portocaval shunts could be differentiated based on the presence of microbubbles in the caudal vena cava and/or the right atrium. In one dog, collateral circulation due to portal hypertension was identified. In dogs with a single extrahepatic shunt, the microbubbles helped identify the shunting vessel. The technique was also used postoperatively to assess the efficacy of shunt closure. All abnormal vessels were confirmed by exploratory laparotomy or with ultrasonographic identification of the shunting vessel. Ultrasound-guided transsplenic injection of agitated saline with heparinized blood should be considered as a valuable technique for the diagnosis of PSS; it is easy to perform, safe, and the results are easily reproducible.

  7. Abnormal Gas Diffusing Capacity and Portosystemic Shunt in Patients With Chronic Liver Disease

    OpenAIRE

    Park, Moon-Seung; Lee, Min-Ho; Park, Yoo-Sin; Kim, Shin-Hee; Kwak, Min-Jung; Kang, Ju-Seop

    2012-01-01

    Background Pulmonary dysfunctions including the hepatopulmonary syndrome and portosystemic shunt are important complications of hepatic cirrhosis. To investigate the severity and nature of abnormal gas diffusing capacity and its correlation to portosystemic shunt in patients with chronic liver disease. Methods Forty-four patients with chronic liver disease (15 chronic active hepatitis (CAH), 16 Child-Pugh class A, and 13 Child-Pugh class B) without other diseases history were enrolled in the ...

  8. Tratamento da síndrome de Budd-Chiari por meio da colocação de tips e de "stent" venoso supra-hepático Transjugular intrahepatic portosystemic shunt (TIPS and suprahepatic venous stenting in the management of Budd-Chiari syndrome

    Directory of Open Access Journals (Sweden)

    Jurandi A. Bettio

    2002-11-01

    Full Text Available OBJETIVOS: Descrever o uso do "shunt" intra-hepático portossistêmico (TIPS e do "stent" venoso supra-hepático no manejo da síndrome de Budd-Chiari, enfocando suas indicações, aspectos técnicos e benefícios do procedimento. MATERIAIS E MÉTODOS: De janeiro de 1999 a março de 2002, nove casos de síndrome de Budd-Chiari foram encaminhados ao Serviço de Hemodinâmica do Hospital São Lucas, Porto Alegre, RS. A obstrução venosa supra-hepática foi constatada em todos os casos por meio de ultra-sonografia com Doppler em cores. A criação de TIPS foi realizada entre o sistema venoso supra-hepático ou a veia cava inferior e a veia porta, posicionando-se a endoprótese entre as duas abordagens. Doppler em cores pós-procedimento foi efetuado em todos os pacientes em períodos seriados. RESULTADOS: Três casos foram tratados inicialmente com inserção de "stent" venoso por apresentarem estenose preponderante em veias supra-hepáticas. Em dois desses casos ocorreu trombose do "stent", sendo necessária colocação de TIPS. Os demais seis casos foram tratados primariamente com TIPS. Dos oito "shunts" criados, trombose da endoprótese foi constatada em três casos, resolvidas com limpeza dos trombos e dilatação com balão em um caso e inserção de novas próteses nos demais. Embolização com molas de colaterais venosas ectasiadas foi efetuada em um paciente. CONCLUSÕES: A colocação de TIPS constitui-se numa estratégia terapêutica segura e efetiva na síndrome de Budd-Chiari, promovendo uma significativa melhora clínica e hemodinâmica dos pacientes, evitando procedimentos mais invasivos e podendo, em casos sem cirrose estabelecida, servir de tratamento definitivo da hipertensão portal.OBJECTIVE: To evaluate the use of transjugular intrahepatic portosystemic shunt (TIPS and suprahepatic venous stenting in the management of Budd-Chiari syndrome, emphasizing the indications, technical aspects and the advantages of the procedure

  9. Immunohistochemical analysis of restenotic tissue after transjugular portosystemic shunt

    International Nuclear Information System (INIS)

    Lu Qin; An Yanli; Deng Gang; Fang Wen; Zhu Guangyu; Li Guozhao; Wei Xiaoying; Liu Yuanyuan; Teng Gaojun

    2005-01-01

    Objective: To investigate the changes of several restenotic tissue elements after transjugular portosystemic shunt, and to provide more informations for the mechanism of TIPS restenosis. Methods: TIPS was performed in 6 swine to set up TIPS animal models. 14-21 days after operation, the models were sacrificed to obtain the TIPS tissues for pathological examinations, including electric microscope, HE staining, and immunohistochemical staining of anti-SMC-actin-α, PCNA, Vementin, myoglobulin, eNOS and iNOS. Then , the results were comparatively analyzed between TIPS obstructed shunt tissues and non-obstructed shunt tissues. Results: Restenosis was occurred with different degrees in 4 swine of the 6 TIPS models. Electric microscopic results showed that the restenosis tissues were composed of over proliferated collagen, SMCs and fibroblasts. Anti-SMC-actin-α and PCNA were strongly positive expression in restenotic tissues, and also positive in patent tissues. Vimentin expressed strongly in unstenotic tissues, on the contrary, it expressed obviously weaker in restenotic tissues. Myoglobulin expressed more strongly in restenotic tissues and weakened in unstenotic tissues. eNOS expressed positive in normal liver tissues, and expressed weaker near TIPS restenotic tissues. iNOS showed stronger expression in restenotic tissues and could hardly expressed in normal liver tissues. Conclusions: Restenotic rate may be 67% in TIPS swine models. Restenotic tissues may be mainly composed of proliferated SMCs positively expressed anti-SMC-actin-α with strong ability of movement. eNOS may be expressed in normal liver tissues and instead iNOS be expressed in strongly injured liver tissues. (authors)

  10. A Single-Institution Review of Portosystemic Shunts in Children: An Ongoing Discussion

    Directory of Open Access Journals (Sweden)

    J. B. Lillegard

    2010-01-01

    Full Text Available Purpose. Review the safety and long-term success with portosystemic shunts in children at a single institution. Methods. An IRB-approved, retrospective chart review of all children ages 19 and undergoing surgical portosystemic shunt from January 1990–September 2008. Results. Ten patients were identified, 8 females and 2 males, with a mean age of 15 years (range 5–19 years. Primary diagnoses were congenital hepatic fibrosis (5, hepatic vein thrombosis (2, portal vein thrombosis (2, and cystic fibrosis (1. Primary indications were repeated variceal bleeding (6, symptomatic hypersplenism (2, and significant liver dysfunction (2. Procedures performed were distal splenorenal bypass (4, side-to-side portocaval shunt (3, proximal splenorenal shunt (2, and an interposition H-graft portocaval shunt (1. There was no perioperative mortality and only minor morbidity. Seventy percent of patients had improvement of their symptoms. Eighty percent of shunts remained patent. Two were occluded at a median follow-up of 50 months (range 0.5–13.16 years. Two patients underwent subsequent liver transplantation. Two patients died at 0.5 and 12.8 years postoperatively, one from multisystem failure with cystic fibrosis and one from post-operative transplant complications. Conclusions. The need for portosystemic shunts in children is rare. However, in the era of liver transplantation, portosystemic shunts in selected patients with well-preserved liver function remains important. We conclude that portosystemic shunts are safe and efficacious in the control of variceal hemorrhage and symptoms related to hypersplenism.

  11. A new method for the measurement of intrahepatic shunts

    International Nuclear Information System (INIS)

    Hoefs, J.C.; Reynolds, T.B.; Pare, P.; Sakimura, I.

    1984-01-01

    After transhepatic portal pressure determination, 96 patients were assessed for the presence of intrahepatic shunts by injection of microspheres (25 +/- 5 micron diameter) into the portal vein using RISA-131I as an indicator of dilution. Multiple portal vein injections in each patient allowed blood sampling from the hepatic vein (site 1) and from two inferior vena cava sampling sites (site 2, at the junction of the hepatic vein orifice with the inferior vena cava, and site 3, 2 to 3 cm closer to or within the right atrium). Intrahepatic shunting was calculated from each site: hepatic vein in 57 patients and inferior vena cava, site 2 in 43 patients and site 3 in 77 patients. At least one valid IHS calculation was available in 92 of the patients. Intrahepatic shunting calculated from sequential portal vein injections with sampling from the hepatic vein was highly correlated (r . 0.98, p less than 0.0001, slope . 1.0), with a mean difference of 1.9% +/- 1.9%. There was no significant difference by t test comparison of the mean IHS calculated from sites 1, 2, and 3. Occasional marked discrepancies were noted between IHS calculated from site 1 or site 2 compared with site 3, and the site 3 calculation was always greater. A shunt index in all patients included shunts calculated from the hepatic vein in 57 patients plus shunt calculation from the inferior vena cava in the remaining patients (site 2 in 26 patients and site 3 in nine). The 82 patients with portal hypertension or chronic liver disease had a higher portal pressure, 13.8 +/- 4.6 mm Hg, and a significantly greater shunt index, 13.7% +/- 24.5% compared with controls. The frequency distribution of IHS in patients with chronic liver disease demonstrated less than 2% IHS in 49% of patients and less than 5% IHS in 63%. The validity of our methods and the implications of the infrequent demonstration of a large IHS are discussed

  12. Surgical attenuation of congenital portosystemic shunts in dogs. Techniques, complications and prognosis

    NARCIS (Netherlands)

    Kummeling, A.

    2009-01-01

    The general aim of this thesis was to identify factors associated with outcome after surgical attenuation of congenital portosystemic shunts (CPSS) in dogs and to clarify underlying mechanisms of postoperative recovery in this disease. Two surgical techniques used for CPSS attenuation, ligation and

  13. Distribution of extrahepatic congenital portosystemic shunt morphology in predisposed dog breeds

    NARCIS (Netherlands)

    van den Bossche, L.; van Steenbeek, F.G.|info:eu-repo/dai/nl/314417958; Favier, R.P.|info:eu-repo/dai/nl/304828742; Kummeling, A.|info:eu-repo/dai/nl/304828793; Leegwater, P.A.J.|info:eu-repo/dai/nl/074236539; Rothuizen, J.|info:eu-repo/dai/nl/071276033

    2012-01-01

    Distribution of extrahepatic congenital portosystemic shunt morphology in predisposed dog breeds Lindsay van den Bossche, Frank G van Steenbeek, Robert P Favier, Anne Kummeling, Peter A J Leegwater and Jan Rothuizen For all author emails, please log on. BMC Veterinary Research 2012, 8:112

  14. Cellophane banding for the gradual attenuation of single extrahepatic portosystemic shunts in eleven dogs.

    Science.gov (United States)

    Youmans, K R; Hunt, G B

    1998-08-01

    To evaluate the efficacy and short term effects of a cellophane banding technique for progressive attenuation of canine single extrahepatic portosystemic shunts. A prospective trial of 11 dogs with single congenital extrahepatic shunts. Rectal ammonia tolerance testing and routine biochemical tests were performed preoperatively on all dogs. In seven dogs, preoperative abdominal Doppler ultrasonography was also performed. Exploratory laparotomy revealed a single extrahepatic portocaval shunt in each animal, which was attenuated using a cellophane band with an internal diameter of 2 to 3 mm. The abdomen was closed routinely. Follow-up biochemical analysis and abdominal Doppler ultrasonography or splenoportography were performed postoperatively. The shunt was not amenable to total ligation in 11 dogs, based upon reported criteria. All dogs recovered uneventfully from surgery without evidence of portal hypertension, and showed clinical improvement thereafter. Shunt occlusion was deemed to have occurred in 10 dogs based on resolution of biochemical and/or sonographic abnormalities. One dog continued to have sonographic evidence of portosystemic shunting when evaluated 3 weeks after surgery, despite normal ammonia tolerance, but was lost to subsequent follow-up. Two dogs, in which 3 mm cellophane bands were placed, experienced delayed shunt occlusion. Cellophane banding is simple to perform, and causes progressive attenuation of single extrahepatic shunts in dogs. Further work is needed to determine the maximum diameter of a cellophane band which will produce total attenuation, and the long-term safety and reliability of the treatment.

  15. Usefulness of color and pulsed Doppler's in the evaluation of surgical portosystemic shunts in pediatric patients

    International Nuclear Information System (INIS)

    Berrocal, T.; Prieto, C.; Cortes, P.; Rodriguez, R.; Pastor, I.

    2003-01-01

    Portosystemic shunts are performed to relieve symptomatic portal hypertension symptomatic or removal pressure in hepatic vascularisation in patients with Budd-Chiari's syndrome. Most surgical portosystemic shunts can be suitably studied by means of ultrasound scan complemented by color and pulsed Dopplers, proved one understands the hemodynamics of the surgical procedures involved. This article demonstrates the usefulness and limitations of the ultrasound scan Duplex Doppler in the evaluation of portosystemic shunts performed on pediatric patients. Pulsed Doppler provides information regarding the nature and direction of blood flow. Color doppler is capable of directly revealing the shunt and, in most cases, permits the anastomosis to be located. The types of shunts that appear include proximal and distal spleno-renal, portocaval and mesocaval. Types of vascular connections are illustrated,s well as expected post-surgical blood flow direction in affected vessels. The ultrasound scanning technique is discussed, as well as the criteria for determining vascular permeability. Also highlighted are the advantages, limitations and diagnostic difficulties associated with the different forms of Doppler. (Author) 17 refs

  16. Morphology of congenital portosystemic shunts involving the left colic vein in dogs and cats.

    Science.gov (United States)

    White, R N; Parry, A T

    2016-05-01

    To describe the anatomy of congenital portosystemic shunts involving the left colic vein in dogs and cats. Retrospective review of a consecutive series of dogs and cats managed for congenital portosystemic shunts. For inclusion a shunt involving the left colic vein with recorded intraoperative mesenteric portovenography or computed tomography angiography along with direct gross surgical observations at the time of surgery was required. Six dogs and three cats met the inclusion criteria. All cases had a shunt which involved a distended left colic vein. The final communication with a systemic vein was variable; in seven cases (five dogs, two cats) it was via the caudal vena cava, in one cat it was via the common iliac vein and in the remaining dog it was via the internal iliac vein. In addition, two cats showed caudal vena cava duplication. The morphology of this shunt type appeared to be a result of an abnormal communication between either the left colic vein or the cranial rectal vein and a pelvic systemic vein (caudal vena cava, common iliac vein or internal iliac vein). This information may help with surgical planning in cases undergoing shunt closure surgery. © 2016 British Small Animal Veterinary Association.

  17. Staged Transcatheter Treatment of Portal Hypoplasia and Congenital Portosystemic Shunts in Children

    Energy Technology Data Exchange (ETDEWEB)

    Bruckheimer, Elchanan, E-mail: elchananb@bezeqint.net; Dagan, Tamir [Schneider Children' s Medical Center Israel, Section of Pediatric Cardiology (Israel); Atar, Eli; Schwartz, Michael [Schneider Children' s Medical Center Israel, Section of Radiology (Israel); Kachko, Ludmila [Schneider Children' s Medical Center Israel, Section of Anesthesiology (Israel); Superina, Riccardo; Amir, Gabriel [Schneider Children' s Medical Center Israel, Section of Pediatric Cardiology (Israel); Shapiro, Rivka [Schneider Children' s Medical Center Israel, Section of Gastroenterology (Israel); Birk, Einat [Schneider Children' s Medical Center Israel, Section of Pediatric Cardiology (Israel)

    2013-12-15

    Purpose: Congenital portosystemic shunts (CPSS) with portal venous hypoplasia cause hyperammonemia. Acute shunt closure results in portal hypertension. A transcatheter method of staged shunt reduction to afford growth of portal vessels followed by shunt closure is reported. Methods: Pressure measurements and angiography in the CPSS or superior mesenteric artery (SMA) during temporary occlusion of the shunt were performed. If vessels were diminutive and the pressure was above 18 mmHg, a staged approach was performed, which included implantation of a tailored reducing stent to reduce shunt diameter by {approx}50 %. Recatheterization was performed approximately 3 months later. If the portal pressure was below 18 mmHg and vessels had developed, the shunt was closed with a device. Results: Six patients (5 boys, 1 girl) with a median age of 3.3 (range 0.5-13) years had CPSS portal venous hypoplasia and hyperammonemia. Five patients underwent staged closure. One patient tolerated acute closure. One patient required surgical shunt banding because a reducing stent could not be positioned. At median follow-up of 3.8 (range 2.2-8.4) years, a total of 21 procedures (20 transcatheter, 1 surgical) were performed. In all patients, the shunt was closed with a significant reduction in portal pressure (27.7 {+-} 11.3 to 10.8 {+-} 1.8 mmHg; p = 0.016), significant growth of the portal vessels (0.8 {+-} 0.5 to 4.0 {+-} 2.4 mm; p = 0.037), and normalization of ammonia levels (202.1 {+-} 53.6 to 65.7 {+-} 9.6 {mu}mol/L; p = 0.002) with no complications. Conclusion: Staged CPSS closure is effective in causing portal vessel growth and treating hyperammonemia.

  18. Staged Transcatheter Treatment of Portal Hypoplasia and Congenital Portosystemic Shunts in Children

    International Nuclear Information System (INIS)

    Bruckheimer, Elchanan; Dagan, Tamir; Atar, Eli; Schwartz, Michael; Kachko, Ludmila; Superina, Riccardo; Amir, Gabriel; Shapiro, Rivka; Birk, Einat

    2013-01-01

    Purpose: Congenital portosystemic shunts (CPSS) with portal venous hypoplasia cause hyperammonemia. Acute shunt closure results in portal hypertension. A transcatheter method of staged shunt reduction to afford growth of portal vessels followed by shunt closure is reported. Methods: Pressure measurements and angiography in the CPSS or superior mesenteric artery (SMA) during temporary occlusion of the shunt were performed. If vessels were diminutive and the pressure was above 18 mmHg, a staged approach was performed, which included implantation of a tailored reducing stent to reduce shunt diameter by ∼50 %. Recatheterization was performed approximately 3 months later. If the portal pressure was below 18 mmHg and vessels had developed, the shunt was closed with a device. Results: Six patients (5 boys, 1 girl) with a median age of 3.3 (range 0.5–13) years had CPSS portal venous hypoplasia and hyperammonemia. Five patients underwent staged closure. One patient tolerated acute closure. One patient required surgical shunt banding because a reducing stent could not be positioned. At median follow-up of 3.8 (range 2.2–8.4) years, a total of 21 procedures (20 transcatheter, 1 surgical) were performed. In all patients, the shunt was closed with a significant reduction in portal pressure (27.7 ± 11.3 to 10.8 ± 1.8 mmHg; p = 0.016), significant growth of the portal vessels (0.8 ± 0.5 to 4.0 ± 2.4 mm; p = 0.037), and normalization of ammonia levels (202.1 ± 53.6 to 65.7 ± 9.6 μmol/L; p = 0.002) with no complications. Conclusion: Staged CPSS closure is effective in causing portal vessel growth and treating hyperammonemia

  19. Small-Diameter PTFE Portosystemic Shunts: Portocaval vs Mesocaval

    Directory of Open Access Journals (Sweden)

    Robert Shields

    1998-01-01

    Full Text Available Fifty-seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty-one patients had Child-Pugh gradeA disease and 26 grade B; all had a liver volume of 1000– 2500 ml. Follow-up ranged from 16 months to 6 years 3 months. Three patients (5 per cent died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child-Pugh grade A 88 per cent and for grade B 67 per cent. Small-lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.

  20. Comparison of Technical and Clinical Outcome of Transjugular Portosystemic Shunt Placement Between a Bare Metal Stent and a PTFE-Stentgraft Device

    Energy Technology Data Exchange (ETDEWEB)

    Lauermann, J., E-mail: jostlauermann@gmail.com [Hannover Medical School, Department of Diagnostic and Interventional Radiology (Germany); Potthoff, A. [Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology (Germany); Mc Cavert, M. [Beaumont Hospital, Department of Diagnostic and Interventional Radiology (Ireland); Marquardt, S. [Hannover Medical School, Department of Diagnostic and Interventional Radiology (Germany); Vaske, B. [Hannover Medical School, Institute of Biometry (Germany); Rosenthal, H. [Hannover Medical School, Department of Diagnostic and Interventional Radiology (Germany); Hahn, T. von [Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology (Germany); Wacker, F.; Meyer, B. C.; Rodt, Thomas, E-mail: rodt.thomas@mh-hannover.de [Hannover Medical School, Department of Diagnostic and Interventional Radiology (Germany)

    2016-04-15

    PurposeTo analyse technical and clinical success of transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension and compare a stent and a stentgraft with regard to clinical and technical outcome and associated costs.Materials and Methods170 patients (56 ± 12 years, 32.9 % females) treated with TIPS due to portal hypertension were reviewed. 80 patients received a stent (group 1) and 83 a stentgraft (group 2), and seven interventions were unsuccessful. Technical data, periprocedural imaging, follow-up ultrasound and clinical data were analysed with focus on technical success, patency, clinical outcome and group differences. Cost analysis was performed.ResultsPortal hypertension was mainly caused by ethyltoxic liver cirrhosis with ascites as dominant symptom (80 %). Technical success was 93.5 % with mean portosystemic gradient decrease from 16.1 ± 4.8 to 5.1 ± 2.1 mmHg. No significant differences in technical success and portosystemic gradient decrease between the groups were observed. Kaplan–Meier analysis yielded significant differences in primary patency after 14 days, 6 months and 2 years in favour of the stentgraft. Both groups showed good clinical results without significant difference in 1-year survival and hepatic encephalopathy rate. Costs to establish TIPS and to manage 2-year follow-up with constant patency and clinical success were 8876 € (group 1) and 9394 € (group 2).ConclusionTIPS is a safe and effective procedure to manage portal hypertension. Stent and stentgraft enabled good technical and clinical results with a low complication rate. Primary patency rates are clearly in favour of the stentgraft, whereas the stent was more cost effective with similar clinical results in both groups.

  1. Abnormal Gas Diffusing Capacity and Portosystemic Shunt in Patients With Chronic Liver Disease

    Science.gov (United States)

    Park, Moon-Seung; Lee, Min-Ho; Park, Yoo-Sin; Kim, Shin-Hee; Kwak, Min-Jung; Kang, Ju-Seop

    2012-01-01

    Background Pulmonary dysfunctions including the hepatopulmonary syndrome and portosystemic shunt are important complications of hepatic cirrhosis. To investigate the severity and nature of abnormal gas diffusing capacity and its correlation to portosystemic shunt in patients with chronic liver disease. Methods Forty-four patients with chronic liver disease (15 chronic active hepatitis (CAH), 16 Child-Pugh class A, and 13 Child-Pugh class B) without other diseases history were enrolled in the study. Evaluation of liver function tests, arterial blood gases analysis, ultrasonography, pulmonary function test including lung diffusing capacity of carbon monoxide (DLco), forced vital capacity(FVC), forced expiratory volume 1 seconds(FEV1), total lung capacity(TLC), DLco/AV(alveolar volume) and thallium-201 per rectum scintigraphy were performed. We were analyzed correlations between pulmonary function abnormalities and heart/liver (H/L) ratio in patients with chronic liver diseases. Results In CAH, percentage of patients with DLco and DLco/VA (Child-Pugh class A and B patients. The means of DLco and DLco/VA were significantly (P Child-Pugh class. The mean H/L ratio in Child-Pugh class B increased markedly (P Child-Pugh class A. The frequency of specific pulmonary function abnormality in patients with Child-Pugh class B was significantly (P Child-Pugh class A and CAH. There was a inverse linear correlation between H/L ratio and DLco (r = -0.339, P < 0.05) and DLco/VA (r = -0.480, P < 0.01). Conclusion A total of 62% of patients with advanced liver disease have abnormal pulmonary diffusion capacity with a reduced DLco or DLco/VA and abnormal portosystemic shunt (increased H/L ratio) is common hemodynamic abnormality. Therefore, inverse linear correlation between DLco or DLco/VA and H/L ratio may be an important factor in predicting pulmonary complication and meaningful diagnostic and prognostic parameters in patients with advanced chronic liver disease. PMID:27785203

  2. Understanding the Pathophysiology of Portosystemic Shunt by Simulation Using an Electric Circuit.

    Science.gov (United States)

    Kim, Moonhwan; Lee, Keon-Young

    2016-01-01

    Portosystemic shunt (PSS) without a definable cause is a rare condition, and most of the studies on this topic are small series or based on case reports. Moreover, no firm agreement has been reached on the definition and classification of various forms of PSS, which makes it difficult to compare and analyze the management. The blood flow can be seen very similar to an electric current, governed by Ohm's law. The simulation of PSS using an electric circuit, combined with the interpretation of reported management results, can provide intuitive insights into the underlying mechanism of PSS development. In this article, we have built a model of PSS using electric circuit symbols and explained clinical manifestations as well as the possible mechanisms underlying a PSS formation.

  3. Histologic examination of hepatic biopsy samples as a prognostic indicator in dogs undergoing surgical correction of congenital portosystemic shunts: 64 cases (1997-2005).

    Science.gov (United States)

    Parker, Jacquelyn S; Monnet, Eric; Powers, Barbara E; Twedt, David C

    2008-05-15

    To determine whether results of histologic examination of hepatic biopsy samples could be used as an indicator of survival time in dogs that underwent surgical correction of a congenital portosystemic shunt (PSS). Retrospective case series. 64 dogs that underwent exploratory laparotomy for an extrahepatic (n = 39) or intrahepatic (25) congenital PSS. All H&E-stained histologic slides of hepatic biopsy samples obtained at the time of surgery were reviewed by a single individual, and severity of histologic abnormalities (ie, arteriolar hyperplasia, biliary hyperplasia, fibrosis, cell swelling, lipidosis, lymphoplasmacytic cholangiohepatitis, suppurative cholangiohepatitis, lipid granulomas, and dilated sinusoids) was graded. A Cox proportional hazards regression model was used to determine whether each histologic feature was associated with survival time. Median follow-up time was 35.7 months, and median survival time was 50.6 months. Thirty-eight dogs were alive at the time of final follow-up; 15 had died of causes associated with the PSS, including 4 that died immediately after surgery; 3 had died of unrelated causes; and 8 were lost to follow-up. None of the histologic features examined were significantly associated with survival time. Findings suggested that results of histologic examination of hepatic biopsy samples obtained at the time of surgery cannot be used to predict long-term outcome in dogs undergoing surgical correction of a PSS.

  4. Successful Treatment of Small Intestinal Bleeding in a Crohn’s Patient with Noncirrhotic Portal Hypertension by Transjugular Portosystemic Shunt Placement and Infliximab Treatment

    Directory of Open Access Journals (Sweden)

    Benjamin Heimgartner

    2016-10-01

    Full Text Available Small intestinal bleeding in Crohn’s disease patients with noncirrhotic portal hypertension and partial portal and superior mesenteric vein thrombosis is a life-threatening event. Here, a case is reported in which treatment with azathioprine may have resulted in nodular regenerative hyperplasia, portal hypertension and portal vein thrombosis. The 56-year-old patient with Crohn’s disease developed nodular regenerative hyperplasia under treatment with azathioprine. He was admitted with severe bleeding. Gastroscopy showed small esophageal varices without bleeding stigmata. Blood was detected in the terminal ileum. CT scan revealed a partial portal vein thrombosis with extension to the superior mesenteric vein, thickening of the jejunal wall and splenomegaly. Because intestinal bleeding could not be controlled by conservative treatment, the thrombus was aspirated and a transjugular intrahepatic portosystemic shunt (TIPS was placed. Switching the immunosuppressive medication to infliximab controlled Crohn’s disease activity. Bleeding was stopped, hemoglobin normalized, and thrombocytopenia and bowel movements improved. In summary, small intestinal bleeding in a Crohn’s patient with nodular regenerative hyperplasia, portal hypertension and portal vein thrombosis can be efficiently treated by TIPS. TIPS placement together with infliximab treatment led to the improvement of the blood panel and remission in this patient.

  5. Plasma Glucose Level Is Predictive of Serum Ammonia Level After Retrograde Occlusion of Portosystemic Shunts.

    Science.gov (United States)

    Ishikawa, Tsuyoshi; Aibe, Yuki; Matsuda, Takashi; Iwamoto, Takuya; Takami, Taro; Sakaida, Isao

    2017-09-01

    The purpose of this study was to evaluate predictors of reduction in ammonia levels by occlusion of portosystemic shunts (PSS) in patients with cirrhosis. Forty-eight patients with cirrhosis (21 women, 27 men; mean age, 67.8 years) with PSS underwent balloon-occluded retrograde transvenous obliteration (BRTO) at one institution between February 2008 and June 2014. The causes of cirrhosis were hepatitis B in one case, hepatitis C in 20 cases, alcohol in 15 cases, nonalcoholic steatohepatitis in eight cases, and other conditions in four cases. The Child-Pugh classes were A in 24 cases, B in 23 cases, and C in one case. The indication for BRTO was gastric varices in 40 cases and hepatic encephalopathy in eight cases. Testing was conducted before and 1 month after the procedure. Statistical analyses were performed to identify predictors of a clinically significant decline in ammonia levels after BRTO. Occlusion of PSS resulted in a clinically significant decrease in ammonia levels accompanied by increased portal venous flow and improved Child-Pugh score. Univariate analyses showed that a reduction in ammonia levels due to BRTO was significantly related to lower plasma glucose levels, higher RBC counts, and higher hemoglobin concentration before the treatment. Furthermore, multivariate logistic regression identified preoperative plasma glucose level as the strongest independent predictor of a significant ammonia reduction in response to BRTO. In addition, although BRTO resulted in significantly declined ammonia levels in patients with normal glucose tolerance before the procedure, ammonia levels were not significantly decreased after shunt occlusion in patients with diabetes mellitus or impaired glucose tolerance before BRTO, according to 75-g oral glucose tolerance test results. Preoperative plasma glucose level is a useful predictor of clinically significant ammonia reduction resulting from occlusion of PSS in patients with cirrhosis. Even if PSS are present, control

  6. Shunt occlusion for portosystemic shunt syndrome related refractory hepatic encephalopathy-A single-center experience in 21 patients from Kerala.

    Science.gov (United States)

    Philips, Cyriac Abby; Kumar, Lijesh; Augustine, Philip

    2017-09-01

    Large spontaneous portosystemic shunts (SPSS) are seen in a subset of patients with liver disease and medically refractory recurrent/persistent hepatic encephalopathy (MRHE). Shunt occlusion has been shown to improve clinical outcomes. We retrospectively analyzed patient characteristics, SPSS attributes, procedural features, baseline clinical and investigational parameters, neurological outcomes, adverse effects (procedure and portal hypertension related), and risk factors predicting outcomes in liver disease patients undergoing shunt occlusion procedure for MRHE. Between October 2016 and July 2017, 21 patients (Child-Pugh score, CTP 6 to 13) with mean model of end-stage liver disease (MELD) and MELD-sodium scores 15.7 and 19.3 respectively with MRHE [3-cirrhotic Parkinsonism (CP)] were diagnosed to have single or multiple large SPSSs. A total of 29 shunts were occluded (1 surgical, 20 non-surgical). Recurrent and persistent HE and CP markedly improved in the short (n=20, 1 to 3 months), intermediate (n=12, 3 to 6 months), and long (n=7, 6 to 9 months) follow up. None had spontaneous or persistent HE at a median follow up 105 (30 to 329) days (p11 predicted mortality post shunt occlusion (p=0.04). Embolization of large SPSS in liver disease patients with MRHE and modestly preserved liver function is safe and efficacious and associated with improved quality of life and can function as a bridge to liver transplantation in accurately selected patients.

  7. Congenital intrahepatic arterioportal and portosystemic venous fistulae with jejunal arteriovenous malformation depicted on multislice spiral CT

    International Nuclear Information System (INIS)

    Chae, Eun Jin; Goo, Hyun Woo; Yoon, Chong Hyun; Kim, Seong-Chul

    2004-01-01

    We report a symptomatic infant with very rare congenital arterioportal and portosystemic venous fistulae in the liver. Multislice CT after partial transcatheter embolisation revealed not only the complicated vascular architecture of the lesion, but also an incidental jejunal arteriovenous malformation which explained the patient's melena. The patient underwent ligation of the hepatic artery and resection of the jejunal arteriovenous malformation. Postoperative multislice CT clearly demonstrated the success of the treatment. (orig.)

  8. Globus pallidus MR signal abnormalities in children with chronic liver disease and/or porto-systemic shunting

    Energy Technology Data Exchange (ETDEWEB)

    Hanquinet, Sylviane; Anooshiravani, Mehrak; Merlini, Laura [University Hospital of Geneva, Department of Pediatric Radiology, Geneva (Switzerland); Morice, Claire; Cousin, Vladimir; McLin, Valerie A. [University Hospital of Geneva, Swiss Center for Liver Disease in Children, Geneva (Switzerland); Courvoisier, Delphine S. [University Hospital of Geneva, Division of Quality of Care, Geneva (Switzerland)

    2017-10-15

    Detection of subclinical hepatic encephalopathy in children is difficult. We aimed to assess the changes in imaging of the central nervous system in children with chronic liver disease using MR imaging, diffusion, and {sup 1}H -spectroscopy. Forty three children with chronic liver disease and/or porto-systemic shunting (111.4±56.9 months) and 24 controls (72.0±51.8 months) underwent brain MRI/spectroscopy on a 1.5T to examine T1, T2, ADC, Cho/Cr, ml/Cr, Glx/Cr ratio spectroscopy in the globus pallidus. Patients were divided into 3 groups according to the ratios of globus pallidus/putamen T1 signal: isointense (i), hyperintense (h), much more hyperintense (h+). The relationship with clinical and biological data was analyzed. T1 signal intensity and ml/Cr were significantly different between controls and group h+ (p=0.001). ADC did not differ significantly between groups. Age correlated strongly with the presence of a T1 signal ratio (p > 0.001). There was no correlation between imaging findings and biological parameters. In children with chronic liver disease and/or porto-systemic shunting, the presence of a hyperintense T1 signal in the globus pallidus correlated strongly with age. Biological and clinical parameters were not predictive of these changes. MRI may become a useful screening tool for hepatic encephalopathy in children. (orig.)

  9. Globus pallidus MR signal abnormalities in children with chronic liver disease and/or porto-systemic shunting

    International Nuclear Information System (INIS)

    Hanquinet, Sylviane; Anooshiravani, Mehrak; Merlini, Laura; Morice, Claire; Cousin, Vladimir; McLin, Valerie A.; Courvoisier, Delphine S.

    2017-01-01

    Detection of subclinical hepatic encephalopathy in children is difficult. We aimed to assess the changes in imaging of the central nervous system in children with chronic liver disease using MR imaging, diffusion, and 1 H -spectroscopy. Forty three children with chronic liver disease and/or porto-systemic shunting (111.4±56.9 months) and 24 controls (72.0±51.8 months) underwent brain MRI/spectroscopy on a 1.5T to examine T1, T2, ADC, Cho/Cr, ml/Cr, Glx/Cr ratio spectroscopy in the globus pallidus. Patients were divided into 3 groups according to the ratios of globus pallidus/putamen T1 signal: isointense (i), hyperintense (h), much more hyperintense (h+). The relationship with clinical and biological data was analyzed. T1 signal intensity and ml/Cr were significantly different between controls and group h+ (p=0.001). ADC did not differ significantly between groups. Age correlated strongly with the presence of a T1 signal ratio (p > 0.001). There was no correlation between imaging findings and biological parameters. In children with chronic liver disease and/or porto-systemic shunting, the presence of a hyperintense T1 signal in the globus pallidus correlated strongly with age. Biological and clinical parameters were not predictive of these changes. MRI may become a useful screening tool for hepatic encephalopathy in children. (orig.)

  10. Use of 99mTCO4(-) trans-splenic portal scintigraphy for diagnosis of portosystemic shunts in 28 dogs.

    Science.gov (United States)

    Morandi, Federica; Cole, Robert C; Tobias, Karen M; Berry, Clifford R; Avenell, James; Daniel, Gregory B

    2005-01-01

    Ultrasound-guided percutaneous trans-splenic portal scintigraphy (TSPS) using 99mTcO4(-) has been used to image the portal venous system in normal dogs. Compared with per-rectal portal scintigraphy, it provides higher count density, consistent nuclear venograms of the splenic and portal vein, and significantly decreased radiation exposures. This paper describes the use of TSPS for the diagnosis of portosystemic shunts in 28 dogs. TSPS was performed injecting 70 +/- 28 MBq of 99mTcO4(-) (mean +/- SD) into the splenic parenchyma with ultrasound guidance. A dynamic acquisition at a frame rate of four frames/s for 5 min was initiated after placement of the needle and approximately 2s prior to injection. All dogs had diagnoses confirmed via exploratory laparotomy or ultrasonographic identification of the shunting vessel(s). Three studies (10.7%) were nondiagnostic because of intraperitoneal rather than intrasplenic injection of the radionuclide. Three pathways were recognized on the scintigraphic images: (1) portoazygos shunts--the 99mTcO4(-) bolus traveled dorsally, running parallel to the spine and entering the heart craniodorsally; (2) single portocaval or splenocaval shunts--the 99mTcO4(-) bolus ran from the area of the portal vein/splenic vein junction in a linear fashion toward the caudal vena cava entering the heart caudally; (3) internal thoracic shunt-the 99mTcO4 bolus traveled ventrally along the thorax and abdomen entering the cranial aspect of the heart. Single and multiple shunts were easily distinguished. There were no distinguishing features between single intra and extrahepatic portocaval shunts.

  11. Acquired portosystemic collaterals: anatomy and imaging

    International Nuclear Information System (INIS)

    Leite, Andrea Farias de Melo; Mota Junior, Americo; Chagas-Neto, Francisco Abaete; Teixeira, Sara Reis; Elias Junior, Jorge; Muglia, Valdair Francisco

    2016-01-01

    Portosystemic shunts are enlarged vessels that form collateral pathological pathways between the splanchnic circulation and the systemic circulation. Although their causes are multifactorial, portosystemic shunts all have one mechanism in common - increased portal venous pressure, which diverts the blood flow from the gastrointestinal tract to the systemic circulation. Congenital and acquired collateral pathways have both been described in the literature. The aim of this pictorial essay was to discuss the distinct anatomic and imaging features of portosystemic shunts, as well as to provide a robust method of differentiating between acquired portosystemic shunts and similar pathologies, through the use of illustrations and schematic drawings. Imaging of portosystemic shunts provides subclinical markers of increased portal venous pressure. Therefore, radiologists play a crucial role in the identification of portosystemic shunts. Early detection of portosystemic shunts can allow ample time to perform endovascular shunt operations, which can relieve portal hypertension and prevent acute or chronic complications in at-risk patient populations. (author)

  12. Acquired portosystemic collaterals: anatomy and imaging

    Energy Technology Data Exchange (ETDEWEB)

    Leite, Andrea Farias de Melo; Mota Junior, Americo, E-mail: andreafariasm@gmail.com [Instituto de Medicina Integral Professor Fernando Figueira de Pernambuco (IMIP), Recife, PE (Brazil); Chagas-Neto, Francisco Abaete [Universidade de Fortaleza (UNIFOR), Fortaleza, CE (Brazil); Teixeira, Sara Reis; Elias Junior, Jorge; Muglia, Valdair Francisco [Universidade de Sao Paulo (FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina

    2016-07-15

    Portosystemic shunts are enlarged vessels that form collateral pathological pathways between the splanchnic circulation and the systemic circulation. Although their causes are multifactorial, portosystemic shunts all have one mechanism in common - increased portal venous pressure, which diverts the blood flow from the gastrointestinal tract to the systemic circulation. Congenital and acquired collateral pathways have both been described in the literature. The aim of this pictorial essay was to discuss the distinct anatomic and imaging features of portosystemic shunts, as well as to provide a robust method of differentiating between acquired portosystemic shunts and similar pathologies, through the use of illustrations and schematic drawings. Imaging of portosystemic shunts provides subclinical markers of increased portal venous pressure. Therefore, radiologists play a crucial role in the identification of portosystemic shunts. Early detection of portosystemic shunts can allow ample time to perform endovascular shunt operations, which can relieve portal hypertension and prevent acute or chronic complications in at-risk patient populations. (author)

  13. Association Between Portosystemic Shunts and Increased Complications and Mortality in Patients With Cirrhosis.

    Science.gov (United States)

    Simón-Talero, Macarena; Roccarina, Davide; Martínez, Javier; Lampichler, Katharina; Baiges, Anna; Low, Gavin; Llop, Elba; Praktiknjo, Michael; Maurer, Martin H; Zipprich, Alexander; Triolo, Michela; Vangrinsven, Guillaume; Garcia-Martinez, Rita; Dam, Annette; Majumdar, Avik; Picón, Carmen; Toth, Daniel; Darnell, Anna; Abraldes, Juan G; Lopez, Marta; Kukuk, Guido; Krag, Aleksander; Bañares, Rafael; Laleman, Wim; La Mura, Vincenzo; Ripoll, Cristina; Berzigotti, Annalisa; Trebicka, Jonel; Calleja, Jose Luis; Tandon, Puneeta; Hernandez-Gea, Virginia; Reiberger, Thomas; Albillos, Agustín; Tsochatzis, Emmanuel A; Augustin, Salvador; Genescà, Joan

    2018-05-01

    Spontaneous portosystemic shunts (SPSS) have been associated with hepatic encephalopathy (HE). Little is known about their prevalence among patients with cirrhosis or clinical effects. We investigated the prevalence and characteristics of SPSS in patients with cirrhosis and their outcomes. We performed a retrospective study of 1729 patients with cirrhosis who underwent abdominal computed tomography or magnetic resonance imaging analysis from 2010 through 2015 at 14 centers in Canada and Europe. We collected data on demographic features, etiology of liver disease, comorbidities, complications, treatments, laboratory and clinical parameters, Model for End-Stage Liver Disease (MELD) score, and endoscopy findings. Abdominal images were reviewed by a radiologist (or a hepatologist trained by a radiologist) and searched for the presence of SPSS, defined as spontaneous communications between the portal venous system or splanchnic veins and the systemic venous system, excluding gastroesophageal varices. Patients were assigned to groups with large SPSS (L-SPSS, ≥8 mm), small SPSS (S-SPSS, SPSS (W-SPSS). The main outcomes were the incidence of complications of cirrhosis and mortality according to the presence of SPSS. Secondary measurements were the prevalence of SPSS in patients with cirrhosis and their radiologic features. L-SPSS were identified in 488 (28%) patients, S-SPSS in 548 (32%) patients, and no shunt (W-SPSS) in 693 (40%) patients. The most common L-SPSS was splenorenal (46% of L-SPSS). The presence and size of SPSS increased with liver dysfunction: among patients with MELD scores of 6-9, 14% had L-SPSS and 28% had S-SPSS; among patients with MELD scores of 10-13, 30% had L-SPSS and 34% had S-SPSS; among patients with MELD scores of 14 or higher, 40% had L-SPSS and 32% had S-SPSS (P SPSS, 34% of patients with S-SPSS, and 20% of patients W-SPSS (P SPSS groups). Recurrent or persistent HE was reported in 52% of patients with L-SPSS, 44% of patients with S

  14. Extrahepatic portosystemic shunt in a 8 month-old female maltese dogShunt portossistêmico extra-hepático em cadela maltês de 8 meses

    Directory of Open Access Journals (Sweden)

    Rafaella Cristina Reginatto

    2011-07-01

    Full Text Available The shunt portosystemic or portosystemic deviation (PSD are unique or multiples vascular communications between the systemic circulaton and the portal circulation, that permit blood flow reaches the circulatory system without first passing trhought the hepatic metabolization. May be acquired or congenital and can also be classified as intrahepatic located within the liver or extrahepatic located outside the liver parenquima. The acquired form is usually associated with intra-hepatic disorders. They usually suggest tortuous vessels that communicate with the caudal vena cava in the region of the left kidney. The congenital form is associated with genetic lineage and one of the most affected is Maltese breed. This case report describes the diagnostis and treatment of a eight year-old female Maltese dog presenting extrahepatic Portosystemic Shunt. The patient showed signs of hepatic encephalopathy, such as restlessnees, weakness, deambulation, head tremor and impaired visual. Complementary exam demonstrated: postprandial glicemia near the lower limit of reference, alkaline phosphatase (ALP and alanine aminotransferase (ALT increased and hipoalbuminemia. Ultrasonography revealed the presence of vesical calculus and bilateral kidney, liver decreases and increased echogenicity, gallbladder with anechoic content and high cellularity may suggest liver/ colangiohepatopatia and extrahepatic DPS was detected. The use of Doppler assisted in identifying the location of the bypass communication and the turbulence detecting the extrahepatic DPS. Protein-restricted diet and antibiotic therapy with amoxicillin achieved good results. The clinical treatment was decided make only the clinical and maintain the quality of life of the patient.O shunt portossistêmico ou desvio portossistêmico (DPS são comunicações vasculares únicas ou múltiplas entre a circulação sistêmica e a circulação portal, que permite que o sangue portal chegue ao sistema circulat

  15. Agenesis of the venous duct: two cases of extrahepatic drainage of the umbilical vein and extrahepatic portosystemic shunt with a review of the literature.

    Science.gov (United States)

    Loomba, Rohit S; Frommelt, Michele; Moe, David; Shillingford, Amanda J

    2015-02-01

    Agenesis of the venous duct is a rare congenital anomaly resulting in abnormal drainage of the umbilical vein into the foetal venous circulation. The clinical presentation and prognosis is variable, and may depend on the specific drainage pathways of the umbilical vein. We present two foetuses with agenesis of the venous duct, both associated with a postnatal portosystemic shunt, but with markedly different postnatal clinical courses. We also review all previously reported cases to better characterise this foetal disorder and the prognosis.

  16. Encefalopatía hepática secundaria a la existencia de un shunt portosistémico tratada satisfactoriamente mediante radiología intervencionista Hepatic encephalophaty secondary to porto-systemic shunt satisfactorily treated with interventionist radiology

    Directory of Open Access Journals (Sweden)

    L. Crespo

    2007-11-01

    Full Text Available La encefalopatía hepática es un estado reversible de alteración en la función cognitiva, que puede ocurrir en pacientes con enfermedad hepática aguda o crónica o shunts porto-sistémicos, en el que puede aparecer cualquiera de los signos neurológicos o psiquiátricos conocidos. Las sustancias nitrogenadas procedentes de la digestión intestinal alcanzan el cerebro sin la depuración que supone su paso por el hígado, debido a las derivaciones porto-sistémicas, y dan lugar a los signos característicos de la encefalopatía hepática. A continuación presentamos dos casos clínicos de pacientes con shunt porto-sistémicos, diagnosticados de encefalopatía hepática crónica recurrente refractaria al tratamiento médico convencional, tratados satisfactoriamente con embolización de dicho shunt mediante técnicas de radiología intervencionista.Hepatic encephalopathy is a reversible state of altered cognition that may occur in patients with acute or chronic liver disease or porto-systemic shunt, and in which known neurological or psychiatric signs may develop. Nitrogenated substances from intestinal digestion reach the brain without being cleared by their passage through the liver due to the presence of porto-systemic shunt. We report two cases of patients with porto-systemic shunt diagnosed with recurrent chronic hepatic encephalopathy refractory to conventional medical treatment. They were satisfactorily treated with shunt embolization using interventionist radiology techniques.

  17. Procedure-related complications of transjugular intrahepatic portosystemic shunt (TIPS) and its clinical significance

    International Nuclear Information System (INIS)

    Oh, Hyun Han; Byun, Kyung Hwan; Kim, Tae Gwon; Kang, Duk Sik; Kim, Yong Joo

    1995-01-01

    The purpose who to evaluate the procedure-related complications of the TIPS and its clinical significance. The materials consisted of 52 patients who had 57 TIPS procedures for the management of variceal bleeding due to portal hypertension. To detect the occurrence of complications during transhepatic needle puncture (from hepatic vein to the portal vein), contrast material was injected with the with drawl of the puncture needle. Procedure-related complications occurred in 28 patients (54%) among 52 patients. The complications were biliary tree puncture (15 cases), transperitoneal puncture (14 cases), stent malposition (3 cases), stent migration (1 case), hepatic arteries puncture (1 case), splenic vein perforation (1 case), and paroxysmal ventricular tachycardia (1 case). Three patients had acute stent thrombosis with rebleeding immediately after the procedure. The procedure was repeated in two patients. One patient was expired due to rebleeding. The procedure related complications were clinically insignificant in most instances, except when stent thrombosis or proxysmal ventricular tachycardia was developed

  18. Cardiac and renal effects of a transjugular intrahepatic portosystemic shunt in cirrhosis

    DEFF Research Database (Denmark)

    Busk, Troels M; Bendtsen, Flemming; Møller, Søren

    2013-01-01

    to improve in patients with the hepatorenal syndrome. The clinical and haemodynamic effects of TIPS have been studied intensively and will be reviewed in the present paper. Considerable knowledge on the effects of TIPS on the pathophysiology of cirrhosis has been gained, but studies on the central...

  19. Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients.

    Science.gov (United States)

    Gomez Gavara, Concepcion; Bhangui, Prashant; Salloum, Chady; Osseis, Michael; Esposito, Francesco; Moussallem, Toufic; Lahat, Eylon; Fuentes, Liliana; Compagnon, Philippe; Ngongang, Norbert; Lim, Chetana; Azoulay, Daniel

    2018-04-01

    The management of large spontaneous portosystemic shunt (SPSS) during liver transplantation (LT) is a matter of debate. The aim of this study is to compare the short-term and longterm outcomes of SPSS ligation versus nonligation during LT, when both options are available. From 2011 to 2017, 66 patients with SPSS underwent LT: 56 without and 10 with portal vein thrombosis (PVT), all of whom underwent successful thrombectomy and could have portoportal reconstruction. The SPSS were either splenorenal (n = 40; 60.6%), left gastric (n = 16; 24.2%), or mesenterico-iliac (n = 10; 15.1%). Following portoportal anastomosis, the SPSS was ligated in 36 (54.4%) patients and left in place in 30 (45.5%) patients, based on the effect of the SPSS clamping/unclamping test on portal vein flow during the anhepatic phase. Intraoperatively, satisfactory portal flow was obtained in both groups. Primary nonfunction (PNF) and primary dysfunction (PDF) rates did not differ significantly between the 2 groups. Nonligation of SPSS was significantly associated with a higher rate of postoperative encephalopathy (P SPSS in LT (ie, PNF and PDF, PVT, and encephalopathy) was present in 16 (44.4%) and 22 (73.3%) patients of the ligated and nonligated shunt group, respectively (P = 0.02). Patient (P = 0.05) and graft (P = 0.02) survival rates were better in the ligated shunt group. In conclusion, the present study supports routine ligation of large SPSS during LT whenever feasible. Liver Transplantation 24 505-515 2018 AASLD. © 2018 by the American Association for the Study of Liver Diseases.

  20. Ammonia concentrations in arterial blood, venous blood, and cerebrospinal fluid of dogs with and without congenital extrahepatic portosystemic shunts.

    Science.gov (United States)

    Or, Matan; Devriendt, Nausikaa; Kitshoff, Adriaan M; Peremans, Kathelijne; Vandermeulen, Eva; Paepe, Dominique; Polis, Ingeborgh; Martlé, Valentine; de Rooster, Hilde

    2017-11-01

    OBJECTIVE To compare ammonia concentrations in arterial blood, venous blood, and CSF samples of dogs with and without extrahepatic portosystemic shunts (EHPSS). ANIMALS 19 dogs with congenital EHPSS and 6 healthy control dogs. PROCEDURES All dogs underwent a physical examination and then were anesthetized for transsplenic portal scintigraphy to confirm the presence or absence of EHPSS. While dogs were anesthetized, arterial and venous blood samples and a CSF sample were simultaneously collected for determination of ammonia concentration, which was measured by use of a portable blood ammonia analyzer (device A) and a nonportable biochemical analyzer (device B). Results were compared between dogs with EHPSS and control dogs. RESULTS Arterial, venous, and CSF ammonia concentrations for dogs with EHPSS were significantly greater than those for control dogs. For dogs with EHPSS, ammonia concentrations in both arterial and venous blood samples were markedly increased from the reference range. There was a strong positive correlation between arterial and venous ammonia concentrations and between blood (arterial or venous) and CSF ammonia concentrations. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that blood and CSF ammonia concentrations in dogs with EHPSS were greater than those for healthy dogs and were strongly and positively correlated, albeit in a nonlinear manner. This suggested that the permeability of the blood-brain barrier to ammonia may be abnormally increased in dogs with EHPSS, but further investigation of the relationship between blood or CSF ammonia concentration and clinical signs of hepatic encephalopathy or the surgical outcome for dogs with EHPSS is warranted.

  1. Contrast-enhanced computed tomography angiography and volume-rendered imaging for evaluation of cellophane banding in a dog with extrahepatic portosystemic shunt

    Directory of Open Access Journals (Sweden)

    H. Yoon

    2011-04-01

    Full Text Available A 4-year-old, 1.8 kg, male, castrated Maltese was presented for evaluation of urolithiasis. Urinary calculi were composed of ammonium biurate. Preprandial and postprandial bile acids were 44.2 and 187.3 μmol/ , respectively (reference ranges 0–10 and 0–20 μmol/ , respectively. Single-phase contrast-enhanced computed tomography angiography (CTA with volume-rendered imaging (VRI was obtained. VRI revealed a portocaval shunt originating just cranial to a tributary of the gastroduodenal vein and draining into the caudal vena cava at the level of the epiploic foramen. CTA revealed a 3.66 mm-diameter shunt measured at the level of the termination of the shunt and a 3.79 mm-diameter portal vein measured at the level between the origin of the shunt and the porta of the liver. Surgery was performed using cellophane banding without attenuation. Follow-up single-phase CTA with VRI was obtained 10 weeks after surgery. VRI revealed no evidence of portosystemic communication on the level of a cellophane band and caudal to the cellophane band. CTA demonstrated an increased portal vein diameter (3.79–5.27 mm measured at the level between the origin of the shunt and the porta of the liver. Preprandial and postprandial bile acids were 25 and 12.5 μmol/ , respectively (aforementioned respective reference ranges, 3 months post-surgery. No problems were evident at 6 months.

  2. Hyperammonemia and systemic inflammatory response syndrome predicts presence of hepatic encephalopathy in dogs with congenital portosystemic shunts.

    Directory of Open Access Journals (Sweden)

    Mickey S Tivers

    Full Text Available Hepatic encephalopathy (HE is an important cause of morbidity and mortality in patients with liver disease. The pathogenesis of he is incompletely understood although ammonia and inflammatory cytokines have been implicated as key mediators. To facilitate further mechanistic understanding of the pathogenesis of HE, a large number of animal models have been developed which often involve the surgical creation of an anastomosis between the hepatic portal vein and the caudal vena cava. One of the most common congenital abnormalities in dogs is a congenital portosystemic shunt (cpss, which closely mimics these surgical experimental models of HE. Dogs with a cPSS often have clinical signs which mimic clinical signs observed in humans with HE. Our hypothesis is that the pathogenesis of HE in dogs with a cPSS is similar to humans with HE. The aim of the study was to measure a range of clinical, haematological and biochemical parameters, which have been linked to the development of HE in humans, in dogs with a cPSS and a known HE grade. One hundred and twenty dogs with a cPSS were included in the study and multiple regression analysis of clinical, haematological and biochemical variables revealed that plasma ammonia concentrations and systemic inflammatory response syndrome scores predicted the presence of HE. Our findings further support the notion that the pathogenesis of canine and human HE share many similarities and indicate that dogs with cPSS may be an informative spontaneous model of human HE. Further investigations on dogs with cPSS may allow studies on HE to be undertaken without creating surgical models of HE thereby allowing the number of large animals used in animal experimentation to be reduced.

  3. Association Between Portosystemic Shunts and Increased Complications and Mortality in Patients With Cirrhosis

    DEFF Research Database (Denmark)

    Simón-Talero, Macarena; Roccarina, Davide; Martínez, Javier

    2018-01-01

    , comorbidities, complications, treatments, laboratory and clinical parameters, model for end-stage liver disease (MELD) score, and endoscopy findings. Abdominal images were reviewed by a radiologist (or a hepatologist trained by a radiologist) and searched for the presence of SPSS, defined as spontaneous...... communications between the portal venous system or splanchnic veins and the systemic venous system, excluding gastroesophageal varices. Patients were assigned to groups with large SPSSs (L-SPSSs, ≥8 mm), small SPSSs (S-SPSSs, SPSS (W-SPSS). The main outcomes were the incidence of complications...... of cirrhosis and mortality according to the presence of SPSS. Secondary measurements were the prevalence of SPSSs in patients with cirrhosis and their radiologic features. RESULTS: L-SPSS were identified in 488 patients (28%), S-SPSS in 548 patients (32%), and no shunt (W-SPSS) in 693 patients (40%). The most...

  4. Metformin reduces intrahepatic fibrosis and intrapulmonary shunts in biliary cirrhotic rats

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    Mu-Tzu Ko

    2017-08-01

    Conclusion: Metformin reduced liver injury and improved hepatic fibrosis in cirrhotic rats. It also attenuated the intrapulmonary shunts. However, the effects of metformin on pulmonary angiogenesis and hypoxia were insignificant.

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

    International Nuclear Information System (INIS)

    Bercu, Zachary L.; Sheth, Sachin B.; Noor, Amir; Lookstein, Robert A.; Fischman, Aaron M.; Nowakowski, F. Scott; Kim, Edward; Patel, Rahul S.

    2015-01-01

    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

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

    Science.gov (United States)

    Bercu, Zachary L; Sheth, Sachin B; Noor, Amir; Lookstein, Robert A; Fischman, Aaron M; Nowakowski, F Scott; Kim, Edward; Patel, Rahul S

    2015-10-01

    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.

  7. 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.

  8. Custom-made covered transjugular intrahepatic portosystemic shunt (TIPS) in an infant with trisomy 22 and biliary atresia

    Energy Technology Data Exchange (ETDEWEB)

    Chlapoutaki, Chrysanthi Emmanouil; Franchi-Abella, Stephanie; Pariente, Daniele [Bicetre Hospital University Paris XI, Assistance Publique Hopitaux de Paris, Department of Paediatric Radiology, Paris (France); Habes, Dalila [Bicetre Hospital University Paris XI, Assistance Publique Hopitaux de Paris, Pediatric Hepatology and National Reference Center for Biliary Atresia, Paris (France)

    2009-07-15

    We report an 8-month-old girl with portal hypertension secondary to biliary atresia. The decision to treat with TIPS was made at the age of 8 months due to recurrent variceal bleeding. The procedure was carried out with a 6-mm bare stent due to her small size. Radiological follow-up with Doppler US showed gradual stenosis and finally occlusion of the stent 80 days after implantation. Revision was performed with placement of an additional 6-mm expanded polytetrafluoroethylene (e-PTFE) stent-graft that had remained patent for 9 months, proving that in small children with a portal vein diameter less than 8 mm, the combination of a bare stent and stent-graft can provide excellent results. (orig.)

  9. Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Treatment of Venous Symptomatic Chronic Portal Thrombosis in Non-cirrhotic Patients

    International Nuclear Information System (INIS)

    Bilbao, Jose I.; Elorz, Mariana; Vivas, Isabel; Martinez-Cuesta, Antonio; Bastarrika, Gorka; Benito, Alberto

    2004-01-01

    Purpose: To present a series of cases of non-cirrhotic patients with symptomatic massive portal thrombosis treated by percutaneous techniques. All patients underwent a TIPS procedure in order to maintain the patency of the portal vein by facilitating the outflow. Methods: A total of six patients were treated for thrombosis of the main portal vein (6/6); the main right and left branches (3/6) and the splenic vein (5/6) and superior mesenteric vein (6/6). Two patients had a pancreatic malignancy; one patient with an orthotopic liver transplant had been surgically treated for a pancreatic carcinoma. Two patients had idiopathic thrombocytosis, and in the remaining patient no cause for the portal thrombosis was identified. During the initial procedure in each patient one or more approaches were tried: transhepatic (5/6), transileocolic (1/6), trans-splenic (1/6) or transjugular (1/6). In all cases the procedure was completed with a TIPS with either ultrasound guidance (3/6), 'gun-shot' technique (2/6) or fluoroscopic guidance (1/6).Results: No complications were observed during the procedures. One patient had a repeat episode of variceal bleeding at 30 months, one patient remained asymptomatic and was lost to follow-up at 24 months, two patients were successfully treated surgically (cephalic duodenopancreatectomy) and are alive at 4 and 36 months. One patient remains asymptomatic (without new episodes of abdominal pain) at 16 months of follow-up. One patient died because of tumor progression at 10 months. Conclusion: Percutaneous techniques for portal recanalization are an interesting alternative even in non-acute thrombosis. Once flow has been restored in the portal vein TIPS may be necessary to obtain an adequate outflow, hence facilitating and maintaining the portal flow

  10. Intrahepatic arterioportal shunting and anomalous venous drainage: understanding the CT features in the liver

    International Nuclear Information System (INIS)

    Breen, David J.; Rutherford, Elizabeth E.; Stedman, Brian; Lee-Elliott, Catherine; Hacking, C. Nigel

    2004-01-01

    The increased use of high-contrast volume, arterial-phase studies of the liver has demonstrated the frequent occurrence of arterioportal shunts within both the cirrhotic and non-cirrhotic liver. This article sets out to explain the underlying microcirculatory mechanisms behind these commonly encountered altered perfusion states. Similarly, well-recognised portal perfusion defects occur around the perifalciform and perihilar liver and are largely caused by anomalous venous drainage via the paraumbilical and parabiliary venous systems. The underlying anatomy will be discussed and illustrated. These vascular anomalies are all caused by or result in diminished portal perfusion and are often manifest in the setting of portal venous thrombosis. The evolving concept of zonal re-perfusion following portal vein thrombosis will be discussed. (orig.)

  11. Long-term survival and quality of life in dogs with clinical signs associated with a congenital portosystemic shunt after surgical or medical treatment.

    Science.gov (United States)

    Greenhalgh, Stephen N; Reeve, Jenny A; Johnstone, Thurid; Goodfellow, Mark R; Dunning, Mark D; O'Neill, Emma J; Hall, Ed J; Watson, Penny J; Jeffery, Nick D

    2014-09-01

    To compare long-term survival and quality of life data in dogs with clinical signs associated with a congenital portosystemic shunt (CPSS) that underwent medical or surgical treatment. Prospective cohort study. 124 client-owned dogs with CPSS. Dogs received medical or surgical treatment without regard to signalment, clinical signs, or clinicopathologic results. Survival data were analyzed with a Cox regression model. Quality of life information, obtained from owner questionnaires, included frequency of CPSS-associated clinical signs (from which a clinical score was derived), whether owners considered their dog normal, and (for surgically treated dogs) any ongoing medical treatment for CPSS. A Mann-Whitney U test was used to compare mean clinical score data between surgically and medically managed dogs during predetermined follow-up intervals. 97 dogs underwent surgical treatment; 27 were managed medically. Median follow-up time for all dogs was 1,936 days. Forty-five dogs (24 medically managed and 21 surgically managed) died or were euthanized during the follow-up period. Survival rate was significantly improved in dogs that underwent surgical treatment (hazard ratio, 8.11; 95% CI, 4.20 to 15.66) than in those treated medically for CPSS. Neither age at diagnosis nor shunt type affected survival rate. Frequency of clinical signs was lower in surgically versus medically managed dogs for all follow-up intervals, with a significant difference between groups at 4 to 7 years after study entry. Surgical treatment of CPSS in dogs resulted in significantly improved survival rate and lower frequency of ongoing clinical signs, compared with medical management. Age at diagnosis did not affect survival rate and should not influence treatment choice.

  12. Measurement of brain trace elements in a dog with a portosystemic shunt: relation between hyperintensity on T1-weighted magnetic resonance images in lentiform nuclei and brain trace elements.

    Science.gov (United States)

    Torisu, Shidow; Washizu, Makoto; Hasegawa, Daisuke; Orima, Hiromitsu

    2008-12-01

    Prior to euthanasia, brain magnetic resonance imaging (MRI) was performed for a five-year-old male Yorkshire Terrier following portosystemic shunt (PSS) surgical attenuation. Hyperintensity was observed on T1W images of the lentiform nuclei. Trace elements in this area were measured by inductively coupled plasma atomic emission spectrometry. The manganese concentration in the lentiform nuclei was four times higher than that in the control group. Therefore, the manganese accumulation would be the substance that causes the hyperintensity on T1W images of the lentiform nuclei in PSS dogs.

  13. Portacaval shunt established in six dogs using magnetic compression technique.

    Directory of Open Access Journals (Sweden)

    Xiaopeng Yan

    Full Text Available BACKGROUND AND AIMS: Installing the transjugular intrahepatic portosystemic shunt for portal hypertension is relatively safe, but complications are still high. To explore a new method of portacaval shunt, the magnetic compression technique was introduced into the shunting procedure. METHODS: A portal-inferior vena cava shunt was performed on 6 male mongrel dogs by two hemocompatible Nd-Fe-B permanent magnets, parent and daughter. The parent magnet was applied to the inferior vena cava guided by a catheter through the femoral vein. The daughter magnet was moved to the anastomosis position on the portal vein with a balloon catheter through the splenic vein. After the daughter magnet reached the target position, the two magnets acted to compress the vessel wall and hold it in place. Five to 7 days later, under X-ray guidance, the magnets were detached from the vessel wall with a rosch-uchida transjugular liver access set. One month later, histological analysis and portal venography were performed. RESULTS: 5-7 days after the first surgery, a mild intimal hyperplasia in the portal vein and the inferior vena cava, and continuity of the vascular adventitia from the portal vein to the inferior vena cava as observed. During the second surgery, the contrast media could be observed flowing from the portal vein into the inferior vena cava. Portal venography revealed that the portosystemic shunt was still present one month after the second surgery. CONCLUSIONS: Magnamosis via a device of novel design was successfully used to establish a portacaval shunt in dogs.

  14. Canine intrahepatic vasculature: is a functional anatomic model relevant to the dog?

    Science.gov (United States)

    Hall, Jon L; Mannion, Paddy; Ladlow, Jane F

    2015-01-01

    To clarify canine intrahepatic portal and hepatic venous system anatomy using corrosion casting and advanced imaging and to devise a novel functional anatomic model of the canine liver to investigate whether this could help guide the planning and surgical procedure of partial hepatic lobectomy and interventional radiological procedures. Prospective experimental study. Adult Greyhound cadavers (n = 8). Portal and hepatic vein corrosion casts of healthy livers were assessed using computed tomography (CT). The hepatic lobes have a consistent hilar hepatic and portal vein supply with some variation in the number of intrahepatic branches. For all specimens, 3 surgically resectable areas were identified in the left lateral lobe and 2 surgically resectable areas were identified in the right medial lobe as defined by a functional anatomic model. CT of detailed acrylic casts allowed complex intrahepatic vascular relationships to be investigated and compared with previous studies. Improving understanding of the intrahepatic vascular supply facilitates interpretation of advanced images in clinical patients, the planning and performance of surgical procedures, and may facilitate interventional vascular procedures, such as intravenous embolization of portosystemic shunts. Functional division of the canine liver similar to human models is possible. The left lateral and right medial lobes can be consistently divided into surgically resectable functional areas and partial lobectomies can be performed following a functional model; further study in clinically affected animals would be required to investigate the relevance of this functional model in the dog. © Copyright 2014 by The American College of Veterinary Surgeons.

  15. Percutaneous Transjugular Direct Porto-caval Shunt in Patients with Budd-Chiari Syndrome

    International Nuclear Information System (INIS)

    Quateen, A.; Pech, M.; Berg, T.; Bergk, A.; Podrabsky, P.; Felix, R.; Ricke, J.

    2006-01-01

    The purpose of the study was to evaluate the feasibility and effectiveness of direct porto-caval shunts in patients with Budd-Chiari syndrome (BCS) in whom there is no access to the hepatic veins during transjugular intrahepatic portosystemic shunt (TIPSS). We included six consecutive patients with fulminant/acute Budd-Chiari syndrome (mean age: 35 years) in whom a conventional TIPSS was not possible due to inaccessible hepatic veins. We performed a direct porto-caval shunt via a transhepatic approach. Patients were followed up by means of clinical examination, laboratory investigations, and Doppler ultrasound. TIPSS implantation from the inferior vena cava (IVC) was successful in all six patients (100%). The median transhepatic shunt length was 9 cm (8-10 cm). No procedure-related complications were observed in our patients. Early shunt occlusion occurred in three out of six patients (50%). In all three of these patients, the stent used to stabilize the shunt ended 1-2 cm before reaching the IVC. All occlusions were successfully recanalized. One of these patients developed recurrent early shunt as well as mesenteric and splenic vein occlusions. She died 7 days after TIPSS placement due to an unmanageable coagulation disorder. The remaining five patients were followed up by planned clinical examination and laboratory investigations (mean follow-up time was 15 months; patient 1 was followed up for 13 months, patient 2 for 14 months, patient 3 for 15 months, and patients 4 and 5 for 16 months) and all displayed a complete and durable resolution of liver failure and ascites without reintervention. In patients with acute liver failure originating from BCS and inaccessible hepatic veins, a direct transhepatic porto-caval shunt can be performed safely and effectively under ultrasound guidance. Future studies in larger patient groups should investigate if the patency of transcaval TIPSS with long transhepatic shunt segments is similar compared to conventional TIPSS via

  16. Cirrose biliar em felinos associada à ectasia do ducto cístico e desvios portossistêmicos extra-hepáticos Biliary cirrhosis in cats associated with cystic duct ectasia and extra-hepatic portosystemic Shunts

    Directory of Open Access Journals (Sweden)

    Marcia Regina da Silva Ilha

    2004-08-01

    (ectasia, extrahepatic portosystemic venous shunts, cavitary effusions and thin carcasses. Microscopic lesions included severe periportal, dissecting fibrosis with lymphoplasmacytic inflammation, biliary proliferation and cholestasis. In one case, Brown-Hopps’ stained slides revealed gram-positive cocci with associated inflammation inside the ductal lumen. The histological finding of intralesional bacteria in cases of feline cholangitis/cholangiohepatis complex is reported only on rare occasions and has not been described for biliary cirrhosis. Dilation of the cystic duct and formation of portosystemic shunts are also unusual complications of this syndrome. Biliary cirrhosis is an uncommon condition since most cats die or are euthanatized before reaching the final stage of this progressive inflammatory hepatic disease. The prevalence of this entity in local feline populations remains to be determined in Brazil.

  17. Pre-Liver Transplant: Tips Versus Distal Splenorenal Shunt

    Directory of Open Access Journals (Sweden)

    Thomas W. Faust

    1997-01-01

    Full Text Available Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT. Endoscopic sclero-therapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS. In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients or DSRS (17 patients for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P=0.014 but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132±725 ml/min in the TIPS group compared with 1120±351ml/min in the DSRS group (P<0.001. Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P=0.1. We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intra0Perative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.

  18. Treatment of Occluded Distal Splenorenal Shunts with Endovascular Stents: A Report of Two Cases

    International Nuclear Information System (INIS)

    Lopez-Medina, Antonio; Peiro, Javier; Gonzalez de Garay, Miguel; Antonana, Miguel A.; Sustacha, Jon; Grande, Domingo

    2001-01-01

    Surgical treatment of an occluded or stenotic portosystemic shunt is difficult and carries a high risk of mortality. We report two cases of early thrombosis of distal splenorenal shunt (DSRS) successfully treated by transcatheter recanalization and stent placement. At 18-month follow-up, the patients remained asymptomatic and control venograms showed continued patency of the shunt with no evidence of stenosis or collaterals

  19. [Intrahepatic lithiasis].

    Science.gov (United States)

    Torres-Zevallos, Hernando; Sánchez-Gambetta, Sergio; Mendivil Zapata, Rolando; Valcárcel Saldaña, María

    2008-01-01

    Presence of stones in the intrahepatic bile ducts is a common problem especially in East Asia. We report two cases: the first is a man who through several years had repeated episodes of obstructive jaundice. He underwent multiple procedures due to the recurrences. The second case is a woman who had recurrences and serious complications. A detailed evaluation and early diagnosis of each case are essential for a good treatment, which is challenging due to the high rate of recurrence and complications.

  20. Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children

    Directory of Open Access Journals (Sweden)

    Nitin Sharma

    2014-01-01

    Full Text Available Background: Extrahepatic portal venous obstruction (EHPVO is the most common cause of pediatric portal hypertension. We analyzed the investigative protocol and results of portosystemic shunts in this group of patients. Materials and Methods: A total of 40 consecutive children aged below 12 years operated with a diagnosis of extra-hepatic portal hypertension formed the study group. Historical data and clinical data were collected. All patients underwent upper gastrointestinal endoscopy, ultrasound Doppler and computed tomographic portogram pre-operatively and post-operatively. Results with respect to shunt patency, hypersplenism and efficacy of different radiological investigations were collected. Results: A total of 40 patients, 28 boys and 12 girls constituted the study group. Lienorenal shunt (LRS was performed in 14 patients; distal splenorenal shunt in 21 patients and side-to-side lienorenal shunt in 4 patients, inferior mesenteric renal shunt was performed in 1 patient. Follow-up ranged from 36 to 70 months. At a minimum follow-up of 3 years, 32 (80% patients were found to have patent shunts. Patent shunts could be visualized in 30/32 patients with computer tomographic portogram (CTP and 28/32 with ultrasound. Varices regressed completely in 26/32 patients and in the rest incomplete regression was seen. Spleen completely regressed in 19/25 patients. Hypersplenism resolved in all patients with patent shunts. Conclusions: Portosystemic shunting in children with EHPVO is a viable option. While long-term cure rates are comparable with sclerotherapy, repeated hospital visits are reduced with one time surgery. Pre-operative and post-operative assessment can be performed with complimentary use of ultrasound, CTP and endoscopy.

  1. Percutaneous transhepatic portacaval shunt (PTPS)

    International Nuclear Information System (INIS)

    Chu Jianguo; Sun Xiaoli; Lv Chunyan; Xu Xiaoming; Huang He; Yang Shuhui; Zhou Hua

    2005-01-01

    Objective: To present a latest procedures for portal hypertension with preliminary results and evaluate the technical feasibility and efficacy of the portacaval shunt creation through percutaneous transhepatic approach with its potential clinical significance. Methods: Nineteen patients with portal hypertension (17 men; mean age 57 years, range 32-73) were referred for PTPS procedure because of bleeding varices (n=16), intractable ascites (n=2), and hepatopulmonary syndrome (n=1). The severity of liver disease was Child's B in 4 and Child's C in 15. The PTPS was created by a percutaneous transhepatic puncture through left portal vein to the IVC and a polytetrafluoroethylene (PTFE) stent-grafts was placed through a transhepatic approach. Results: Technical and functional successes were achieved in all patients-arerage without any procedure-related complications. The postprocedural portal vein-IVC gradients decreased with a mean 13 cmH 2 O and with average 216 days of follow-up showing no recurrent variceal bleeding and refractory ascites. The primary patency ratefor 365 days was 94.8%, obviously higher than classical TIPS. Conclusions: Portacaval shunt creation using the percutaneous transhepatic technique is secure and feasible with favorable primary patency due to the a straight line shunt construction and provide a good alternative to the standard portosystemic shunt in difficult or impossible circumstances. (authors)

  2. Splenophrenic portosystemic shunt in dogs with and without portal ...

    African Journals Online (AJOL)

    The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like more information about how to print, save, and work with PDFs, Highwire Press provides a helpful Frequently Asked Questions about PDFs.

  3. Multidetector Computed Tomography Assessment in Biliary Atresia for the Diagnosis of Portosystemic Collaterals before Liver Transplant

    International Nuclear Information System (INIS)

    Cadavid A, Lina; Barber, Ignasi; Bueno, Javier

    2011-01-01

    Introduction: Chronic liver disease increases portal vein pressure and modifies splanchnic circulation. This is particularly significant in infants with biliary atresia. Large collaterals steal portal flow and increase the risk of post transplant portal vein thrombosis. Objective: to describe different types of portosystemic collaterals prior to liver transplantation with low-dose multidetector CT (MDCT) in patients with biliary atresia. Material and methods: 13 patients with severe liver dysfunction due to biliary atresia underwent low-dose 64-MDCT before liver transplantation (effective tube current ranged from 20 to 120 mAs according to weight, with a kilo voltage of 80-120 for all CT). Hepatic arterial and portal venous phases were performed after IV contrast administration [1.5-2 ml/kg]. The mean age of the study group was1 year (range, 4 months to 3.6 years). Two radiologists reviewed the CT images to determine the grade and types of the portosystemic collaterals. Results: A total of 16 CT scans were obtained.the most common portosystemic collaterals found were esophageal (11), gastric submucosal (8), gastric adventitial (7, splenic (7), hemorrhoidal (10), mesenteric [dilated or tortuous branches of the inferior mesenteric vein (8)], retroperitoneal varices [gastro renal shunt (10), splenorenal shunt (4)] and dilated or tortuous left gastric vein (13). Conclusion: MDCT provides important information on venous system patency, presence of varices, and location of venous shunts in pediatric patients with biliary atresia going to liver transplant. in addition, it is critical to detect collaterals that are not evident on ultrasound in order to avoid the steal phenomenon that may lead to portal vein thrombosis and graft failure.

  4. Manganese accumulation in the brain: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A.; Nomiyama, K.; Takase, Y.; Nakazono, T.; Nojiri, J.; Kudo, S. [Saga Medical School, Department of Radiology, Saga (Japan); Noguchi, T. [Kyushu University, Department of Clinical Radiology, Graduate School of Medicine, Fukuoka (Japan)

    2007-09-15

    Manganese (Mn) accumulation in the brain is detected as symmetrical high signal intensity in the globus pallidi on T1-weighted MR images without an abnormal signal on T2-weighted images. In this review, we present several cases of Mn accumulation in the brain due to acquired or congenital diseases of the abdomen including hepatic cirrhosis with a portosystemic shunt, congenital biliary atresia, primary biliary cirrhosis, congenital intrahepatic portosystemic shunt without liver dysfunction, Rendu-Osler-Weber syndrome with a diffuse intrahepatic portosystemic shunt, and patent ductus venosus. Other causes of Mn accumulation in the brain are Mn overload from total parenteral nutrition and welding-related Mn intoxication. (orig.)

  5. The transjugular intrahepatic porto- systemic shunt (TIPSS) procedure

    African Journals Online (AJOL)

    Enrique

    Management of acute variceal bleeding. Patients with portal hypertension may either be asymptomatic or pre- sent with symptoms due to variceal bleeding, ascites, encephalopathy or hypersplenism. Variceal haemorrhage occurs in up to 85% of cases at the gastro-oesophageal junction. The management of variceal ...

  6. Progressive familial intrahepatic cholestasis

    International Nuclear Information System (INIS)

    Mirza, R.; Abbas, Z.; Luck, N.H.; Azam, S.M.Z.; Aziz, S.; Hassan, S.M; Somro, G.B.

    2006-01-01

    Progressive familial intrahepatic cholestasis (PFIC) is an important cause of cholestatic liver disease and biliary cirrhosis in pediatric population. Three cases of PFIC are described that were diagnosed on the basis of family history, pruritis, cirrhosis and / or paucity of interlobular bile ducts on liver biopsy and presence of extrahepatic biliary tree on imaging. These patients were initially labeled as suffering from extra-hepatic biliary atresia and neonatal hepatitis. PFIC-1 and 2 could not be differentiated on histological grounds, since these patients presented late and process of fibrosis was advanced. (author)

  7. Intrahepatic cholangiocarcinoma: current perspectives

    Directory of Open Access Journals (Sweden)

    Buettner S

    2017-02-01

    Full Text Available Stefan Buettner, Jeroen LA van Vugt, Jan NM IJzermans, Bas Groot Koerkamp Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands Abstract: Intrahepatic cholangiocarcinoma (ICC is the second most common malignancy arising from the liver. ICC makes up about 10% of all cholangiocarcinomas. It arises from the peripheral bile ducts within the liver parenchyma, proximal to the secondary biliary radicals. Histologically, the majority of ICCs are adenocarcinomas. Only a minority of patients (15% present with resectable disease, with a median survival of less than 3 years. Multidisciplinary management of ICC is complicated by large differences in disease course for individual patients both across and within tumor stages. Risk models and nomograms have been developed to more accurately predict survival of individual patients based on clinical parameters. Predictive risk factors are necessary to improve patient selection for systemic treatments. Molecular differences between tumors, such as in the epidermal growth factor receptor status, are promising, but their clinical applicability should be validated. For patients with locally advanced disease, several treatment strategies are being evaluated. Both hepatic arterial infusion chemotherapy with floxuridine and yttrium-90 embolization aim to downstage locally advanced ICC. Selected patients have resectable disease after downstaging, and other patients might benefit because of postponing widespread dissemination and biliary obstruction. Keywords: intrahepatic cholangiocarcinoma, diagnosis, treatment, developments 

  8. Angiographic and hemodynamic evaluation of the mesoatrial shunt in patients with Budd-Chiari syndrome and inferior vena caval obstruction

    International Nuclear Information System (INIS)

    Redmond, P.L.; Kadir, S.; Cameron, J.L.; Kaufman, S.L.; White, R.I. Jr.

    1986-01-01

    Obstruction of the inferior vena cava (IVC) is not uncommon in patients with the Budd-Chiari syndrome. The caval obstruction may be due to thrombus or compression by an enlarged caudate lobe. Conventional portosystemic shunts are not possible in the presence of an obstructed IVC; the mesoatrial shunt is indicated in these patients. Between 1973 and 1986, the authors studied 13 patients (ten female, three male) with Budd-Chiari syndrome and IVC obstruction in whom mesoatrial shunts were subsequently constructed. Polycythemia rubra vera was the most common predisposing condition. Preoperative evaluation included US, scintigraphy, CT, and angiography (hepatic arteriography, hepatic venography and pressure measurements, inferior vena cavography, arterial portography). Postoperatively shunts were assessed angiographically and hemodynamically, and several patients underwent CT. The shunts were catheterized via a brachial or femoral venous approach, which allowed pressures along the shunt from the superior mesenteric vein to the right atrium to be measured. The mesoatrial shunt is a relatively new procedure which is indicated in patients with the Budd-Chiari syndrome complicated by IVC obstruction. Shunt patency may be demonstrated arteriographically or with CT, but hemodynamic evaluation with measurement of pressure gradients is required to assess shunt function

  9. CT of intrahepatic lithiasis

    International Nuclear Information System (INIS)

    Regge, D.; Debernardi, S.; Kienle, S.; Martina, M.C.; Biselli, S.; Gandini, G.

    1992-01-01

    Twenty out of 65 patients, submitted to percutaneous treatment for intrahepatic stones at our department since 1983, had ultrasound (US) and computed tomography (CT) performed before any treatment. CT visualised stones in 65% of patients while distribution of stones was assessed correctly in 40%. In 5 patients CT provided information useful for treatment: in one case extremely dilated bile ducts hindered cholangiographic evaluation of lithiasis while in the other four cases CT examinations showed stones in dilated bile ducts unrecognised on percutaneous or endoscopic retrograde cholangiography. It is concluded that CT is a useful tool in the diagnosis of bile duct lithiasis. It aids in treatment selection and, when the percutaneous approach is chosen, allows the interventional radiologist to select the ducts to be catheterised. (orig.)

  10. CT of intrahepatic lithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Regge, D. [Ist. di Radiologia, Univ. di Torino, Torino (Italy); Debernardi, S. [Ist. di Radiologia, Univ. di Torino, Torino (Italy); Kienle, S. [Ist. di Radiologia, Univ. di Torino, Torino (Italy); Martina, M.C. [Ist. di Radiologia, Univ. di Torino, Torino (Italy); Biselli, S. [Ist. di Radiologia, Univ. di Torino, Torino (Italy); Gandini, G. [Ist. di Radiologia, Univ. di Torino, Torino (Italy)

    1992-12-01

    Twenty out of 65 patients, submitted to percutaneous treatment for intrahepatic stones at our department since 1983, had ultrasound (US) and computed tomography (CT) performed before any treatment. CT visualised stones in 65% of patients while distribution of stones was assessed correctly in 40%. In 5 patients CT provided information useful for treatment: in one case extremely dilated bile ducts hindered cholangiographic evaluation of lithiasis while in the other four cases CT examinations showed stones in dilated bile ducts unrecognised on percutaneous or endoscopic retrograde cholangiography. It is concluded that CT is a useful tool in the diagnosis of bile duct lithiasis. It aids in treatment selection and, when the percutaneous approach is chosen, allows the interventional radiologist to select the ducts to be catheterised. (orig.)

  11. Ultrasonographic finding of intrahepatic stones

    International Nuclear Information System (INIS)

    Lee, Wang Yul; Koh, Byung Hee; Cho, On Koo; Hahm, Chang Kok

    1983-01-01

    Correct diagnosis of intrahepatic stone with differentiation from extrahepatic stone is very important because of their different surgical procedure. The ultrasonography is very simple and noninvasive diagnostic method for detection of intrahepatic stone than other method. So the authors analysed the ultrasonographic findings of 30 patients with intrahepatic stones and the results are as follows: 1. Among 30 cases, 13(43.3%) were male, 17(56.7%) were female with predominancy in 5th and 6th decades. 2. 1) In distribution of stones 16 cases(53.5%) were in the left duct, 11 cases(36.7%) in both ducts, 3 cases(10%) in the right duct. 2) In location of intrahepatic stones, 9 cases(30%) were only in the intrahepatic ducts, 21 cases (70%) associated stones in the extrahepatic duct and or GB. 3. In sonography of 30 cases of intrahepatic stones 1) The shape of stone was round in 27 cases(90%) and tubular due to impacted stone in 3 cases (10%) 2) The echogenicity of stones was strong in 25 cases(83.3%) and weak in 5 cases(16.7%). 3) The shadow posterior to stones was strong in 23 cases(76.7%) and weak in 7 cases(23.3%) 4. As associated findings, metastatic lesion in liver 2 cases(6.7%), liver cirrhosis 2 cases(6.7%), hepatic and perihepatic abscess 4 cases(13.3%)were found liver(13.3%) were found

  12. Intrahepatic transposition of bile ducts.

    Science.gov (United States)

    Delić, Jasmin; Savković, Admedina; Isaković, Eldar; Marković, Sergije; Bajtarevic, Alma; Denjalić, Amir

    2012-01-01

    Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24-43% of cases, out of which 1-22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications.

  13. Standardization of MIP technique in three-dimensional CT portography: usefulness in evaluation of portosystemic collaterals in cirrhotic patients

    International Nuclear Information System (INIS)

    Kim, Jong Gi; Kim, Yong; Kim, Chang Won; Lee, Jun Woo; Lee, Suk Hong

    2003-01-01

    To assess the usefulness of three-dimensional CT portography using a standardized maximum intensity projection (MIP) technique for the evaluation of portosystemic collaterals in cirrhotic patients. In 25 cirrhotic patients with portosystemic collaterals, three-phase CT using a multide-tector-row helical CT scanner was performed to evaluate liver disease. Late arterial-phase images were transferred to an Advantage Windows 3.1 workstation (Gener Electric). Axial images were reconstructed by means of three-dimensional CT portography, using both a standardized and a non-standardized MIP technique, and the respective reconstruction times were determined. Three-dimensional CT portography with the standardized technique involved eight planes, namely the spleno-portal confluence axis (coronal, lordotic coronal, lordotic coronal RAO 30 .deg. C, and lordotic coronal LAO 30 .deg. C), the left renal vein axis (lordotic coronal), and axial MIP images (lower esophagus level, gastric fundus level and splenic hilum). The eight MIP images obtained in each case were interpreted by two radiologists, who reached a consensus in their evaluation. The portosystemic collaterals evaluated were as follows: left gastric vein dilatation; esophageal, paraesophageal, gastric, and splenic varix; paraumbilical vein dilatation; gastro-renal, spleno-renal, and gastro-spleno-renal shunt; mesenteric, retroperitoneal, and omental collaterals. The average reconstruction time using the non-standardized MIP technique was 11 minutes 23 seconds, and with the standardized technique, the time was 6 minutes 5 seconds. Three-dimensional CT portography with the standardized technique demonstrated left gastric vein dilatation (n=25), esophageal varix (n=18), paraesophageal varix (n=13), gastric varix (n=4), splenic varix (n=4), paraumbilical vein dilatation (n=4), gastro-renal shunt (n=3), spleno-renal shunt (n=3), and gastro-spleno-renal shunt (n=1). Using three-dimensional CT protography and the non

  14. Cholecystitis in an intrahepatic gallbladder

    International Nuclear Information System (INIS)

    Schmahmann, J.D.; Dent, D.M.; Mervis, B.; Kottler, R.E.

    1982-01-01

    A case of cholecystilis in an intrahepatic gallbladder with concurrent choledocholithiasis is reported. The patient initially presented with pyrexia of unknown origin and subsequently with suppurative cholangitis; the diagnosis was resolved pre-operatively using contemporary techniques of gallbladder delineation. Simple drainage of the gallbladder with choledocholithotomy proved effective

  15. Sarcomatoid Change in Intrahepatic Cholangiocarcinoma

    DEFF Research Database (Denmark)

    Albrechtsen, Nicolai Jacob Wewer; Zhang, Da; Abdulkarim, Bashar

    2013-01-01

    Sarcomatoid transformation is a rare but well documented change that may occur in intrahepatic cholangiocarcinomas.We report a tumor of this type to illustrate the difficulties in properly diagnosing cholangiocarcinoma when only the sarcomatous component is sampled by transcutaneous needle biopsy...

  16. Computed tomography of intrahepatic cholangiocarcinoma

    International Nuclear Information System (INIS)

    Kamimura, Ryoichi; Takashima, Tsutomu; Matsui, Osamu; Tsuji, Masahiko; Hirose, Shoichiro.

    1983-01-01

    Intrahepatic cholangiocarcinoma is an uncommon tumor as primary hepatic neoplasm. Five cases of cholangiocarcinoma, mass forming peripheral type, are reported about its CT findings. They were manifested as a poorly marginated low density mass with a irregular stellate area. In one case, a cut section of the gross specimen following surgery showed a central callagenous scar and vessels within the necrotic tumor. (author)

  17. Hydrocephalus and Shunts

    Science.gov (United States)

    SBA National Resource Center: 800-621-3141 Hydrocephalus and Shunts Approximately 80% of people with SB have Hydrocephalus Hydrocephalus means there is a build-up of cerebrospinal also called CSF, around ...

  18. Pathophysiology of shunt dysfunction in shunt treated hydrocephalus

    DEFF Research Database (Denmark)

    Blegvad, C.; Skjolding, A D; Broholm, H

    2013-01-01

    We hypothesized that shunt dysfunction in the ventricular catheter and the shunt valve is caused by different cellular responses. We also hypothesized that the cellular responses depend on different pathophysiological mechanisms....

  19. Intrahepatic stones: a case report

    International Nuclear Information System (INIS)

    Santos, A.M. dos; Borba Filho, P.

    1992-01-01

    A 23-year-old man from Palmares - Pernambuco, presented to our center with a 7-month history of jaundice and right upper quadrant abdominal pain. His past medical history revealed similar bouts since adolescence. Physical examination revealed icteric sclerae, soft abdomen with a palpable liver. An ultrasound examination showed a normal gallbladder and multiple echogenic areas with acoustic shadow in the liver. A percutaneous cholangiogram demonstrated dilated intrahepatic bile ducts with multiple stones. The patient underwent an exploratory laparotomy and cholecystectomy and a Roux-en-Y hepatic jejunostomy were performed. (author)

  20. Portosystemic pressure reduction achieved with TIPPS and impact of portosystemic collaterals for the prediction of the portosystemic-pressure gradient in cirrhotic patients

    International Nuclear Information System (INIS)

    Grözinger, Gerd; Wiesinger, Benjamin; Schmehl, Jörg; Kramer, Ulrich; Mehra, Tarun; Grosse, Ulrich; König, Claudius

    2013-01-01

    Purpose: The portosystemic pressure gradient is an important factor defining prognosis in hepatic disease. However, noninvasive prediction of the gradient and the possible reduction by establishment of a TIPSS is challenging. A cohort of patients receiving TIPSS was evaluated with regard to imaging features of collaterals in cross-sectional imaging and the achievable reduction of the pressure gradient by establishment of a TIPSS. Methods: In this study 70 consecutive patients with cirrhotic liver disease were retrospectively evaluated. Patients received either CT or MR imaging before invasive pressure measurement during TIPSS procedure. Images were evaluated with regard to esophageal and fundus varices, splenorenal collaterals, short gastric vein and paraumbilical vein. Results were correlated with Child stage, portosystemic pressure gradient and post-TIPSS reduction of the pressure gradient. Results: In 55 of the 70 patients TIPSS reduced the pressure gradient to less than 12 mmHg. The pre-interventional pressure and the pressure reduction were not significantly different between Child stages. Imaging features of varices and portosystemic collaterals did not show significant differences. The only parameter with a significant predictive value for the reduction of the pressure gradient was the pre-TIPSS pressure gradient (r = 0.8, p < 0.001). Conclusions: TIPSS allows a reliable reduction of the pressure gradient even at high pre-interventional pressure levels and a high collateral presence. In patients receiving TIPSS the presence and the characteristics of the collateral vessels seem to be too variable to draw reliable conclusions concerning the portosystemic pressure gradient

  1. Portosystemic pressure reduction achieved with TIPPS and impact of portosystemic collaterals for the prediction of the portosystemic-pressure gradient in cirrhotic patients

    Energy Technology Data Exchange (ETDEWEB)

    Grözinger, Gerd, E-mail: gerd.groezinger@med.uni-tuebingen.de [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany); Wiesinger, Benjamin; Schmehl, Jörg; Kramer, Ulrich [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany); Mehra, Tarun [Department of Dermatology, University of Tübingen (Germany); Grosse, Ulrich; König, Claudius [Department of Diagnostic Radiology, Department of Radiology, University of Tübingen (Germany)

    2013-12-01

    Purpose: The portosystemic pressure gradient is an important factor defining prognosis in hepatic disease. However, noninvasive prediction of the gradient and the possible reduction by establishment of a TIPSS is challenging. A cohort of patients receiving TIPSS was evaluated with regard to imaging features of collaterals in cross-sectional imaging and the achievable reduction of the pressure gradient by establishment of a TIPSS. Methods: In this study 70 consecutive patients with cirrhotic liver disease were retrospectively evaluated. Patients received either CT or MR imaging before invasive pressure measurement during TIPSS procedure. Images were evaluated with regard to esophageal and fundus varices, splenorenal collaterals, short gastric vein and paraumbilical vein. Results were correlated with Child stage, portosystemic pressure gradient and post-TIPSS reduction of the pressure gradient. Results: In 55 of the 70 patients TIPSS reduced the pressure gradient to less than 12 mmHg. The pre-interventional pressure and the pressure reduction were not significantly different between Child stages. Imaging features of varices and portosystemic collaterals did not show significant differences. The only parameter with a significant predictive value for the reduction of the pressure gradient was the pre-TIPSS pressure gradient (r = 0.8, p < 0.001). Conclusions: TIPSS allows a reliable reduction of the pressure gradient even at high pre-interventional pressure levels and a high collateral presence. In patients receiving TIPSS the presence and the characteristics of the collateral vessels seem to be too variable to draw reliable conclusions concerning the portosystemic pressure gradient.

  2. The soluble mannose receptor is released from the liver in cirrhotic patients, but is not associated with bacterial translocation

    DEFF Research Database (Denmark)

    Laursen, Tea L; Rødgaard-Hansen, Sidsel; Møller, Holger J

    2017-01-01

    for transjugular intrahepatic portosystemic shunt insertion as a result of refractory ascites (n=17), acute (n=3), or recurrent variceal bleeding (n=8). We analysed plasma from the portal and hepatic veins for bacterial DNA and soluble mannose receptor with qPCR and ELISA. RESULTS: The median soluble mannose...... correlated with the portal pressure prior to transjugular intrahepatic portosystemic shunt insertion (r=.52, Pvariceal bleeding compared...... levels in patients with acute variceal bleeding indicating the soluble mannose receptor as a marker of complications of cirrhosis, but not bacterial translocation....

  3. Intrahepatic portal occlusion by microspheres: a new model of portal hypertension in the rat.

    Science.gov (United States)

    Jaffe, V; Alexander, B; Mathie, R T

    1994-06-01

    Available experimental models of portal hypertension are based either on cirrhosis or externally applied portal vein constricting devices. A new method is described of raising portal pressure, which uses intraportally injected microspheres to block intrahepatic portal radicles, which has the advantages of retaining normal liver architecture and providing a more clinically relevant intrahepatic obstruction to portal flow. Measured aliquots of microspheres (15, 25, 50, 90 microns) or equivalent volumes of saline were injected into a peripheral portal tributary (caecal vein) of 22 normal rats. The resultant changes in arterial, portal, and splenic pulp pressures were monitored. Sequential microsphere injections produced graduated rises in portal pressure up to a peak of 18.5-22.5 mm Hg (8.7-12.4 mm Hg increase from basal), which declined gradually to a steady state pressure of 13.3-15.1 mm Hg (4.0-5.0 mm Hg increase). There was no significant difference between pressure increases produced by microspheres of differing sizes. It is concluded that portal hypertension can be produced acutely by blocking portal radicles with microspheres. The maximum pressure achieved, however, is substantially less than that obtained by total portal vein occlusion (mean: 57.6 mm Hg). This suggests the existence of functional intrahepatic portal systemic shunts not previously described in the normal liver.

  4. Genetics Home Reference: benign recurrent intrahepatic cholestasis

    Science.gov (United States)

    ... expand/collapse boxes. Description Benign recurrent intrahepatic cholestasis (BRIC) is characterized by episodes of liver dysfunction called ... a lack of appetite. A common feature of BRIC is the reduced absorption of fat in the ...

  5. Intrahepatic cholestasis with parental alimentation.

    Science.gov (United States)

    Rodgers, B M; Hollenbeck, J I; Donnelly, W H; Talbert, J L

    1976-02-01

    From July 1971 to March 1975, elevan infants receiving total or partial parenteral alimentation at the University of Florida showed histologic evidence of intrahepatic cholestasis. The clinical records of these patients have been examined. These infants were critically ill and had protracted hospital courses with only two survivors. Liver biopsies demonstrated marked cholestasis with some fibrosis and thickening of the limiting membrane of the hepatocyte. In those patients in whom serial liver biopsies were obtained, hepatic histology returned toward normal, paralleling improvement in liver function studies, as intravenous alimentation was discontinued. Careful monitoring of the liver function tests is essential to detect this progressive abnormality as early as possible and discontinue intravenous alimentation. Follow-up as long as two and a half years in the two surviving patients has demonstrated no chronic dysfunction.

  6. Molecular profiling of intrahepatic cholangiocarcinoma

    DEFF Research Database (Denmark)

    Oliveira, Douglas V N P; Zhang, Shanshan; Chen, Xin

    2017-01-01

    . Areas covered: The present review article outlines the main studies and resulting discoveries on the molecular profiling of iCCA, with a special emphasis on the different techniques used for this purpose, the diagnostic and prognostic markers identified, as well as the genes and pathways that could......INTRODUCTION: Intrahepatic cholangiocarcinoma (iCCA) is the second most frequent primary tumor of the liver and a highly lethal disease. Therapeutic options for advanced iCCA are limited and ineffective due to the largely incomplete understanding of the molecular pathogenesis of this deadly tumor...... be potentially targeted with innovative therapies. Expert commentary: Molecular profiling has led to the identification of distinct iCCA subtypes, characterized by peculiar genetic alterations and transcriptomic features. Targeted therapies against some of the identified genes are ongoing and hold great promise...

  7. Gut does not contribute to systemic ammonia release in humans without portosystemic shunting

    NARCIS (Netherlands)

    van de Poll, Marcel C. G.; Ligthart-Melis, Gerdien C.; Damink, Steven W. M. Olde; van Leeuwen, Paul A. M.; Beets-Tan, Regina G. H.; Deutz, Nicolaas E. P.; Wigmore, Stephen J.; Soeters, Peter B.; Dejong, Cornelis H. C.

    2008-01-01

    The gut is classically seen as the main source of circulating ammonia. However, the contribution of the intestines to systemic ammonia production may be limited by hepatic extraction of portal-derived ammonia. Recent data suggest that the kidney may be more important than the gut for systemic

  8. Intraoperative cholangiographic findings of intrahepatic duct stones

    International Nuclear Information System (INIS)

    Kim, Mi Young; Suh, Chang Hae; Choi, Hye Ran; Ahn, Byeong Yeob; Chung, Woun Kyun; Lee, Yong

    1989-01-01

    Operative cholangiography is considered essential during biliary operation in order to minimise the chance of negative exploration and to demonstrate the anatomy and pathology of intra and extrahepatic biliary tree. Although many authors have evaluated and accepted various techniques for operative cholangiography, the image of operative cholangiography is affected mainly by intrahepatic duct stones and anatomic characteristic of biliary tree. In case of intrahepatic duct stones accurate evaluation of the operative cholangiographic findings is important for a plan of further treatment including interventional procedures. We reviewed 45 operative cholangiograms of 30 patients with intrahepatic duct stones from January,1986 to September, 1988, and analysed operative cholangiographic findings with a special attention to the correlation between cholangiographic findings and the location of intrahepatic duct stones. The results were as follows: 1. Common bile duct stones were found in 72%, and generalized cholangitis was combined in 43% of patient with intrahepatic duct stones. 2. Incomplete ductal filling of contrast media was the most frequent findings of left intrahepatic duct stones in operative cholangiograms with four different cholangiogram catheters. 3. Nonfilling and partial filling were the most frequent findings; nonfilling was prevalent in right anterior and left medial ducts, and partial filling was prevalent in left medial and left lateral ducts

  9. Spinal arteriovenous shunts in children.

    Science.gov (United States)

    Davagnanam, Indran; Toma, Ahmed K; Brew, Stefan

    2013-11-01

    Pediatric spinal arteriovenous shunts are rare and, in contrast to those in adults, are often congenital or associated with underlying genetic disorders. These are thought to be a more severe and complete phenotypic spectrum of all spinal arteriovenous shunts seen in the overall spinal shunt population. The pediatric presentation thus accounts for its association with significant morbidity and, in general, a more challenging treatment process compared with the adult presentation. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Aqueous shunts for glaucoma.

    Science.gov (United States)

    Tseng, Victoria L; Coleman, Anne L; Chang, Melinda Y; Caprioli, Joseph

    2017-07-28

    Aqueous shunts are employed to control intraocular pressure (IOP) for people with primary or secondary glaucomas who fail or are not candidates for standard surgery. To assess the effectiveness and safety of aqueous shunts for reducing IOP in glaucoma compared with standard surgery, another type of aqueous shunt, or modification to the aqueous shunt procedure. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 8), MEDLINE Ovid (1946 to August 2016), Embase.com (1947 to August 2016), PubMed (1948 to August 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to August 2016), ClinicalTrials.gov (www.clinicaltrials.gov); searched 15 August 2016, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 15 August 2016. We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 15 August 2016. We also searched the reference lists of identified trial reports and the Science Citation Index to find additional trials. We included randomized controlled trials that compared various types of aqueous shunts with standard surgery or to each other in eyes with glaucoma. Two review authors independently screened search results for eligibility, assessed the risk of bias, and extracted data from included trials. We contacted trial investigators when data were unclear or not reported. We graded the certainty of the evidence using the GRADE approach. We followed standard methods as recommended by Cochrane. We included 27 trials with a total of 2099 participants with mixed diagnoses and comparisons of interventions. Seventeen studies reported adequate methods of randomization, and seven reported adequate allocation concealment. Data collection and follow-up times varied.Four trials compared an aqueous shunt (Ahmed or Baerveldt) with trabeculectomy, of which

  11. Ventriculoperitoneal shunt infections in children

    African Journals Online (AJOL)

    1991-02-02

    Feb 2, 1991 ... The following information was extracted from the bed- letters of patients identified as having shunt infections: age; sex; primary diagnosis; preceding operative procedure (primary insertion or revision of an existing shunt); time interval between_ operation and diagnosis of infection; CSF fmdings; and site of.

  12. Rex shunt preoperative imaging: diagnostic capability of imaging modalities.

    Directory of Open Access Journals (Sweden)

    Sharon W Kwan

    Full Text Available The purpose of this study was to evaluate the diagnostic capability of imaging modalities used for preoperative mesenteric-left portal bypass ("Rex shunt" planning. Twenty patients with extrahepatic portal vein thrombosis underwent 57 preoperative planning abdominal imaging studies. Two readers retrospectively reviewed these studies for an ability to confidently determine left portal vein (PV patency, superior mesenteric vein (SMV patency, and intrahepatic left and right PV contiguity. In this study, computed tomographic arterial portography allowed for confident characterization of left PV patency, SMV patency and left and right PV continuity in 100% of the examinations. Single phase contrast-enhanced CT, multi-phase contrast-enhanced CT, multiphase contrast-enhanced MRI, and transarterial portography answered all key diagnostic questions in 33%, 30%, 0% and 8% of the examinations, respectively. In conclusion, of the variety of imaging modalities that have been employed for Rex shunt preoperative planning, computed tomographic arterial portography most reliably allows for assessment of left PV patency, SMV patency, and left and right PV contiguity in a single study.

  13. To tilfælde af svær variceblødning ved Brickerblærestomi

    DEFF Research Database (Denmark)

    Lunden, Dagmar; Poulsen, Johan; Kloster, Brian O

    2014-01-01

    Variceal haemorrhage from an ileal conduit is a rare but well-known complication to portal hypertension. Many treatments are described and a transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice if possible, because this addresses the underlying portal hypertension. We...

  14. Endovascular management of porto-mesenteric venous thrombosis developing after trans-arterial occlusion of a superior mesenteric arteriovenous fistula.

    Science.gov (United States)

    Garg, Deepak; Lopera, Jorge Enrique; Goei, Anthony D

    2013-09-01

    Porto-mesenteric venous thrombosis following a trans-arterial occlusion of a superior mesenteric arteriovenous fistula is a rare occurrence. We present a case of endovascular management of one such case treated pharmacomechanically with catheter-directed mesenteric thrombolysis and transjugular intrahepatic portosystemic shunt creation without long-term successful outcome.

  15. Tips for TIPS

    NARCIS (Netherlands)

    Cuijpers, C.F.

    2015-01-01

    The transjugular intrahepatic portosystemic shunt (TIPS) procedure is one of the most technically challenging procedures in interventional radiology. During the procedure, interventional radiologists (IRs) insert very thin and long instruments through a little incision in the patient’s neck. They

  16. Pathophysiological basis of pharmacotherapy in the hepatorenal syndrome

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming; Henriksen, Jens Henrik

    2005-01-01

    a combined approach should be applied with reduction of portal pressure with e.g. ss-adrenergic blockers and transjugular intrahepatic portosystemic shunt (TIPS), with amelioration of arterial hypotension and central hypovolaemia with vasoconstrictors such as terlipressin and plasma expanders. New...... experimental treatments with endothelin- and adenosine antagonists and long-acting vasoconstrictors may have a future role in the management of HRS....

  17. Mesoatrial shunt in Budd-Chiari syndrome

    Directory of Open Access Journals (Sweden)

    Mirković Darko

    2009-01-01

    Full Text Available Background. Budd-Chiari syndrome (BCS represents partial or total occlusion of the hepatic veins with or without simultaneous obstruction of vena cava inferior (VCI. The symptoms of BCS are abdominal pain, hepatomegaly, ascites, varices of the abdominal wall, sometimes bleeding from the upper part of gastointestinal tract (GIT, lower limbs swelling and jaundice. Primary BSC is a relatively rare condition occurring in one per 100 000 of the population worldwide. Case report. A male patient, 25-year-old, facing tooth postextraction complications, was presented with acute BCS. On admission, physical examination revealed pale-grayish complexion, more pronounced veins over the thorax and abdomen, ascites, enlarged liver rising 8 cm below the right costal arch and having a minor pleural effusion by the right side. The patient was submitted to Doppler sonography and computed tomography (CT that verified the right leg deep veins thrombosis, as well as the presence of a thrombus in the intrahepatic portion of the VCI. Multislice computed tomography (MSCT showed occlusion of hepatic veins (Budd-Chiari syndrome and thrombosis of the VCI in the retrohepatic part 6 cm long. Also, increased values of transaminases and gamma GT and reduced values of albumines and serum ferrum were registered. Molecular examination revealed Factor V Leiden mutation - heterozygote. After preoperative preparations a mesocaval shunt was made using Gore- Tex ring graft of 12 mm. Intraoperatively, the blue enlarged liver was found with almost black zones of tense capsule. After a graft making, liver congestion decreased followed by the change of colour and volume. Within postoperative course metabolic and synthetic liver functions were obvious. Conclusion. In patients with BCS medicamentous treatment does not yield adequate results, but even causes worsening of general condition. Surgical therapy in the presented patient was performed timely regarding the stage of the disease due to

  18. Laparoscopic liver resection for intrahepatic cholangiocarcinoma.

    Science.gov (United States)

    Uy, Billy James; Han, Ho-Seong; Yoon, Yoo-Seok; Cho, Jai Young

    2015-04-01

    Reports on laparoscopic liver resection for intrahepatic cholangiocarcinoma are still scarce. With increased experience in laparoscopic liver resection, its application to intrahepatic cholangiocarcinoma can now be considered. Our aim is to determine the feasibility and safety of laparoscopic liver resection for intrahepatic cholangiocarcinoma and to analyze its clinical and oncologic outcomes. Among the 84 patients with intrahepatic cholangiocarcinoma operated on from March 2004 to April 2012, 37 patients with a T-stage of 2b or less were included in the study. Eleven patients underwent laparoscopic liver resection, and 26 underwent open liver resection. Treatment and survival outcomes were analyzed. Intraoperative blood loss was significantly greater in the open group (P=.024), but with no difference in the blood transfusion requirement between groups (P=.074), and no operative mortality occurred. The median operative time, postoperative resection margin, and length of hospital stay were comparable between groups (P=.111, P=.125, and P=.077, respectively). Four (36.4%) patients in the laparoscopic group developed recurrence compared with 12 (46.2%) patients in the open group (P=.583). After a median follow-up of 17 months, the 3- and 5-year overall survival rates were 77.9% and 77.9%, respectively, in the laparoscopic group compared with 66.2% and 66.2%, respectively, in the open group (P=.7). There was also no significant difference in the 3- and 5-year disease-free survival rates for the laparoscopic group at 56.2% and 56.2%, respectively, versus the open group at 39.4% and 39.4%, respectively (P=.688). Laparoscopic liver resection for intrahepatic cholangiocarcinoma is technically safe with survival outcome comparable to that of open liver resection in selected cases.

  19. An Imaging and Histological Study on Intrahepatic Microvascular Passage of Contrast Materials in Rat Liver

    Directory of Open Access Journals (Sweden)

    Qian Xia

    2017-01-01

    Full Text Available Background. Lipiodol has been applied for decades in transarterial chemoembolization to treat liver malignancies, but its intrahepatic pathway through arterioportal shunt (APS in the liver has not been histologically revealed. This rodent experiment was conducted to provide evidence for the pathway of Lipiodol delivered through the hepatic artery (HA but found in the portal vein (PV and to elucidate the observed unidirectional APS. Methods. Thirty rats were divided into 5 groups receiving systemic or local arterial infusion of red-stained iodized oil (RIO or its hydrosoluble substitute barium sulfate suspension (BSS, or infusion of BSS via the PV, monitored by real-time digital radiography. Histomorphology of serial frozen and paraffin sections was performed and quantified. Results. After HA infusion, RIO and BSS appeared extensively in PV lumens with peribiliary vascular plexus (PVP identified as the responsible anastomotic channel. After PV infusion, BSS appeared predominantly in the PV and surrounding sinusoids and to a much lesser extent in the PVP and HA (P<0.001. Fluid mechanics well explains the one-way-valve phenomenon of APS. Conclusions. Intravascularly injected rat livers provide histomorphologic evidences: (1 the PVP exists in between the HA and PV, which is responsible to the APS of Lipiodol; and (2 the intrahepatic vascular inflow appears HA-PVP-PV unidirectional without a physical one-way valve, which can be postulated by the fluid mechanics.

  20. Intrahepatic chemoembolization in unresectable pediatric liver malignancies

    International Nuclear Information System (INIS)

    Arcement, C.M.; Towbin, R.B.; Meza, M.P.; Kaye, R.D.; Carr, B.I.; Gerber, D.A.; Mazariegos, G.V.; Reyes, J.

    2000-01-01

    Objective. To determine the effectiveness of a new miltidisciplinary approach using neoadjuvant intrahepatic chemoembolization (IHCE) and liver transplant (OLTx) in patients with unresectable hepatic tumors who have failed systemic chemotherapy. Materials and methods. From November 1989 to April 1998, 14 children (2-15 years old) were treated with 50 courses of intra-arterial chemotherapy. Baseline and post-treatment contrast-enhanced CT and alpha-fetoprotein levels were performed. Seven had hepatoblastoma, and 7 had hepatocellular carcinoma (1 fibrolamellar variant). All patients had subselective hepatic angiography and infusion of cisplatin and/or adriamycin (36 courses were followed by gelfoam embolization). The procedure was repeated every 3-4 weeks based on hepatic function and patency of the hepatic artery. Results. Six of 14 children received orthotopic liver transplants (31 courses of IHC). Pretransplant, 3 of 6 showed a significant decrease in alpha-fetoprotein, while only 1 demonstrated a significant further reduction in tumor size. Three of 6 patients are disease free at this time. Three of 6 patients died of metastatic tumor 6, 38, and 58 months, respectively post-transplant. One of 14 is currently undergoing treatment, has demonstrated a positive response, and is awaiting OLTx. Three of 14 withdrew from the program and died. Four of 14 patients developed an increase in tumor size, developed metastatic disease, and were not transplant candidates. Two hepatic arteries thrombosed, and one child had a small sealed-off gastric ulcer as complications of intrahepatic chemoembolization. Conclusion. The results of intrahepatic chemoembolization are promising and suggest that some children who do not respond to systemic therapy can be eventually cured by a combination of intrahepatic chemoembolization orthotopic liver transplant. Alpha-fetoprotein and cross-sectional imaging appear to be complementary in evaluating tumor response. IHCE does not appear to convert

  1. Are shunt series and shunt patency studies useful in patients with shunted idiopathic intracranial hypertension in the emergency department?

    Science.gov (United States)

    Liu, Ann; Elder, Benjamin D; Sankey, Eric W; Goodwin, C Rory; Jusué-Torres, Ignacio; Rigamonti, Daniele

    2015-11-01

    Shunt series and shunt patency studies can be performed in the emergency department (ED) to evaluate for shunt malfunction in patients with idiopathic intracranial hypertension (IIH). Here, we examine the utility of these studies in this specific patient population. We retrospectively reviewed the ED visits of all shunted patients diagnosed with IIH from 2003 to 2014. ED visits for symptoms not related to the patient's IIH were excluded from the study. Collected variables included demographics, symptoms, IIH diagnosis and treatment history, imaging findings, and management changes. Twenty-five (81%) patients had a total of 105 visits involving a shunt series, with four (3.9%) showing problems with the catheter. The majority of shunt series (n=101, 96%) showed no catheter pathology. Based on results of the shunt series alone, in 3 instances, management changes in the form of shunt revision or shunt reprogramming occurred. Of the 105 visits with a shunt series, 17 (16%) resulted in a change in management as compared to 12 out of 66 (18%) visits without a shunt series (p=0.83). Nine patients had a total of 10 visits involving a shunt patency study: five were normal, four were abnormal, and one was inconclusive. Based on findings on the shunt patency study alone, changes in management leading to shunt adjustment or revision occurred in 4 instances. Of the 10 visits with shunt patency studies, 5 resulted in a change in management as compared to 24 out of 161 visits without a shunt patency study (p=0.014). Shunt series detected catheter pathology only 3.9% of the time, and there was no difference in the rate of management changes between those patients who underwent a shunt series and those who did not. There was a significant difference in the rate of management changes in patients who received shunt patency studies as compared to those who did not. Shunt series may not be a useful screening tool to be used universally to diagnose shunt malfunction in IIH patients in

  2. Piezoelectric RL shunt damping of flexible structures

    DEFF Research Database (Denmark)

    Høgsberg, Jan Becker; Krenk, Steen

    2015-01-01

    Resonant RL shunt circuits represent a robust and effective approach to piezoelectric damping, provided that the individual shunt circuit components are calibrated accurately with respect to the dynamic properties of the corresponding flexible structure. The balanced calibration procedure applied...

  3. Ventriculoperitoneal shunt blockage by hydatid cyst

    Directory of Open Access Journals (Sweden)

    Abrar A Wani

    2013-01-01

    Full Text Available Ventriculoperitoneal (VP shunt is one of the commonest procedures done in neurosurgical practice throughout the world. One of the commonest problems after putting the VP shunt is the shunt obstruction, which can be due to varied causes. Shunt obstruction secondary to the parasitic infections is rarely seen. We are presenting a 15-year-old child, a case of operated cerebral hydatid cyst with hydrocephalus. She presented with shunt malfunction after 1 year of surgical excision of the hydatid cyst. Revision of the VP shunt was done and peroperatively, it was found that the shunt tubing was obstructed due to small hydatid cysts. This is the first reported case of VP shunt obstruction by hydatid cyst.

  4. The structural study of prefabrication stress stent and the hemodynamics in percutaneous transhepatic portacaval shunt

    International Nuclear Information System (INIS)

    Chu Jianguo; Sun Xiaoli; Zhou Yijun; Huang He; Zhou Hua; Lv Chunyan; Yang Shuhui

    2006-01-01

    Objective: To present a preliminary latest procedure for portal hypertension and evaluate the technical feasibility and efficacy of portacaval shunt creation through the percutaneous transhepatic approach in order to make a hemodynamic comparison with that of the classic TIPS. Methods: Thirty-eight patients with portal hypertension (36 men; mean age 57 years, range 32-73) were referred for PTPS procedure because of bleeding varices (n=36), intractable ascites (n=1), and hepatopulmonary syndrome (n=1). The severity of liver disease was classified as Child-Pugh B in 27 and C in 11. The PTPS was created by a percutaneous transhepatic puncture into right portal vein and then through left portal vein to the hepatic segment of IVC followed by a prefabrication stress stent-graft placement at the very site. Results: Technical and functional success of 100% was achieved in all patients, without related complications. The postprocedural portal vein-IVC gradients mean 13 cmH 2 O was achieved with the follow-up period mean 493 days. No recurrence of variceal bleeding and controlled refractory ascites were achieved, and still more with primary patency rate of the involved vascular structure up to 94.8% at 365 days, much better than classic TIPS. Conclusions: Portacaval shunt creation using the prefabrication stress stent via percutaneous transhepatic technique is safe and feasible. the compact coincidence was obtained between the stent and the involved vessel with restoration of intrahepatic portal venous hemodynamics together with partial lowering of portal venous pressure and guaranteeing intrahepatic perfusion through right portal vein. It is also obviously to have postoperative prevention of shunt restenoses and lowering postoperative incidence of hepato-encephalopathy. (authors)

  5. 30 CFR 56.6401 - Shunting.

    Science.gov (United States)

    2010-07-01

    ... HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Explosives Electric Blasting § 56.6401 Shunting. Except during testing— (a) Electric detonators shall be kept shunted until connected to the blasting line or wired into a blasting round; (b) Wired rounds shall be kept shunted until...

  6. Subacute bacterial endocarditis and subsequent shunt nephritis from ventriculoatrial shunting 14 years after shunt implantation

    DEFF Research Database (Denmark)

    Burström, Gustav; Andresen, Morten; Bartek, Jiri Jr.

    2014-01-01

    of causing subacute bacterial endocarditis and subsequent shunt nephritis. The patient was successfully treated with antibiotics combined with ventriculoatrial shunt removal and endoscopic third ventriculocisternostomy (VCS). This case illustrates the nowadays rare, but potentially severe complication...... of subacute bacterial endocarditis and shunt nephritis. It also exemplifies the VCS as an alternative to implanting foreign shunt systems for CSF diversion....... of inconclusive multidisciplinary investigations, the patient progressed into end-stage renal disease before an echocardiogram revealed a vegetative plaque on the tendinous chords of the tricuspid valve. CSF cultures were grown from the shunt valve, confirming bacterial growth of Propionibacterium acnes suspected...

  7. Ventriculoperitoneal shunt surgery and shunt infections in children ...

    African Journals Online (AJOL)

    Objective: To study infections complicating ventriculoperitoneal (VP) shunt surgery in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. Design: A retrospective survey. Setting: Kenyatta National Hospital, Nairobi between January 1982 and December 1991. Subjects: Three hundred and ...

  8. Radiopaque intrahepatic duct stones in plain radiograph: case report

    International Nuclear Information System (INIS)

    Kim, Mi Young; Suh, Chang Hae; Park, Chan Sup; Chung, Won Kyun

    1994-01-01

    We experienced 3 cases of intrahepatic duct stones detected on plain radiographs. The patients had history of multiple episodes of recurrent cholangitis. Radiographic characteristics of these stones included multiple, round or rectangular radiopaque densities surrounded by calcified rim; these densities showed a branching pattern along the intrahepatic ducts

  9. Differential diagnosis of benign intrahepatic tumours

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, R.; Herter, M.

    1983-01-01

    Differential diagnosis of benign intrahepatic tumours can be very difficult despite numerous non-invasive diagnostic approaches, as is evident from two case reports presented here. The problem appears particularly intricate if two or more masses or space-occupying growths are present at the same time, the diagnostic aspects being different. In the first case, echinococcus alveolaris occurred simultaneously with a cavernous haemangioma and a focal nodular hyperplasia (FNH). In the second case, FNH as a pendulating tumour was combined with a second focus in the superior part of the liver. These two examples are used as basis for discussing various diagnostic approaches, such as sonography, computed tomography and scintiscanning.

  10. Current research on progressive familial intrahepatic cholestasis

    Directory of Open Access Journals (Sweden)

    DENG Baocheng

    2015-09-01

    Full Text Available Progressive familial intrahepatic cholestasis (PFIC refers to a heterogeneous group of autosomal-recessive disorders. The estimated incidence varies between 1/50,000 and 1/100,000 births. Three types of PFIC have been identified and related to mutations in hepatocellular transport system genes involved in bile formation. PFIC-1, PFIC-2, and PFIC-3 are due to mutations in ATP8B1, ABCB11, and ABCB4 genes involved in bile secretion, respectively. Serum gamma-glutamyl transpeptidase is normal in patients with PFIC-1 and PFIC-2, while it is raised in patients with PFIC3. The main clinical manifestation of PFIC is severe intrahepatic cholestasis. PFIC usually appears in infancy or childhood and rapidly progresses to end-stage liver disease before adulthood. Diagnosis of this disease is based on clinical manifestations, liver function tests, liver ultrasonography, liver histology, and genetic testing. Ursodeoxycholic acid therapy is the initial treatment in all PFIC patients to prevent liver damage. In some PFIC1 and PFIC2 patients, biliary diversion may also relieve pruritus and slow disease progression. However, most PFIC patients are ultimately candidates for liver transplantation.

  11. Multidisciplinary management of intrahepatic cholangiocarcinoma: Current approaches.

    Science.gov (United States)

    Guro, Hanisah; Kim, Jin Won; Choi, YoungRok; Cho, Jai Young; Yoon, Yoo-Seok; Han, Ho-Seong

    2017-06-01

    Intrahepatic cholangiocarcinoma (ICC) is a common primary hepatic tumor. However, its outcomes are usually worse than those of hepatocellular carcinoma owing to its non-specific presentation and detection at an advanced stage. The most widely used serum marker, carbohydrate antigen 19-9, is non-specific. Furthermore, imaging studies rarely identify any pathognomonic features. Surgery is the only treatment option that offers a chance of long-term survival. However, the resectability rate is low owing to the high frequencies of intrahepatic metastases, peritoneal carcinomatosis, or extrahepatic metastases. Surgical treatment should be tailored according to the macroscopic classification of ICC (e.g. mass-forming, periductal infiltrating, and intraductal growth types) because it reflects the tumor's dissemination pattern. Although lymph node metastasis is a negative prognostic factor, the importance and extent of lymph node dissection is still controversial. To improve patient survival, liver transplantation is considered in some patients with unresectable ICC, especially in those with an insufficient remnant liver volume. Minimally invasive procedures, including laparoscopic and robotic liver resection, have been tested and achieved comparable outcomes to conventional surgery in preliminary studies. No randomized trials have confirmed the efficacy of adjuvant chemotherapy in ICC, and several trials have evaluated molecular-targeted agents as monotherapy or in combination with cytotoxic chemotherapy. Multidisciplinary approaches are necessary to improve the outcomes of ICC. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Intrahepatic venous collaterals forming via the inferior right hepatic vein in 3 patients with obstruction of the inferior vena cava

    International Nuclear Information System (INIS)

    Takayasu, K.; Moriyama, N.; Muramatsu, Y.

    1985-01-01

    When the inferior vena cava is obstructed, collateral veins enlarge, connecting with the inferior (acessory) right hepatic vein (IRHV) and thence through various hepatic veins to the right atrium. Three such cases are described. In one patient, most contrast material flowed into the IRHV and from there to the left hepatic vein. The second patient had several large collaterals arising from the IRHV and flowing into the right and middle hepatic veins, while the third patient demonstrated anastomoses between the IRHV and the middle hepatic vein. All of these hepatic venous shunts eventually drained into the right atrium. There were no clinical manifestations such as ascites, edema, or dilatation of the abdominal veins. Cavography alone or combined with computed tomography proved to be diagnostic in the assessment of these intrahepatic collaterals

  13. Pediatric ventriculoperitoneal shunts and their complications: An analysis

    Directory of Open Access Journals (Sweden)

    Nitin Agarwal

    2017-01-01

    Conclusion: With this retrospective review of complications of VP shunts, age at initial shunt insertion and the interval between the age of initial shunt placement and onset of complications were the most important patient-related predictors of shunt failure. The different predominant etiological factors responsible for early and late shunt failure were infective and mechanical complications, respectively.

  14. Intrahepatic ascariasis – Common parasite at an uncommon site

    Directory of Open Access Journals (Sweden)

    Udit Chauhan

    2016-08-01

    Full Text Available Bacterial infections of the biliary tree are common infections of the biliary system which frequently lead to life-threatening sepsis. Parasitic infections of the biliary tree like ascariasis are not uncommon. Most adult worms reside into the extrahepatic biliary system. Intrahepatic existence is not commonly described. Urgent recognition of the intrahepatic existence of this common parasite is of paramount importance in order to start timely treatment of this lifethreatening infection. Authors described a case of intrahepatic ascariasis in a young male who was diagnosed radiologically and thereafter managed with endoscopic retrograde cholangiopancreatography and antibiotics.

  15. Intrahepatic cholestasis of pregnancy or azithromycin-induced intrahepatic cholestasis: A case report.

    Science.gov (United States)

    Han, Baoshi; Sheng, Yan; Wang, Li; Feng, Hao; Hou, Xianzeng; Li, Yan

    2017-12-01

    Azithromycin-induced liver injury has been rarely reported in adult individuals, let alone in a pregnant woman. Here, we describe the clinical features and outcomes of azithromycin-induced liver injury in a pregnant woman. A 30-year-old pregnant woman presented with generalized pruritus and elevated serum bile acid level (123.6 μmol/L) on day 4 of azithromycin administration. A diagnosis of intrahepatic cholestasis of pregnancy was made, and cesarean section was performed immediately. Interestingly, the alanine aminotransferase level (ALT) reached 211.2 U/L on day 9 after azithromycin administration. Therefore, drug-induced intrahepatic cholestasis was considered. (1) Azithromycin withdrawal after the patient hospitalized. (2) Termination of pregnancy by cesarean section was performed inmmediately to protect the fetus. (3) Silymarin capsules and bifendate are used to protect the liver after liver enzymes elevation was discovered. The liver enzymes recovered within 4 weeks without any symptoms after treatment with silymarin capsules and bifendate, which helps reduce ALT level and protects the liver from further injury. A pregnant woman developed azithromycin-induced intrahepatic cholestasis. Physicians should be aware of this side effect of azithromycin, which is widely prescribed. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  16. Solitary intrahepatic bile-duct cyst presenting with Jaundice

    International Nuclear Information System (INIS)

    Park, Jeong Mi; Chun, Ki Sung; Ha, Hyun Kwon; Shinn, Kyung Sub; Bahk, Yong Whee; Kim, Jun Gi

    1989-01-01

    Caroli's disease is an uncommon condition, and characterized by congenital segmental saccular dilatation of intrahepatic bile ducts. A case of Caroli's disease, manifested by only a large communicating cystic dilatation of left intrahepatic bile duct and causing extrinsic pressure over the extrahepatic bile duct, is presented. The patient was 43-year-old housewife, hospitalized because of abdominal distension and severe jaundice. To relieve jaundice and alleviate surgical intervention, percutaneous drainage of the bile-duct cyst preceded surgery

  17. Homocysteine deteriorates intrahepatic derangement and portal-systemic collaterals in cirrhotic rats.

    Science.gov (United States)

    Tung, Hung-Chun; Hsu, Shao-Jung; Tsai, Ming-Hung; Lin, Te-Yueh; Hsin, I-Fang; Huo, Te-Ia; Lee, Fa-Yauh; Huang, Hui-Chun; Ho, Hsin-Ling; Lin, Han-Chieh; Lee, Shou-Dong

    2017-01-01

    In liver cirrhosis, the altered levels of vasoactive substances, especially endothelin-1 (ET-1) and nitric oxide (NO) lead to elevated intrahepatic resistance, increased portal-systemic collaterals and abnormal intra- and extra-hepatic vascular responsiveness. These derangements aggravate portal hypertension-related complications such as gastro-oesophageal variceal bleeding. Homocysteine, a substance implicated in cardiovascular diseases, has been found with influences on vasoresponsiveness and angiogenesis. However, their relevant effects in liver cirrhosis have not been investigated. In the present study, liver cirrhosis was induced by common bile duct ligation (BDL) in Sprague-Dawley rats. In acute study, the results showed that homocysteine enhanced hepatic vasoconstriction to ET-1 but decreased portal-systemic collateral vasocontractility to arginine vasopressin (AVP). Homocysteine down-regulated hepatic phosphorylated endothelial NO synthase (p-eNOS) and p-Akt protein expressions. Inducible NOS (iNOS) and cyclooxygenase (COX)-2 expressions were up-regulated by homocysteine in splenorenal shunt (SRS), the most prominent intra-abdominal collateral vessel. In chronic study, BDL or thioacetamide (TAA) rats received homocysteine or vehicle for 14 days. The results revealed that homocysteine increased hepatic collagen fibre deposition and fibrotic factors expressions in both BDL- and TAA-induced liver fibrotic rats. Portal-systemic shunting and expressions of mesenteric angiogenetic factors [vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), PDGF receptor β (PDGFRβ) and p-eNOS] were also increased in BDL rats. In conclusion, homocysteine is harmful to vascular derangements and liver fibrosis in cirrhosis. © 2016 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society.

  18. CT findings of intrahepatic cholangiocarcinoma associated with hepatolithiasis

    International Nuclear Information System (INIS)

    Min, Byung Cheol; Yoon, Kwon Ha; Kim, Chang Guhn; Roh, Byung Suck; Won, Jong Jin

    1999-01-01

    To assess the CT findings of intrahepatic cholangiocarcinoma associated with hepatolithiasis. The CT features of 26 patients with cholangiocarcinoma and hepatolithiasis were reviewed and compared with those of 23 patients with intrahepatic stones alone, acting as control subjects. CT findings were analyzed for tumor appearance and adjacency to hepatolithiasis. We studied clinical findings, noting the presence or absence of wall thickening or soft tissue attenuation within the bile duct, the luminal diameter of dilated bile duct, and the presence of periductal enhancement, and compared these with the findings for control groups. CT images of the tumor revealed a hepatic low-attenuating mass with peripheral rim enhancement(n = 14,54 %), or periductal thickening, or low-attenuating lesions in segmental dilatation of intrahepataic bile ducts(n = 12, 46 %). Most hepatic tumors were seen in areas adjacent to hepatolithiasis, or in a bile duct. Compared with control groups, patients with cholangiocarcinoma were old (p 0.05). When an intrahepatic low-attenuating mass, or peridutal thickening and low-attenuating lesions in segmental dilated intrahepatic duct are found associated in adjacent intrahepatic stones, intrahepatic cholangiocarcinoma should be considered

  19. Evaluation of computed tomography on diagnosis of portosystemic collaterals in portal hypertension

    International Nuclear Information System (INIS)

    Ohe, Takashi; Kuronuma, Yukio; Fujiwara, Hiromichi; Ibuki, Yoshikazu; Maehara, Misao; Sugaya, Hitoshi; Harada, Takashi; Iwasaki, Naoya; Hyodo, Haruo

    1987-01-01

    We analyzed the diagnostic capability of CT to demonstrate the eight types of portosystemic collaterals in patient with portal hypertension. A total of 62 patients with portal hypertension underwent both CT and conventional angiography. All of these eight types of collaterals, such as esophageal varices, paraesophageal varices, coronary and short gastric pathway, dilated vein in splenic hilus, splenorenal and splenoretroperitoneal pathway, paraumbilical pathway and small veins on liver surface, caput medusa, azygos system, were demonstrated on CT better than angiography, except coronary and short gastric pathyway. And we also made comparative study of CT with per-rectal portal scintigraphy in 9 patients who underwent both studies. In 7 of these 9 patients, portosystemic collaterals were recognized on scintigram less than CT. In conclusion, CT provides much qualified images than conventional angiography or per-rectal portal scintigraphy in evaluating portosystemic collaterals. (author)

  20. Cerebral arteriovenous shunts in children.

    Science.gov (United States)

    Toma, Ahmed K; Davagnanam, Indran; Ganesan, Vijeya; Brew, Stefan

    2013-11-01

    Intracranial arteriovenous shunts (AVSs) in children can be divided into pial arteriovenous malformations, vein of Galen malformations, and arteriovenous fistulae (AVF). Dural AVF and dural sinus malformations are rare entities within this group. The relative immaturity of the anatomy and physiology of the neonatal and infant brain results in the inability of the hydrovenous system to compensate in the face of such disorders. Thus, the clinical presentation reflects this difference in the underlying anatomy, physiology, and disorder between children and adults. In this article, we briefly review the presentation, natural history and management of these entities. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. 30 CFR 57.6401 - Shunting.

    Science.gov (United States)

    2010-07-01

    ... HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Explosives Electric Blasting-Surface and Underground § 57.6401 Shunting. Except during testing— (a) Electric detonators shall be kept shunted until connected to the blasting line or wired into a blasting round; (b) Wired rounds shall be...

  2. Comparison of Quality Metrics for Pediatric Shunt Surgery and Proposal of the Negative Shunt Revision Rate.

    Science.gov (United States)

    Beez, Thomas; Steiger, Hans-Jakob

    2018-01-01

    Shunt surgery is common in pediatric neurosurgery and is associated with relevant complication rates. We aimed to compare previously published metrics in a single data set and propose the Negative Shunt Revision Rate (NSRR), defined as proportion of shunt explorations revealing a properly working system, as a new quality metric. Retrospective analysis of our shunt surgery activity in 2015 was performed. Demographic, clinical, and radiologic variables were extracted from electronic medical notes. Surgical Activity Rate, Revision Quotient, 30-day shunt malfunction rate, 90-day global shunt revision rate, Preventable Shunt Revision Rate, and novel NSRR were calculated. Of 60 shunt operations analyzed, 18 (39%) were new shunt insertions, and 42 (70%) were revisions. Median age was 18 months (range, 0.03-204 months), and main etiologies were posthemorrhagic (n = 16; 41%), congenital (n = 11; 28%), and tumor-associated (n = 8; 21%) hydrocephalus. Within 90 days after index surgery, 13 shunt failures occurred, predominantly owing to proximal failure (n = 6; 46%). Surgical Activity Rate was 0.127, Revision Quotient was 2.333, 30-day shunt malfunction rate was 0.166, 90-day global shunt revision rate was 21.7%, and Preventable Shunt Revision Rate was 38.5%. NSRR was 7.1%. Our results correlate with published values and offer measurement of quality that can be compared across studies and considered patient-oriented, easily measurable, and potentially modifiable. We propose NSRR as a new quality metric, covering an aspect of shunt surgery that was not addressed previously. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. MR imaging of syringoperitoneal and syringosubarachnoid shunts

    International Nuclear Information System (INIS)

    Hasso, A.N.; Kucharczyk, W.; Mall, J.C.; Colombo, N.; Newton, T.H.; Norman, D.

    1986-01-01

    The authors utilized MR imaging for the evaluation of syringohydromelic shunt procedures in 16 patients. Four characteristic MR imaging findings were seen: ''tethering'' of the spinal cord posteriorly at the site of laminectomy and placement of the shunt tube distortion of the usual elliptical shape of the spinal cord at the site of the shunt, a ''snake-eyes'' appearance of the cord on transverse images which corresponded to the position of the shunt within or next to a collapsed syringohydromelic cavity, and a generous amount of subachnoid space surrounding the collapsed portion of the cavity. Occasionally the shunt could not be visualized on sagittal images but could be seen on transverse images. In the majority of cases, the MR imaging findings were sufficiently characteristic to warrant accurate diagnosis

  4. Shunt resistance for deflecting magnets

    International Nuclear Information System (INIS)

    Sato, Shigeru

    1981-01-01

    The SOR-RING main magnet system consists of 8 deflecting magnets and 4 sets of three quadrupole magnets, each. The stability of magnet current is about 0.02 percent per day. The currents of magnets are adjustable simultaneously. The current-magnetic field relation for a deflecting magnet was measured. The magnetic field of 11.4 kG was obtained at the current of 470 A. This field corresponds to the electron energy of 376 MeV for the present SOR-RING. For the fine adjustment of the field of deflecting magnets, shunt resistors were equipped parallel to the magnet coils. The magnet current is adjustable by varying the value of resistance. The maximum adjustable range of the current is 1 percent. The field intensity was measured in relation to shunt resistance with a rotating coil flux meter. A slight difference was observed between the designed and the measured values. However this difference did not affect on the practical operation of SOR-RING. (Kato, T.)

  5. Treatment of intrahepatic stones with shock wave lithotripsy

    International Nuclear Information System (INIS)

    Martin, L.G.; Amerson, J.R.; Ambrose, S.S.; Alspaugh, J.P.; Chuang, V.P.; Casarella, W.J.

    1987-01-01

    Extracorporeal shock wave lithotripsy administered with a renal lithotriptor was used for the successful removal of intrahepatic biliary stones in two patients with Oriental cholangiohepatitis. Both patients had undergone multiple surgical explorations and multiple attempts at percutaneous stone removal. Targeting of the stones was facilitated by placing the tip of an angiographic guide wire, inserted through a transhepatic catheter, adjacent to the stone. Shock waves of 16-18 keV were applied. The patients were monitored with serial vital signs, chest radiography, liver chemistry profiles, and MR imaging. No major adverse reaction was detected in either patient. Limitations to the use of lithography for intrahepatic stone removal include patient body size, target-skin disease, location of the stones, and potential injury to the lung base. The authors' preliminary experience suggests that the lithtripsy can greatly facilitate the treatment of intrahepatic stones in selected patients

  6. Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices

    Energy Technology Data Exchange (ETDEWEB)

    Kodama, Hideaki [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Aikata, Hiroshi, E-mail: aikata@hiroshima-u.ac.jp [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Takaki, Shintaro; Azakami, Takahiro; Katamura, Yoshio; Kawaoka, Tomokazu; Hiramatsu, Akira; Waki, Koji; Imamura, Michio; Kawakami, Yoshiiku; Takahashi, Shoichi [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Toyota, Naoyuki; Ito, Katsuhide [Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Chayama, Kazuaki [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan)

    2010-11-15

    Objective: To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment. Methods: Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n = 24) and no-change (n = 25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates. Results: The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P = 0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P = 0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P = 0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P = 0.435). Conclusion: Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.

  7. Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices

    International Nuclear Information System (INIS)

    Kodama, Hideaki; Aikata, Hiroshi; Takaki, Shintaro; Azakami, Takahiro; Katamura, Yoshio; Kawaoka, Tomokazu; Hiramatsu, Akira; Waki, Koji; Imamura, Michio; Kawakami, Yoshiiku; Takahashi, Shoichi; Toyota, Naoyuki; Ito, Katsuhide; Chayama, Kazuaki

    2010-01-01

    Objective: To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment. Methods: Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n = 24) and no-change (n = 25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates. Results: The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P = 0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P = 0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P = 0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P = 0.435). Conclusion: Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.

  8. Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts--case series and literature review.

    LENUS (Irish Health Repository)

    Abubaker, Khalid

    2012-02-01

    OBJECTIVES: Idiopathic intracranial hypertension (IIH) is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken to review our experience in the treatment of IIH by neuronavigation-assisted ventriculoperitoneal (VP) shunts with programmable valves as compared to lumboperitoneal (LP) shunts. METHODS: A retrospective chart review was conducted on 25 patients treated for IIH between 2001 and 2009. Age, sex, clinical presentation, methods of treatment and failure rates were recorded. RESULTS: Seventy-two per cent were treated initially with LP shunts. Failure rate was 11% in this group. Neuronavigation-assisted VP shunts were used to treat 28%. In this group, the failure rate was 14%. CONCLUSION: Our experience indicates that both LP shunts and VP shuts are effective in controlling all the clinical manifestations of IIH in the immediate postoperative period. Failure rates are slightly higher for VP shunts (14%) than LP shunts (11%). However, revision rates are higher with LP shunts (60%) than with VP shunts (30%).

  9. Ventriculosubgaleal shunt in the management of obstructive ...

    African Journals Online (AJOL)

    Wael M. Moussa

    2012-10-05

    Oct 5, 2012 ... ORIGINAL ARTICLE. Ventriculosubgaleal shunt in the management of obstructive hydrocephalus caused by cerebellar infarction. Wael M. Moussa *, Ahmed Farhoud. 1. Department of Neurosurgery, Faculty of Medicine, Alexandria University, Egypt. Received 21 February 2012; accepted 18 May 2012.

  10. Radiofrequency Wire Recanalization of Chronically Thrombosed TIPS

    Energy Technology Data Exchange (ETDEWEB)

    Majdalany, Bill S., E-mail: bmajdala@med.umich.edu [University of Michigan Health System, Division of Interventional Radiology, Department of Radiology (United States); Elliott, Eric D., E-mail: eric.elliott@osumc.edu [The Ohio State University Wexner Medical Center, Division of Interventional Radiology, Department of Radiology (United States); Michaels, Anthony J., E-mail: Anthony.michaels@osumc.edu; Hanje, A. James, E-mail: James.Hanje@osumc.edu [The Ohio State University Wexner Medical Center, Division of Gastroenterology and Hepatology, Department of Medicine (United States); Saad, Wael E. A., E-mail: wsaad@med.umich.edu [University of Michigan Health System, Division of Interventional Radiology, Department of Radiology (United States)

    2016-07-15

    Radiofrequency (RF) guide wires have been applied to cardiac interventions, recanalization of central venous thromboses, and to cross biliary occlusions. Herein, the use of a RF wire technique to revise chronically occluded transjugular intrahepatic portosystemic shunts (TIPS) is described. In both cases, conventional TIPS revision techniques failed to revise the chronically thrombosed TIPS. RF wire recanalization was successfully performed through each of the chronically thrombosed TIPS, demonstrating initial safety and feasibility in this application.

  11. Endoscopic Third Ventriculostomy in Previously Shunted Children

    Directory of Open Access Journals (Sweden)

    Eva Brichtova

    2013-01-01

    Full Text Available Endoscopic third ventriculostomy (ETV is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%. There were two serious complications (4.7%—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

  12. Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts--case series and literature review.

    LENUS (Irish Health Repository)

    Abubaker, Khalid

    2011-02-01

    Idiopathic intracranial hypertension (IIH) is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken to review our experience in the treatment of IIH by neuronavigation-assisted ventriculoperitoneal (VP) shunts with programmable valves as compared to lumboperitoneal (LP) shunts.

  13. Cholecystitis in an intrahepatic gallbladder. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Schmahmann, J.D.; Dent, D.M.; Mervis, B.; Kottler, R.E. (Cape Town Univ. (South Africa))

    1982-12-25

    A case of cholecystitis in an intrahepatic gallbladder with concurrent choledocholithiasis is reported. The patient initially presented with pyrexia of unknown origin and subsequently with suppurative cholangitis; the diagnosis was resolved pre-operatively using contemporary techniques of gallbladder delineation. Simple drainage of the gallbladder with choledocholithotomy proved effective.

  14. [Diagnosis and therapy of blood coagulation disorders in intrahepatic cholestasis].

    Science.gov (United States)

    Herre, H D; Engelmann, C; Wiken, H P

    1976-01-01

    The reduction of prothrombin level below 5% in a patient with intrahepatic cholestasis of pregnancy is reported. The necessity of controlling the Quick level or better factors II, VII, IX and X is discussed. A well-timed Vitamin K therapy in all cases with impaired secretion of bile during pregnancy is recommended.

  15. An Exceptional Case of Spontaneous Fistulization of an Intrahepatic ...

    African Journals Online (AJOL)

    ADMIN

    Intrahepatic Biliary Cyst in to the Colon, Operated Tikur. Anbessa Specialized Hospital, Ethiopia - A Case Report. Nebyou Seyoum, Feron Getachew. 1Department of surgery, Tikur Anbessa Specialized Hospital, Addis Ababa. University, Addis Ababa, Ethiopia. Correspondence to: Nebyou Seyoum, mail: nebyouss@yahoo.

  16. GABA Shunt in Durum Wheat

    Directory of Open Access Journals (Sweden)

    Petronia Carillo

    2018-02-01

    Full Text Available Plant responses to salinity are complex, especially when combined with other stresses, and involve many changes in gene expression and metabolic fluxes. Until now, plant stress studies have been mainly dealt only with a single stress approach. However, plants exposed to multiple stresses at the same time, a combinatorial approach reflecting real-world scenarios, show tailored responses completely different from the response to the individual stresses, due to the stress-related plasticity of plant genome and to specific metabolic modifications. In this view, recently it has been found that γ-aminobutyric acid (GABA but not glycine betaine (GB is accumulated in durum wheat plants under salinity only when it is combined with high nitrate and high light. In these conditions, plants show lower reactive oxygen species levels and higher photosynthetic efficiency than plants under salinity at low light. This is certainly relevant because the most of drought or salinity studies performed on cereal seedlings have been done in growth chambers under controlled culture conditions and artificial lighting set at low light. However, it is very difficult to interpret these data. To unravel the reason of GABA accumulation and its possible mode of action, in this review, all possible roles for GABA shunt under stress are considered, and an additional mechanism of action triggered by salinity and high light suggested.

  17. GABA Shunt in Durum Wheat.

    Science.gov (United States)

    Carillo, Petronia

    2018-01-01

    Plant responses to salinity are complex, especially when combined with other stresses, and involve many changes in gene expression and metabolic fluxes. Until now, plant stress studies have been mainly dealt only with a single stress approach. However, plants exposed to multiple stresses at the same time, a combinatorial approach reflecting real-world scenarios, show tailored responses completely different from the response to the individual stresses, due to the stress-related plasticity of plant genome and to specific metabolic modifications. In this view, recently it has been found that γ-aminobutyric acid (GABA) but not glycine betaine (GB) is accumulated in durum wheat plants under salinity only when it is combined with high nitrate and high light. In these conditions, plants show lower reactive oxygen species levels and higher photosynthetic efficiency than plants under salinity at low light. This is certainly relevant because the most of drought or salinity studies performed on cereal seedlings have been done in growth chambers under controlled culture conditions and artificial lighting set at low light. However, it is very difficult to interpret these data. To unravel the reason of GABA accumulation and its possible mode of action, in this review, all possible roles for GABA shunt under stress are considered, and an additional mechanism of action triggered by salinity and high light suggested.

  18. Simulation model for port shunting yards

    Science.gov (United States)

    Rusca, A.; Popa, M.; Rosca, E.; Rosca, M.; Dragu, V.; Rusca, F.

    2016-08-01

    Sea ports are important nodes in the supply chain, joining two high capacity transport modes: rail and maritime transport. The huge cargo flows transiting port requires high capacity construction and installation such as berths, large capacity cranes, respectively shunting yards. However, the port shunting yards specificity raises several problems such as: limited access since these are terminus stations for rail network, the in-output of large transit flows of cargo relatively to the scarcity of the departure/arrival of a ship, as well as limited land availability for implementing solutions to serve these flows. It is necessary to identify technological solutions that lead to an answer to these problems. The paper proposed a simulation model developed with ARENA computer simulation software suitable for shunting yards which serve sea ports with access to the rail network. Are investigates the principal aspects of shunting yards and adequate measures to increase their transit capacity. The operation capacity for shunting yards sub-system is assessed taking in consideration the required operating standards and the measure of performance (e.g. waiting time for freight wagons, number of railway line in station, storage area, etc.) of the railway station are computed. The conclusion and results, drawn from simulation, help transports and logistics specialists to test the proposals for improving the port management.

  19. Portal hypertension: a review of portosystemic collateral pathways and endovascular interventions

    International Nuclear Information System (INIS)

    Pillai, A.K.; Andring, B.; Patel, A.; Trimmer, C.; Kalva, S.P.

    2015-01-01

    The portal vein is formed at the confluence of the splenic and superior mesenteric vein behind the head of the pancreas. Normal blood pressure within the portal system varies between 5 and 10 mmHg. Portal hypertension is defined when the gradient between the portal and systemic venous blood pressure exceeds 5 mmHg. The most common cause of portal hypertension is cirrhosis. In cirrhosis, portal hypertension develops due to extensive fibrosis within the liver parenchyma causing increased vascular resistance. In addition, the inability of the liver to metabolise certain vasodilators leads to hyperdynamic splanchnic circulation resulting in increased portal blood flow. Decompression of the portal pressure is achieved by formation of portosystemic collaterals. In this review, we will discuss the pathophysiology, anatomy, and imaging findings of spontaneous portosystemic collaterals and clinical manifestations of portal hypertension with emphasis on the role of interventional radiology in the management of complications related to portal hypertension

  20. Balanced calibration of resonant shunt circuits for piezoelectric vibration control

    DEFF Research Database (Denmark)

    Høgsberg, Jan; Krenk, Steen

    2012-01-01

    Shunting of piezoelectric transducers and suitable electric circuits constitutes an effective passive approach to resonant vibration damping of structures. Most common design concepts for resonant resistor-inductor (RL) shunt circuits rely on either maximization of the attainable modal damping...

  1. Laparoscopic insertion of lumbar peritoneal shunts for idiopathic ...

    African Journals Online (AJOL)

    Background: The treatment of idiopathic intracranial hypertension varies from simple observation to the mechanical diversion of cerebrospinal fluid. Objective: To describe our technique and initial experience with the laparoscopic insertion of lumbarperitoneal shunts. Conclusion: Lumbarperitoneal shunts should be ...

  2. Direct intrahepatic portocaval shunt creation via the inter-strut space of the inferior vena cava stent

    International Nuclear Information System (INIS)

    Tsauo, J.; Yu, Y.; Luo, X.; Wang, Z.; Liu, L.; Li, X.

    2014-01-01

    Highlights: • The feasibility of DIPS creation through an IVC stent was investigated. • DIPS creation through the IVC stent was successful in all four patients. • DIPS creation through the IVC stent is feasible

  3. Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter

    NARCIS (Netherlands)

    Overbosch, E. H.; Pattynama, P. M.; Aarts, H. J.; Schultze Kool, L. J.; Hermans, J.; Reekers, J. A.

    1996-01-01

    PURPOSE: To evaluate mechanical thrombectomy of occluded hemodialysis access shunts with a recently developed hydrodynamic device. MATERIALS AND METHODS: Sixty-five thrombosed hemodialysis access shunts were treated in 49 patients. The shunts were of three types: Brescia-Cimino fistulas (24

  4. an unusual cause of post-shunt intestinal obstruction

    African Journals Online (AJOL)

    Ventriculoperitoneal (VP) shunt is the most widely used procedure for the management of hydrocephalus. Various complications, including disconnection, breaking, kinking and tip occlusion of the tube, cerebrospinal fluid loculation, shunt infection, intestinal obstruction, migration of the shunt and perforation of the internal ...

  5. Biophysical shunt theory for neuropsychopathology: Part I.

    Science.gov (United States)

    Naisberg, Y; Avnon, M; Weizman, A

    1995-11-01

    We present a new model of the origin of schizophrenia based on biophysical ionic shunts in neuronal (electrical) pathways. Microstructural and molecular evidence is presented for the way in which changes in the neuronal membrane ionic channels may facilitate membrane property rearrangement, leading to a change in the density and composition of the ion channel charge which in turn causes a change in ionic flow orientation and distribution. We suggest that, under abnormal conditions, ionic flow shunts are created which redirect the biophysical collateral neuronal (electrical) pathways, resulting in psychiatric signs and symptoms. This model is complementary to the biological basis of schizophrenia.

  6. Distal splenorenal shunt with partial spleen resection

    Directory of Open Access Journals (Sweden)

    Gajin Predrag

    2007-01-01

    Full Text Available Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%, while in the second group there were 13 patients with splenomegaly (68%. Before surgery, the mean platelet count in the first group was 51.6±18.3x109/l, to 118.6±25.4x109/l postoperatively. The mean platelet count in the second group was 67.6±22.8x109/l, to 87.8±32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05. Comparing the

  7. Ventricular shunt infections: Immunopathogenesis and clinical management

    Science.gov (United States)

    Gutierrez-Murgas, Yenis; Snowden, Jessica N.

    2014-01-01

    Ventricular shunts are the most common neurosurgical procedure performed in the United States. This hydrocephalus treatment is often complicated by infection of the device with biofilm-forming bacteria. In this review, we discuss the pathogenesis of shunt infection, as well as the implications of the biofilm formation on treatment and prevention of these infections. Many questions remain, including the contribution of glia and the impact of inflammation on developmental outcomes following infection. Immune responses within the CNS must be carefully regulated to contain infection while minimizing bystander damage; further study is needed to design optimal treatment strategies for these patients. PMID:25156073

  8. Endoscopic observations of blocked ventriculoperitoneal (VP) shunt: a step toward better understanding of shunt obstruction and its removal.

    Science.gov (United States)

    Singh, Daljit; Saxena, Anurag; Jagetia, Anita; Singh, Hukum; Tandon, Monica S; Ganjoo, Pragati

    2012-10-01

    Most of our understanding of ventriculoperitoneal (VP) shunt blockage (ventricular end) is based on in vitro studies of blocked VP shunts. Not much information is available regarding the in vivo changes that occur in the tube and in the surrounding ventricle. The primary aim of our study was to observe and analyse these changes, directly, through the endoscope, in patients with blocked shunts undergoing an endoscopic third ventriculostomy (ETV). Based on these findings, we have also suggested criteria for safe removal of the VP shunt tube following ETV. ETV was performed with standard technique in patients with blocked VP shunt. The ventricular end of the shunt tube was inspected through the endoscope, for changes in ventricle linings as well as in the shunt tube. These changes were correlated with the age of the patient, etiology of HC, type or make of the shunt tube, duration of shunt placement to ETV and the CSF findings. Fifty-three patients of blocked VP shunt underwent ETV from July 2006 to April 2010. Thirty patients had Chhabra (CH) V P Shunt (Surgiwear, India) and 23 had ceredrain (CD) shunt (Hindustan Latex, India). The age of the patients ranged from 2 months to 60 years (mean--13.33 years.). Various causes of hydrocephalus (HC) included congenital hydrocephalus (aqueductal stenosis) in 18 patients, post-meningitis hydrocephalus (PMH) in 32 cases, neuro-cysticercosis (NCC) in 2 patients and intraventricular haemorrhagic (IVH) in 1 patient. Clinical and radiological improvement occurred in 33 (62.21%), and 24 (45%) patients, respectively. Freedom from shunt was attained in 20 (38%) patients. The changes around the shunt tube were seen in 41 (77%). Hyperaemia and neovascularised ependyma was seen in 20 (37%) and 15 (28%) patients. Encasement of the tube was seen in 41%. Ependymal growth and neovascularised shunt tubes were noticed in 15% each. Choroid plexus blocking the tube was seen in only four cases (7%). VP shunt was revised in 14 patients (26

  9. Efficacy of intrahepatic absolute alcohol in unrespectable hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Farooqi, J.I.; Hameed, K.; Khan, I.U.; Shah, S.

    2001-01-01

    To determine efficacy of intrahepatic absolute alcohol injection in researchable hepatocellular carcinoma. A randomized, controlled, experimental and interventional clinical trial. Gastroenterology Department, PGMI, Hayatabad Medical Complex, Peshawar during the period from June, 1998 to June, 2000. Thirty patients were treated by percutaneous, intrahepatic absolute alcohol injection sin repeated sessions, 33 patients were not given or treated with alcohol to serve as control. Both the groups were comparable for age, sex and other baseline characteristics. Absolute alcohol therapy significantly improved quality of life of patients, reduced the tumor size and mortality as well as showed significantly better results regarding survival (P< 0.05) than the patients of control group. We conclude that absolute alcohol is a beneficial and safe palliative treatment measure in advanced hepatocellular carcinoma (HCC). (author)

  10. Prominent porto-systemic collateral pathways in patients with portal hypertension: demonstration by gadolinium-enhanced magnetic resonance angiography

    International Nuclear Information System (INIS)

    Caldana, Rogerio Pedreschi; Bezerra, Alexandre Araujo Sergio; Cecin, Alexnadre Oliveira; Souza, Luis Ronan Marques Ferreira de; Goldman, Susan Menasce; D'Ippolito, Giuseppe; Szejnfeld, Jacob

    2003-01-01

    To demonstrate the usefulness of gadolinium-enhanced magnetic resonance angiography in the evaluation of prominent porto-systemic collateral pathways. We reviewed the images from 40 patients with portal hypertension studied with gadolinium-enhanced magnetic resonance angiography and selected illustrative cases of prominent porto-systemic collateral pathways. The scans were performed using high field equipment (1.5 Tesla) and a 3 D volume technique. Image were obtained after intravenous injection of paramagnetic contrast media using a power injector. Magnetic resonance angiography demonstrated with precision the porto-systemic collateral pathways, particularly when investigating extensive territories or large vessels. The cases presented show the potential of this method in the investigation of patients with portal hypertension. Gadolinium-enhanced magnetic resonance angiography is a useful method for the evaluation of patients with portal hypertension and prominent collateral pathways. (author)

  11. Abnormalities of intrahepatic bile ducts in extrahepatic biliary atresia.

    Science.gov (United States)

    Raweily, E A; Gibson, A A; Burt, A D

    1990-12-01

    The infantile cholangiopathies are a group of conditions associated with neonatal jaundice, which include extrahepatic biliary atresia, paucity of intra-hepatic bile ducts and disorders associated with persistence of fetal biliary structures, the so-called ductal plate malformations. Although previously regarded as distinct entities, it has recently been suggested that they may represent parts of a disease spectrum in which the principal process is one of bile duct destruction, the morphological manifestations in individual cases being influenced by the stage of intra-uterine development at which such injury occurs and by the site within the biliary system at which there is maximum damage. To further examine this concept, we have studied liver biopsy specimens from 37 neonates with extrahepatic biliary atresia, with particular reference to abnormalities of the intrahepatic bile ducts. Paucity of intrahepatic ducts, defined as a bile duct: portal tract ratio of less than 0.9, was identified in six cases (16.2%). In eight cases (21.6%) we found concentric tubular ductal structures similar to those observed in ductal plate malformations. In one case, both abnormalities could be demonstrated. Our findings support the concept that there is overlap between the various types of infantile cholangiopathy.

  12. [Primary intrahepatic lithiasis: indications and results of liver resection].

    Science.gov (United States)

    Clemente, Gennaro; De Rose, Agostino Maria; Giordano, Marco; Mele, Caterina; Vellone, Maria; Ardito, Francesco; Murazio, Marino; Giuliante, Felice; Giovannini, Ivo; Nuzzo, Gennaro

    2009-01-01

    The aim of this study was to review a series of patients submitted to hepatectomy for primary intrahepatic lithiasis to evaluate early and late results with an assessment of indications, methods and long-term outcomes. From January 1992 to December 2007, 40 patients (25 males and 15 females with a mean age of 51 years) underwent surgery for primary intrahepatic lithiasis in our Hepato-biliary Surgery Unit. Left hepatectomy (20 patients) and left lateral segmentectomy (12 patients) were the most common procedures performed. A cholangiocarcinoma was found in 4 patients (10%) and only two of these underwent liver resection, while an exploratory laparotomy was performed in the remaining two patients for an unresectable tumour, unexpected before surgery. There was no postoperative mortality. The morbidity rate was 22.5% with a prevalence of infectious complications related to bile leakage. Long-term results, assessed in 30 patients with a follow-up longer than 12 months, were good or fair in 28 patients (93.3%). Primary intrahepatic lithiasis is diagnosed increasingly in Western countries as a result of the improvement in imaging techniques. The stones originate inside the liver at the level of dilatations of the bile ducts above congenital strictures of the main hilar ducts. Biliary pain and cholangitis are the most common presenting symptoms, whereas cholangiocarcinoma represents the unfavourable complication of the disease. In the majority of cases, a single liver lobe or segment is involved and liver resection allows definitive treatment of the disease and prevention of cancer.

  13. Charging effects in the inductively shunted Josephson junction.

    Science.gov (United States)

    Koch, Jens; Manucharyan, V; Devoret, M H; Glazman, L I

    2009-11-20

    The choice of impedance used to shunt a Josephson junction determines if the charge transferred through the circuit is quantized: a capacitive shunt renders the charge discrete, whereas an inductive shunt gives continuous charge. This discrepancy leads to a paradox in the limit of large inductances L. We show that while the energy spectra of the capacitively and inductively shunted junction are vastly different, their high-frequency responses become identical for large L. Inductive shunting thus opens the possibility to observe charging effects unimpeded by charge noise.

  14. Nonconventional mesocaval prosthetic shunt interposition in ...

    African Journals Online (AJOL)

    female infant. Ghazwani Salman, Arnauld Delarue and Bertrand Roquelaure. Surgical treatment of portal hypertension in infants is challenging because of the high risk of shunt thrombosis. A 10-kg female infant underwent six failed procedures before being successfully ... complications of prematurity including anemia and.

  15. Resonant Electromagnetic Shunt Damping of Flexible Structures

    DEFF Research Database (Denmark)

    Høgsberg, Jan Becker

    2016-01-01

    resonance and a resistor to dissipate the correct amount of vibration energy. The modal interaction with residual vibration forms not targeted by the resonant shunt is represented by supplemental flexibility and inertia terms. This leads to modified calibration formulae that maintain the desired damping...

  16. Intrinsically shunted Josephson junctions for electronics applications

    Science.gov (United States)

    Belogolovskii, M.; Zhitlukhina, E.; Lacquaniti, V.; De Leo, N.; Fretto, M.; Sosso, A.

    2017-07-01

    Conventional Josephson metal-insulator-metal devices are inherently underdamped and exhibit hysteretic current-voltage response due to a very high subgap resistance compared to that in the normal state. At the same time, overdamped junctions with single-valued characteristics are needed for most superconducting digital applications. The usual way to overcome the hysteretic behavior is to place an external low-resistance normal-metal shunt in parallel with each junction. Unfortunately, such solution results in a considerable complication of the circuitry design and introduces parasitic inductance through the junction. This paper provides a concise overview of some generic approaches that have been proposed in order to realize internal shunting in Josephson heterostructures with a barrier that itself contains the desired resistive component. The main attention is paid to self-shunted devices with local weak-link transmission probabilities that are so strongly disordered in the interface plane that transmission probabilities are tiny for the main part of the transition region between two super-conducting electrodes, while a small part of the interface is well transparent. We discuss the possibility of realizing a universal bimodal distribution function and emphasize advantages of such junctions that can be considered as a new class of self-shunted Josephson devices promising for practical applications in superconducting electronics operating at 4.2 K.

  17. Nonconventional mesocaval prosthetic shunt interposition in ...

    African Journals Online (AJOL)

    15 Burch PT, Kaza AK, Lambert LM, Holubkov R, Shaddy RE, Hawkins JA. Clinical performance of decellularized cryopreserved valved allografts compared with standard allografts in the right ventricular outflow tract. The Annals of thoracic surgery 2010; 90:1301–1306. Nonconventional mesocaval prosthetic shunt Salman ...

  18. Train shunting at a workshop area

    DEFF Research Database (Denmark)

    Jacobsen, Per Munk; Pisinger, David

    2011-01-01

    We consider the problem of planning the shunting of train units at a railway workshop area. Before and after the maintenance check, a train unit is parked at a depository track. The problem is to schedule the trains to workshops and depot tracks in order to complete the repairs as soon as possibl...

  19. Complications of ventriculoperitoneal shunt in hydrocephalic children

    African Journals Online (AJOL)

    Department of Pediatric Surgery, Dr. Behçet Uz Children's. Hospital, and at the Department of Neurosurgery, Tepecik. Training Hospital. Management of these patients with special emphasis on the literature pertaining to the migration of shunt catheters into the scrotum is reviewed and discussed. Complications of intestinal ...

  20. Complications of ventriculoperitoneal shunt in hydrocephalic children

    African Journals Online (AJOL)

    These children were treated at the Department of Pediatric Surgery, Dr. Behc¸et Uz Children's Hospital, and at the Department of Neurosurgery, Tepecik Training Hospital. Management of these patients with special emphasis on the literature pertaining to the migration of shunt catheters into the scrotum is reviewed and ...

  1. Ga-67 scanning in the detection and localization of suppurative cholangitis complicating intrahepatic lithiasis

    International Nuclear Information System (INIS)

    Yeh, S.H.; Wang, S.J.; Chu, L.S.

    1983-01-01

    Ongoing studies continue. Our initial results indicate that suppurative cholangitis complicating intrahepatic lithiasis has a localized high uptake of Ga-67. Thus, Ga-67 liver scanning can serve as a useful technique for differentiating suppurative cholangitis from nonsuppurative form complicating intrahepatic lithiasis when the patients have the acute attack but without overwhelming sepsis

  2. Sequential scintiphotography with technetium-99m pyridoxylideneglutamate in the detection of intrahepatic lithiasis: concise communication

    International Nuclear Information System (INIS)

    Yeh, S.H.; Liu, O.K.; Huang, M.J.

    1980-01-01

    Sequential scintiphotography with Tc-99m pyridoxylideneglutamate was used to evaluate patients under strong suspicion of intrahepatic stones. The scintiphotos of 19 cases were analyzed. Results indicate that the sequential study reveals an excretion pattern pertinent to the diagnosis of intrahepatic stone. This simple and innocuous approach would be a useful screening technique for this disease

  3. Sequential scintiphotography with technetium-99m pyridoxylideneglutamate in the detection of intrahepatic lithiasis: concise communication

    Energy Technology Data Exchange (ETDEWEB)

    Yeh, S.H.; Liu, O.K.; Huang, M.J.

    1980-01-01

    Sequential scintiphotography with Tc-99m pyridoxylideneglutamate was used to evaluate patients under strong suspicion of intrahepatic stones. The scintiphotos of 19 cases were analyzed. Results indicate that the sequential study reveals an excretion pattern pertinent to the diagnosis of intrahepatic stone. This simple and innocuous approach would be a useful screening technique for this disease.

  4. Effect of electromagnetic navigated ventriculoperitoneal shunt placement on failure rates.

    Science.gov (United States)

    Jung, Nayoung; Kim, Dongwon

    2013-03-01

    To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement. All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma. A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test). The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

  5. Orbital Cellulitis Following Uncomplicated Aqueous Shunt Surgery.

    Science.gov (United States)

    Beck, Daniel E R; El-Assal, Karim S L; Doherty, Mark D; Wride, Nicholas K

    2017-02-01

    To date, there have only been 5 reported cases of orbital cellulitis following implantation of an aqueous tube shunt for glaucoma. Previously reported cases have involved eyes with significant comorbidities and successful management has often required the removal of the device alongside systemic antibiotic therapy. We present a 53-year-old man with severe orbital cellulitis, 3 months after routine implantation of a Baerveldt tube shunt for primary open angle glaucoma. The patient was managed medically, with topical and systemic antibiotic therapy. The patient went on to make a full recovery with the tube in situ. We report that a more conservative approach (without tube removal) to be successful in a case where there is no evidence of tube exposure. It is important to appreciate that in some cases of orbital cellulitis without clear signs of intraocular involvement, a tube can be left in situ.

  6. Angiography in distal spleno-renal shunts

    International Nuclear Information System (INIS)

    Wittrich, G.; Czembirek, H.; Appel, W.; Funovics, J.; Lechner, G.; Vienna Univ.; Vienna Univ.

    1980-01-01

    The conception of Warren's Shunt - selective decompression of esophageal varices while maintaining prograde portal flow - was controlled by pre- and postoperative angiographic examinations on 12 patients: No change in portal perfusion was established angiographically in ten of the patients. Two patients developed aneurysmatic, arterio-portal fistulae as a result of postoperative portal decompression. In one of these cases, a thrombosis of the portal vein with hepatofugal perfusion of the left gastric vein was detected. The postoperative examinations indicated functioning shunts in 9 out of 12 patients. These results formed the basis for the discussion regarding the value of visceral angiography in the selection of the surgical technique and regarding its value in control of therapy. Surgical questions concerning the visceral vascular anatomy can be answered sufficiently. Furthermore, celiac and mesenteric angiography yield information on portal hemodynamics. Nevertheless, the additional application of invasive scintigraphy seems to be necessary for establishing quantitative radiological parameters of prognostic relevance. (orig.) [de

  7. Angiography in distal spleno-renal shunts

    Energy Technology Data Exchange (ETDEWEB)

    Wittrich, G.; Czembirek, H.; Appel, W.; Funovics, J.; Lechner, G.

    1980-11-01

    The conception of Warren's Shunt - selective decompression of esophageal varices while maintaining prograde portal flow - was controlled by pre- and postoperative angiographic examinations on 12 patients: No change in portal perfusion was established angiographically in ten of the patients. Two patients developed aneurysmatic, arterio-portal fistulae as a result of postoperative portal decompression. In one of these cases, a thrombosis of the portal vein with hepatofugal perfusion of the left gastric vein was detected. The postoperative examinations indicated functioning shunts in 9 out of 12 patients. These results formed the basis for the discussion regarding the value of visceral angiography in the selection of the surgical technique and regarding its value in control of therapy. Surgical questions concerning the visceral vascular anatomy can be answered sufficiently. Furthermore, celiac and mesenteric angiography yield information on portal hemodynamics. Nevertheless, the additional application of invasive scintigraphy seems to be necessary for establishing quantitative radiological parameters of prognostic relevance.

  8. Active shunt capacitance cancelling oscillator circuit

    Science.gov (United States)

    Wessendorf, Kurt O.

    2003-09-23

    An oscillator circuit is disclosed which can be used to produce oscillation using a piezoelectric crystal, with a frequency of oscillation being largely independent of any shunt capacitance associated with the crystal (i.e. due to electrodes on the surfaces of the crystal and due to packaging and wiring for the crystal). The oscillator circuit is based on a tuned gain stage which operates the crystal at a frequency, f, near a series resonance frequency, f.sub.S. The oscillator circuit further includes a compensation circuit that supplies all the ac current flow through the shunt resistance associated with the crystal so that this ac current need not be supplied by the tuned gain stage. The compensation circuit uses a current mirror to provide the ac current flow based on the current flow through a reference capacitor that is equivalent to the shunt capacitance associated with the crystal. The oscillator circuit has applications for driving piezoelectric crystals for sensing of viscous, fluid or solid media by detecting a change in the frequency of oscillation of the crystal and a resonator loss which occur from contact of an exposed surface of the crystal by the viscous, fluid or solid media.

  9. ISOLATION AND PRIMARY CULTURES OF HUMAN INTRAHEPATIC BILE DUCTULAR EPITHELIUM

    Science.gov (United States)

    Demetris, A. J.; Markus, B. H.; Saidman, S.; Fung, J. J.; Makowka, L.; Graner, S.; Duquesnoy, R.; Starzl, T. E.

    2010-01-01

    SUMMARY A technique for the isolation of human intrahepatic bile ductular epithelium, and the establishment of primary cultures using a serum- and growth-factor-supplemented medium combined with a connective tissue substrata is described. Initial cell isolates and monolayer cultures display phenotypic characteristics of biliary epithelial cells (low molecular weight prekeratin positive; albumin, alphafetoprotein, and Factor VIII-related antigen negative). Ultrastructural features of the cultured cells show cell polarization with surface microvilli, numerous interepithelial junctional complexes and cytoplasmic intermediate prekeratin filaments. PMID:3131298

  10. Molecular Pathogenesis and Current Therapy in Intrahepatic Cholangiocarcinoma

    DEFF Research Database (Denmark)

    Høgdall, Dan Taksony Solyom; O'Rourke, Colm J; Taranta, Andrzej

    2016-01-01

    Intrahepatic cholangiocarcinoma (iCCA) comprises one of the most rapidly evolving cancer types. An underlying chronic inflammatory liver disease that precedes liver cancer development for several decades and creates a pro-oncogenic microenvironment frequently impairs progress in therapeutic...... approaches. Depending on the cellular target of malignant transformation, a large spectrum of molecular and morphological patterns is observed. As such, it is crucial to advance our existing understanding of the molecular pathogenesis of iCCA, particularly its genomic heterogeneity, to improve current...

  11. Side-to-side aorto-Gore-Tex central shunt.

    Science.gov (United States)

    Gates, R N; Laks, H; Johnson, K

    1998-02-01

    This report details our experience in 13 patients with a technical modification of the standard central shunt. The study was performed using a retrospective chart review approach. In our operation, the aorto-Gore-Tex (W.L. Gore & Assoc, Flagstaff, AZ) anastomosis is created in a side-to-side fashion with the free end of the Gore-Tex shunt being oversewn. All patients had echocardiographic evidence of shunt patency in the immediate postoperative period, and there have been no cases of late shunt occlusion at a mean follow-up period of 10 months. We believe this approach will yield patency rates equivalent to or better than those of the standard central shunt. The technique has the advantage of creating a short, straight-lying shunt that is less likely to kink or be injured on repeated sternotomy and in which flow may be more reliable.

  12. Medulloblastoma: seeding of VP shunt tract and peritoneum.

    Science.gov (United States)

    Pettersson, David; Schmitz, Kelli R; Pollock, Jeffrey M; Hopkins, Katharine L

    2012-03-30

    We report on a 5-year-old boy with seeding of the peritoneum and a ventriculoperitoneal shunt tract by anaplastic medulloblastoma. The role of ventriculoperitoneal shunting in the spread of primary central nervous system tumors has been controversial. In the case reported here, the unique distribution of tumor implants on ultrasound and multiplanar computed tomography gives further credence to the argument that ventriculoperitoneal shunting is a pathway for extraneural metastases of primary central nervous system tumors.

  13. Delayed incidental diagnosis of postoperative extradural hematoma following ventriculoperitoneal shunt

    Directory of Open Access Journals (Sweden)

    Vinay Byrappa

    2015-01-01

    Full Text Available Ventriculo peritoneal (VP shunt uncommonly complicates as intracranial hematomas which can still occur in patients with a functioning VP shunt leading to a delay in the diagnosis which can be extremely dangerous and lead to adverse outcomes. We report a case of an incidental diagnosis of delayed post-operative EDH following VP shunt in an young adult patient with a right cerebellar lesion and highlight the need for meticulous post-operative neurological examination.

  14. Glaucoma Mini-Shunt Implantation After Keratoplasty.

    Science.gov (United States)

    Ledesma-Gil, Jasbeth; García-Rodríguez, María de Los Ángeles; Gurria, Lulu U; Graue-Hernández, Enrique O; Navas, Alejandro

    2017-04-01

    To report the outcomes of patients who underwent miniature glaucoma shunt implantation after secondary glaucoma due to keratoplasty. Prospective study of consecutive clinical cases who underwent mini-glaucoma shunt implantation following keratoplasty. In brief, a fornix-based conjunctival flap was performed, approximately 50% thickness scleral flap. Mitomycin C 0.025% placed under Tenon's capsule. A 25-G needle created entry for mini-shunt. Ex-PRESS model P-50 was inserted. Scleral flap and conjunctiva were closed with 10-0 Nylon. STATA 8.0 and SPSS software were used for statistical analysis. Seventeen eyes of 17 patients with a mean age of 39.70 years (SD=18.33, range: 18 to 76). A total of 64.70% were male and 35.30% female. Eleven cases after penetrating keratoplasty, 3 cases after triple procedure, 2 after deep anterior lamellar keratoplasty, and 1 following endothelial keratoplasty. Most of the indications for keratoplasty were keratoconus in 9 cases (52.94%), 4 due to endothelial failure (23.52%), 3 cases of herpetic keratitis (17.64%), and 1 case of post-LASIK ectasia (5.88%). Mean preoperative intraocular pressure was 35.94 mm Hg with maximal medical therapy (SD=9.65, range: 18 to 55). Decreasing intraocular pressure to 12.76 mm Hg postoperatively (SD=2.51, range 10 to 18) (P=0.001). Mean follow-up after mini-glaucoma shunt implantation was 23.76 months (SD=8.73, range: 10 to 35 mo). Preoperative mean uncorrected distance visual acuity (UDVA) was 1.31±0.63 (20/408 Snellen) and postoperative mean UDVA was 0.85±0.40 (20/141 Snellen) (P=0.001). Preoperative mean corrected distance visual acuity (CDVA) was 0.83±0.76 (20/135 Snellen) and postoperative mean CDVA was 0.56±0.44 (20/72 Snellen) (P=0.032). Ex-PRESS miniature glaucoma shunt could be an alternative treatment in postkeratoplasty glaucoma resistant to medical treatment. This technique may be helpful, in trying to avoid corneal damage produced by conventional glaucoma procedures.

  15. Semi-shunt field emission in electronic devices

    Energy Technology Data Exchange (ETDEWEB)

    Karpov, V. G., E-mail: victor.karpov@utoledo.edu [Department of Physics and Astronomy, University of Toledo, Toledo, Ohio 43606 (United States); Shvydka, Diana, E-mail: diana.shvydka@utoledo.edu [Department of Radiation Oncology, University of Toledo, Toledo, Ohio 43606 (United States)

    2014-08-04

    We introduce a concept of semi-shunts representing needle shaped metallic protrusions shorter than the distance between a device electrodes. Due to the lightening rod type of field enhancement, they induce strong electron emission. We consider the corresponding signature effects in photovoltaic applications; they are: low open circuit voltages and exponentially strong random device leakiness. Comparing the proposed theory with our data for CdTe based solar cells, we conclude that stress can stimulate semi-shunts' growth making them shunting failure precursors. In the meantime, controllable semi-shunts can play a positive role mitigating the back field effects in photovoltaics.

  16. Superconducting fault current-limiter with variable shunt impedance

    Science.gov (United States)

    Llambes, Juan Carlos H; Xiong, Xuming

    2013-11-19

    A superconducting fault current-limiter is provided, including a superconducting element configured to resistively or inductively limit a fault current, and one or more variable-impedance shunts electrically coupled in parallel with the superconducting element. The variable-impedance shunt(s) is configured to present a first impedance during a superconducting state of the superconducting element and a second impedance during a normal resistive state of the superconducting element. The superconducting element transitions from the superconducting state to the normal resistive state responsive to the fault current, and responsive thereto, the variable-impedance shunt(s) transitions from the first to the second impedance. The second impedance of the variable-impedance shunt(s) is a lower impedance than the first impedance, which facilitates current flow through the variable-impedance shunt(s) during a recovery transition of the superconducting element from the normal resistive state to the superconducting state, and thus, facilitates recovery of the superconducting element under load.

  17. A study on CT features of intrahepatic bile duct abscess

    International Nuclear Information System (INIS)

    Min Pengqiu; Li Peng; He Zhiyan; Chen Weixia; Liu Yan

    2001-01-01

    Objective: To evaluate CT features of intrahepatic bile duct abscess (IBDA) and its pathologic basis. Methods: The CT imaging data of 31 consecutive cases of intrahepatic bile duct abscess proved by surgery or clinical treatments from October 1989 to February 1999 were retrospectively studied. The causes included acute obstructive suppurative cholangitis and retrograde infection due to different etiologies. For all the cases, the CT manifestations of liver abscess, bile duct abnormalities, and their relationship were observed respectively. Results: Manifestations of liver abscess were revealed in all cases (31/31, 100%). The CT manifestations of bile duct abnormalities included signs of etiologies caused bile duct obstruction and other signs including cholangiectasis (29/31, 93.5%), the dilated bile ducts communicated with (5/31, 16.1%) or abut on (8/31, 25.8%) the abscesses, and gas collection in bile ducts (10/31, 32.2%). The signs showing the relationship between liver abscess and bile duct abnormalities were that the abscesses complied with the obstructive site and the dilated bile ducts (15/31, 48.4%), and the liver abscesses located in different (7/31, 22.6%) or same (4/31, 12.9%) liver lobes or segments with gas collection in the dilated bile ducts. Conclusion: The CT manifestations of IBDA included signs of liver abscess, abnormalities of bile ducts, and signs showing their relationship. CT scanning was helpful in making comprehensive and accurate diagnosis of IBDA

  18. Button cholecystostomy for management of progressive familial intrahepatic cholestasis syndromes.

    Science.gov (United States)

    Clifton, Matthew S; Romero, Rene; Ricketts, Richard R

    2011-02-01

    Progressive familial intrahepatic cholestasis syndromes are characterized by impaired bile acid secretion resulting in pruritus, coagulopathy, diarrhea, and malnutrition leading to progressive liver failure and death in childhood. Partial internal or external biliary drainage can relieve symptoms and slow the progression of the disease. Objections to partial external biliary drainage include the need for a permanent biliary stoma with all the inherent complications of a stoma. We propose a novel approach to these diseases--placement of a "button" cholecystostomy tube. Under general anesthesia and through a small right subcostal incision, a MIC-KEY button (Kimberly-Clark Worldwide, Inc, Draper, UT) is inserted into the mobilized fundus of the gallbladder and secured with 2 purse-string sutures. Time of drainage is adjusted to relieve pruritus. Three children with progressive familial intrahepatic cholestasis achieved adequate bile drainage via the cholecystostomy button to relieve pruritus for 1, 2, and 2 ½ years postoperatively, with drainage periods of 12 to 14 hours per day. There were no episodes of cholangitis. Dislodged tubes can be replaced, or stones can be retrieved via the tract that is formed. Patient (parent) acceptance has been excellent. Button cholecystostomy is simple to perform, relieves pruritus with intermittent (nighttime) drainage, avoids complications of a permanent stoma, avoids an enteric anastomosis, and is accepted by parents. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Stent Recanalization of Chronic Portal Vein Occlusion in a Child

    International Nuclear Information System (INIS)

    Cwikiel, Wojciech; Solvig, Jan; Schroder, Henrik

    2000-01-01

    An 8-year-old boy with a 21/2 year history of portal hypertension and repeated bleedings from esophageal varices, was referred for treatment. The 3.5-cm-long occlusion of the portal vein was passed and the channel created was stabilized with a balloon-expandable stent; a portosystemic stent-shunt was also created. The portosystemic shunt closed spontaneously within 1 month, while the recanalized segment of the portal vein remained open. The pressure gradient between the intrahepatic and extrahepatic portal vein branches dropped from 17 mmHg to 0 mmHg. The pressure in the portal vein dropped from 30 mmHg to 17 mmHg and the bleedings stopped. The next dilation of the stent was performed 12 months later due to an increased pressure gradient; the gastroesophageal varices disappeared completely. Further dilation of the stent was planned after 2, 4, and 6 years

  20. Subgaleo-peritoneal shunt: An effective and safer alternative to lumboperitoneal shunt in the management of persistent or recurrent iatrogenic cranial pseudomeningoceles.

    Science.gov (United States)

    Kiran, Narayanam Anantha Sai; Thakar, Sumit; Mohan, Dilip; Aryan, Saritha; Rao, Arun Sadashiva; Hegde, Alangar S

    2013-01-01

    Subgaleo-peritoneal (SP) shunting for pseudomeningoceles (PMCs) is an effective and safer alternative as compared to the lumboperitoneal (LP) shunt. SP shunting was done in six patients (14-60 years) with persistent or recurrent PMCs using the cranial (ventricular part) and the distal parts of a Chhabra shunt connected by a rigid connector without any intervening chamber or valve. Two patients had undergone a prior LP shunt that had failed. One patient was unsuitable for a LP shunt placement. The PMC subsided completely in all the patients following the SP shunt. In one patient, the shunt got displaced and required repositioning. None of the patients developed symptoms of over-drainage or any other complication. All patients were asymptomatic at a mean follow-up of 15 months. These results suggest that SP shunting is a safe, simple, and effective alternative to the traditional LP shunt in the management of persistent or recurrent cranial PMCs.

  1. Rate of shunt revision as a function of age in patients with shunted hydrocephalus due to myelomeningocele.

    Science.gov (United States)

    Dupepe, Esther B; Hopson, Betsy; Johnston, James M; Rozzelle, Curtis J; Jerry Oakes, W; Blount, Jeffrey P; Rocque, Brandon G

    2016-11-01

    OBJECTIVE It is generally accepted that cerebrospinal fluid shunts fail most frequently in the first years of life. The purpose of this study was to describe the risk of shunt failure for a given patient age in a well-defined cohort with shunted hydrocephalus due to myelomeningocele (MMC). METHODS The authors analyzed data from their institutional spina bifida research database including all patients with MMC and shunted hydrocephalus. For the entire population, the number of shunt revisions in each year of life was determined. Then the number of patients at risk for shunt revision during each year of life was calculated, thus enabling them to calculate the rate of shunt revision per patient in each year of life. In this way, the timing of all shunt revision operations for the entire clinic population and the likelihood of having a shunt revision during each year of life were calculated. RESULTS A total of 655 patients were enrolled in the spina bifida research database, 519 of whom had a diagnosis of MMC and whose mean age was 17.48 ± 11.7 years (median 16 years, range 0-63 years). Four hundred seventeen patients had had a CSF shunt for the treatment of hydrocephalus and thus are included in this analysis. There were 94 shunt revisions in the 1st year of life, which represents a rate of 0.23 revisions per patient in that year. The rate of shunt revision per patient-year initially decreased as age increased, except for an increase in revision frequency in the early teen years. Shunt revisions continued to occur as late as 43 years of age. CONCLUSIONS These data substantiate the idea that shunt revision surgeries in patients with MMC are most common in the 1st year of life and decrease thereafter, except for an increase in the early teen years. A persistent risk of shunt failure was observed well into adult life. These findings underscore the importance of routine follow-up of all MMC patients with shunted hydrocephalus and will aid in counseling patients and

  2. Shunt hybrid active power filter for harmonic mitigation: A practical ...

    Indian Academy of Sciences (India)

    Abstract. The increasing importance of Power Quality problems has been respon- sible for several improvements in Active Power Filter (APF) typologies in the last decade. The increased cost and switching losses make a pure shunt APF economi- cally impractical for high power applications. In higher power levels shunt ...

  3. Visuospatial deficits in children 3 - 7 years old with shunted ...

    African Journals Online (AJOL)

    All patients with shunted HCP had specific deficiencies in defined cognitive areas of non-verbal intelligence when compared with the controls. Futher studies are warranted to determine the effects of ventriculoperitoneal shunting on non-verbal intelligence so that the special educational needs of HCP children may be met.

  4. Temporary vascular shunting in vascular trauma: A 10-year review ...

    African Journals Online (AJOL)

    Corresponding author: P H Navsaria (pradeep.navsaria@uct.ac.za). Background. Temporary intravascular shunts ... temperature 10 units blood transfusion, systolic blood pressure .... Argyle shunt (CR Bard, Billerica, MA, USA) is a straight PVC tube which is available as 8, 10, 12 or 14F and ...

  5. Shunt hybrid active power filter for harmonic mitigation: A practical ...

    Indian Academy of Sciences (India)

    The increasing importance of Power Quality problems has been responsible for several improvements in Active Power Filter (APF) typologies in the last decade. The increased cost and switching losses make a pure shunt APF economically impractical for high power applications. In higher power levels shunt Hybrid Active ...

  6. Evaluation of Blalock-Taussig shunts using magnetic resonance imaging

    International Nuclear Information System (INIS)

    Okajima, Yoshitomo; Tashima, Kazuyuki; Terai, Masaru; Niwa, Koichirou.

    1988-01-01

    Four patients aged 3 to 18 months (mean 13 months) with a total of five Blalock-Taussig shunts (BT shunts; two were original BT shunts and three were modified BT shunts using GOLASKI grafts) underwent evaluation by ECG-gated magnetic resonance imaging. There were two cases with pulmonary atresia with intact ventricular septum, one with double outlet right ventricle with pulmonary stenosis and one with tetralogy of Fallot with pulmonary atresia who underwent bilateral BT shunts. At the time of study, an auscultory shunt murmur was audible in all patients. The magnetic resonance images were obtained with a Picker International Vista MR with a superconducting magnet operating at 0.5 Tesla. A spin echo sequence (echo time 40 msec) was used. All patients were placed within a 30 cm head coil radio antenna and sedated with chloral hydrate or diazepam. Four of 5 shunts were imaged on both coronal sections and sagittal sections during enddiastole. And there was no signal within the grafts. When the velocity of blood flow is beyond the cutoff velocity, the signal intensity of flowing blood is near background level. So we judged these grafts were patient. Our results showed that MRI was a very useful noninvasive method for evaluation of BT shunts. (author)

  7. Evaluation of Blalock-Taussig shunts using magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Okajima, Yoshitomo; Tashima, Kazuyuki; Terai, Masaru; Niwa, Koichirou.

    1988-10-01

    Four patients aged 3 to 18 months (mean 13 months) with a total of five Blalock-Taussig shunts (BT shunts; two were original BT shunts and three were modified BT shunts using GOLASKI grafts) underwent evaluation by ECG-gated magnetic resonance imaging. There were two cases with pulmonary atresia with intact ventricular septum, one with double outlet right ventricle with pulmonary stenosis and one with tetralogy of Fallot with pulmonary atresia who underwent bilateral BT shunts. At the time of study, an auscultory shunt murmur was audible in all patients. The magnetic resonance images were obtained with a Picker International Vista MR with a superconducting magnet operating at 0.5 Tesla. A spin echo sequence (echo time 40 msec) was used. All patients were placed within a 30 cm head coil radio antenna and sedated with chloral hydrate or diazepam. Four of 5 shunts were imaged on both coronal sections and sagittal sections during enddiastole. And there was no signal within the grafts. When the velocity of blood flow is beyond the cutoff velocity, the signal intensity of flowing blood is near background level. So we judged these grafts were patient. Our results showed that MRI was a very useful noninvasive method for evaluation of BT shunts.

  8. Optimization methods for the Train Unit Shunting Problem

    DEFF Research Database (Denmark)

    Haahr, Jørgen Thorlund; Lusby, Richard Martin; Wagenaar, Joris Camiel

    2017-01-01

    We consider the Train Unit Shunting Problem, an important planning problem for passenger railway operators. This problem entails assigning train units from shunting yards to scheduled train services in such a way that the resulting operations are without conflicts. The problem arises at every shu...

  9. Bandgap control with local and interconnected LC piezoelectric shunts

    Science.gov (United States)

    Flores Parra, Edgar A.; Bergamini, Andrea; Lossouarn, Boris; Van Damme, Bart; Cenedese, Mattia; Ermanni, Paolo

    2017-09-01

    This paper reports on the control of longitudinal wave propagation, in the kHz frequency range, using local and interconnected LC (inductance-capacitance) shunts distributed periodically along a rod. The LC shunts are connected to piezoelectric inserts and tuned to engender narrow or broad-band pass-bands in the forbidden band frequency range. The Bragg-scattering bandgaps are the result of the periodic mechanical mismatch between PMMA (polymethyl-methacrylate) of the rod and PZT (lead-zirconate-titanate). The narrow pass-bands correspond to the local configuration, where an equivalence between the mechanical impedance of the PMMA and PZT occurs around the shunt resonance frequency. Conversely, the interconnected shunts give a way to an electrical medium through which energy can propagate parallel to its mechanical counterpart, leading to broad pass-bands. This paper presents analytical models for calculating the dispersion and displacements of the 1D medium with interconnected LC shunts. An analytical formulation is also introduced to expediently identify the location of bandgaps and pass-bands in the medium comprised of local LC shunts. Moreover, analytical investigations are carried out to elucidate different physical phenomena giving rise to these pass-bands. The findings are experimentally validated using a finite periodic rod. The ability to tune the dispersion properties of the medium to control the width or depth of the bandgap, by utilizing local or interconnected shunts, offers a new and powerful application for piezoelectric shunts.

  10. CSF shunt infections in pediatrics. A seven-year experience.

    Science.gov (United States)

    Odio, C; McCracken, G H; Nelson, J D

    1984-12-01

    The medical records of children who had had CSF shunt procedures were reviewed for the seven-year period from 1975 through 1981. There were 516 procedures performed in 297 patients. Only three were ventriculoatrial shunts; the remainder were ventriculoperitoneal shunts. Fifty-nine infectious episodes (11%) occurred in 50 patients (17%); there were three relapses and six reinfections. The infecting pathogen was staphylococci in 75% of the infections and gram-negative bacilli in 19%, and there were two or more pathogens in 15% of the infections. The onset of the infection was within 15 days of surgery in 53% of the cases. The main symptoms were fever, irritability, and shunt malfunction. Gram's stain of the CSF was positive in 46% of the episodes and blood cultures were positive in 29%. Nineteen percent of patients had wound infection and 7% had peritonitis; in most of these cases there were no neurologic signs or symptoms. Thirteen episodes were managed with antibiotic therapy alone; among these, there were three relapses and two reinfections. Thirty-seven episodes were treated with antibiotics and immediate removal of the shunt; there were no relapses and three reinfections. Nine episodes were managed with antibiotics and delayed removal of the shunt; there was one reinfection. The median duration of antibiotic treatment was 15 days, and the time to defervescence was 24 hours in those with immediate removal of the shunt and six days in those in whom the shunt was not removed.

  11. Major complication after intrauterine vesico-amniotic shunting ...

    African Journals Online (AJOL)

    Major complication after intrauterine vesico-amniotic shunting. A Springer, R Fartacek, CA Reck, E Horcher, D Bettelheim. Abstract. Bilateral foetal uropathy is the leading cause of chronic renal failure in childhood. Vesico-amniotic shunting (VAS) is a simple, feasible, and widely used procedure for decompressing the foetal ...

  12. Spontaneous knot; a rare cause of ventriculoperitoneal shunt blockage.

    LENUS (Irish Health Repository)

    Mohammed, Wail

    2012-02-01

    A 14-year old X linked congenital hydrocephalus presented with unexplained headaches and vomiting. He had external ventricular drain and intracranial pressure monitoring (ICP). Subsequently, he underwent exploration and removal of previously inserted ventriculoperitoneal (VP) shunts. On retrieval of peritoneal catheters a double knot was noted between his two distal catheters. This case illustrates a rare cause of ventriculoperitoneal shunt malfunction.

  13. Experimental model of intracranial arteriovenous shunting in the acute stage.

    Science.gov (United States)

    Numazawa, Shinichi; Sasaki, Tatsuya; Sato, Sonomi; Watanabe, Yoichi; Watanabe, Zenichiro; Kodama, Namio

    2005-06-01

    A model of intracranial arteriovenous (AV) shunting must incorporate local hypoperfusion and simulate the hemodynamics of arteriovenous malformations. In this study, the hemodynamics of an intracranial AV shunt model in the acute stage were clarified. End-to-side anastomoses with a femoral vein graft were performed between a cortical branch of the middle cerebral artery (MCA) and the superior sagittal sinus in anesthetized dogs. Local cerebral blood flow (l-CBF) was measured by laser Doppler blood flowmetry. l-CBF decreased suddenly by 34.2% when the shunt was opened in the ipsilateral MCA territory. Upon re-occlusion, l-CBF immediately equaled or exceeded the pre-opening value and returned to the pre-opening value within the next 15 minutes. Opening the shunt produced little change in l-CBF in the territory of the ipsilateral or contralateral anterior cerebral artery. The decrease in l-CBF was correlated with shunt volume only in the MCA territory. l-CBF manifested a PaCO(2)-dependent increase before shunt opening, but CO(2) reactivity was impaired after opening the shunt only in the MCA territory. This dog model features local hypoperfusion due to intracranial AV shunting and disturbance of CO(2) reactivity in the acute stage. The hemodynamics of this model will be confirmed in the chronic stage.

  14. Clopidogrel in infants with systemic-to-pulmonary-artery shunts

    DEFF Research Database (Denmark)

    Wessel, David L; Berger, Felix; Li, Jennifer S

    2013-01-01

    BACKGROUND: Infants with cyanotic congenital heart disease palliated with placement of a systemic-to-pulmonary-artery shunt are at risk for shunt thrombosis and death. We investigated whether the addition of clopidogrel to conventional therapy reduces mortality from any cause and morbidity relate......-related morbidity. (Funded by Sanofi-Aventis and Bristol-Myers Squibb; ClinicalTrials.gov number, NCT00396877.)....

  15. Spontaneous knot; a rare cause of ventriculoperitoneal shunt blockage.

    LENUS (Irish Health Repository)

    Mohammed, Wail

    2011-02-01

    A 14-year old X linked congenital hydrocephalus presented with unexplained headaches and vomiting. He had external ventricular drain and intracranial pressure monitoring (ICP). Subsequently, he underwent exploration and removal of previously inserted ventriculoperitoneal (VP) shunts. On retrieval of peritoneal catheters a double knot was noted between his two distal catheters. This case illustrates a rare cause of ventriculoperitoneal shunt malfunction.

  16. Hydrocephalus, Ventriculo-Peritoneal shunt and Cerebrospinal fluid ...

    African Journals Online (AJOL)

    CSF) ascites, Ventriculoatrial (VA) shunt. Résumé Un petit nombre de patients, avec congenital hydrocephale, qui ont été traite avec succès par shunts ventriculo-peritoneal, development une augmentation progressive de la sangle abdominale ...

  17. VP-shunt dysfunction caused by malaria CNS infection.

    Science.gov (United States)

    Fehrenbach, Michael Karl; Bernhard, Matthias; Siekmeyer, Manuela; Lippmann, Norman; Kiess, Wieland; Nestler, Ulf; Meixensberger, Jürgen; Preuss, Matthias

    2016-04-01

    Malaria is a widespread mosquito-borne infectious disease with over 300 million cases and roughly 900 thousand deaths in 2013. Cerebral involvement of malaria causes 50 % of all infection-associated deaths, especially in children below the age of 5 years. Hydrocephalus is a medical condition with abnormal accumulation of cerebrospinal fluid in physiological cavities and ventricles. Standard treatment is the implantation of a cerebrospinal fluid shunt device. A common problem associated with shunt treatment especially in pediatric patients is infection and consecutive shunt dysfunction caused by bacteriae or high protein levels clogging the valve. In these cases, Staphylococcus aureus and Staphylococcus epidermidis are predominantly found in CSF cultures. We present a case of a 2-year old boy from Saudi Arabia with a ventriculoperitoneal (VP)-shunt-dependent congenital hydrocephalus who suffered from cerebral malaria and developed consecutive shunt failure. To the best of our knowledge, shunt failure caused by malaria CNS infection with Plasmodium falciparum has not yet been reported in the literature and should be considered as a rare cause of VP-shunt failure in patients with atypical VP-shunt infections living in or traveling from endemic areas.

  18. Migration of the peritoneal catheter of a ventriculoperitoneal shunt ...

    African Journals Online (AJOL)

    Ventricular shunt is a well-established modality in the management of hydrocephalus. However, it can be associated with numerous complications and disastrous consequences. The reported incidence of intra-abdominal complications in infants and children after ventriculoperitoneal (VP) shunt procedures is about 24% ...

  19. Use of silicone rubber to facilitate shunt takedown.

    Science.gov (United States)

    Laks, H

    1981-07-01

    The takedown of systemic-pulmonary artery shunts at the time of corrective operation is time-consuming and potentially dangerous because of adhesions at the previous operative site. A method of facilitating shunt takedown is described in which a strip of silicone rubber is used to surround the subclavian artery or polytetrafluoroethylene graft interposed between the subclavian artery and the pulmonary artery. The ends of the strip are left loosely attached to the anterior mediastinum so that an adhesion-free plane is left between the strips down to the shunt. The experience of the Yale University School of Medicine with this technique in 14 patients is described. Five underwent reoperation, at which time the silicone rubber strip facilitated access to the shunt and shunt takedown.

  20. Percutaneous peritoneovenous shunt positioning: technique and preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Orsi, Franco; Grasso, Rosario Francesco; Bonomo, Guido; Marinucci, Irene [Division of Radiology, European Institute of Oncology, Milan (Italy); Monti, Cinzia [Institute of Radiology, University of Milan (Italy); Bellomi, Massimo [Division of Radiology, European Institute of Oncology, Milan (Italy); Institute of Radiology, University of Milan (Italy)

    2002-05-01

    Nine peritoneovenous shunts were positioned by percutaneous technique in seven patients with advanced malignancy causing severe refractory ascites, and in two patients with hepatic cirrhosis (one with hepatocarcinoma). In all patients the shunts were percutaneously placed through the subclavian vein in the angiographic suite under digital fluoroscopic guide. No complications directly related to the procedure occurred. The shunt was successfully positioned in all patients in 60 min average time. No patient showed symptoms related to pulmonary overload or to disseminated intravascular coagulation. All patients had a significant improvement of the objective symptoms related to ascites such as respiratory symptoms, dyspepsia, and functional impairment to evacuation describing an improvement of their quality of life. Maximum shunt patency was 273 days. Percutaneous placement of peritoneovenous shunt is a safe, fast, and inexpensive procedure, extremely useful in resolution of refractory ascites, reducing symptoms, and allowing effective palliation, with a great improvement in quality of life. (orig.)

  1. Calibration of piezoelectric RL shunts with explicit residual mode correction

    DEFF Research Database (Denmark)

    Høgsberg, Jan Becker; Krenk, Steen

    2017-01-01

    Piezoelectric RL (resistive-inductive) shunts are passive resonant devices used for damping of dominant vibration modes of a flexible structure and their efficiency relies on the precise calibration of the shunt components. In the present paper improved calibration accuracy is attained by an exte......Piezoelectric RL (resistive-inductive) shunts are passive resonant devices used for damping of dominant vibration modes of a flexible structure and their efficiency relies on the precise calibration of the shunt components. In the present paper improved calibration accuracy is attained...... by an extension of the local piezoelectric transducer displacement by two additional terms, representing the flexibility and inertia contributions from the residual vibration modes not directly addressed by the shunt damping. This results in an augmented dynamic model for the targeted resonant vibration mode...

  2. Case of an intrahepatic sewing needle and review of the literature.

    Science.gov (United States)

    Bostancı, Özgür; İdiz, Ufuk Oğuz; Battal, Muharrem; Kaya, Cemal; Mihmanlı, Mehmet

    2017-01-01

    An intrahepatic foreign body (FB) is rarely observed. In most cases, object passes from the gastrointestinal tract to the liver via migration. Uncomplicated intrahepatic FB can be followed without surgical intervention; however, complicated intrahepatic FB requires laparoscopy or laparotomy. Presently described is laparoscopic operation on 22-year-old female patient who had incidental sewing needle in the right liver lobe. As there were initially no complications, follow-up monitoring was recommended. However, the patient subsequently complained of stomach pain and developed fever. Laparoscopic exploration located sewing needle in the right liver lobe lateral to the gall bladder with end of needle protruding from the liver. Needle was removed with laparoscopic grasper. Review of the literature regarding 23 other intrahepatic sewing needle cases is also presented.

  3. Transcriptomic and histopathological analysis of cholangiolocellular differentiation trait in intrahepatic cholangiocarcinoma

    DEFF Research Database (Denmark)

    Rhee, Hyungjin; Ko, Jung Eun; Chung, Taek

    2018-01-01

    BACKGROUND & AIMS: Intrahepatic cholangiocarcinoma (iCCA) is a heterogeneous entity with diverse etiologies, morphologies, and clinical outcomes. Recently, histopathological distinction of cholangiolocellular differentiation (CD) of iCCA has been suggested. However, its genome-wide molecular...

  4. Huge hepatocellular carcinoma with multiple intrahepatic metastases: An aggressive multimodal treatment

    Directory of Open Access Journals (Sweden)

    Satoshi Yasuda

    2015-01-01

    Conclusion: Multimodal treatment involving hepatectomy and TACE might be a good treatment strategy for patients with huge HCC with multiple intrahepatic metastases if the tumors are localized in the liver without distant or peritoneal metastasis.

  5. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa).

    Science.gov (United States)

    Kapp, Friedrich G; Maurer, Hans H; Auwärter, Volker; Winkelmann, Martin; Hermanns-Clausen, Maren

    2011-09-01

    Kratom (Mitragyna speciosa) is a common medical plant in Thailand and is known to contain mitragynine as the main alkaloid. According to an increase in published reports and calls at German poison control centers, it has been used more frequently as a drug of abuse in the western hemisphere during the last couple of years. Despite this increase, reports of severe toxicity are rare within the literature. We describe a case of a young man who presented with jaundice and pruritus after intake of kratom for 2 weeks in the absence of any other causative agent. Alkaloids of M. speciosa were detected in the urine. While M. speciosa is gaining in popularity among illicit drug users, its adverse effects remain poorly understood. This is the first published case of intrahepatic cholestasis after kratom abuse.

  6. Computer tomographic and angiographic studies of histologically confirmed intrahepatic masses

    Energy Technology Data Exchange (ETDEWEB)

    Janson, R.; Lackner, K.; Paquet, K.J.; Thelen, M.; Thurn, P.

    1980-06-01

    The computer tomographic and angiographic findings in 53 patients with intrahepatic masses were compared. The histological findings show that 17 were due to echinococcus, 12 were due to hepatic carcinoma, ten were metastases, five patients had focal nodular hyperplasia, three an alveolar echinococcus and there were three cases with an haemangioma of the liver and a further three liver abscesses. Computer tomography proved superior in peripherally situated lesions, and in those in the left lobe of the liver. Arteriography was better at demonstrating lesions below 2 cm in size, particularly vascular tumours. As a pre-operative measure, angiography is to be preferred since it is able to demonstrate anatomic anomalies and variations in the blood supply, as well as invasion of the portal vein or of the inferior vena cava.

  7. Cell lineage tracing reveals a biliary origin of intrahepatic cholangiocarcinoma

    Science.gov (United States)

    Guest, Rachel V; Boulter, Luke; Kendall, Timothy J; Minnis-Lyons, Sarah E; Walker, Robert; Wigmore, Stephen J; Sansom, Owen J; Forbes, Stuart J

    2014-01-01

    Intrahepatic cholangiocarcinoma (ICC) is a treatment refractory malignancy with a high mortality and an increasing incidence worldwide. Recent studies have observed that activation of Notch and AKT signalling within mature hepatocytes is able to induce the formation of tumours displaying biliary lineage markers, thereby raising the suggestion that it is hepatocytes, rather than cholangiocytes or hepatic progenitor cells that represent the cell of origin of this tumour. Here we utilise a cholangiocyte-lineage tracing system to target p53 loss to biliary epithelia and observe the appearance of labelled biliary lineage tumours in response to chronic injury. Consequent to this, up-regulation of native functional Notch signalling is observed to occur spontaneously within cholangiocytes and hepatocytes in this model as well as in human ICC. These data prove that in the context of chronic inflammation and p53 loss, frequent occurrences in human disease, biliary epithelia are a target of transformation and an origin of ICC. PMID:24310400

  8. Intrahepatic Cholestasis in Sickle Cell Disease: A Case Report

    Directory of Open Access Journals (Sweden)

    Denise Menezes Brunetta

    2011-01-01

    Full Text Available Intrahepatic cholestasis (SCIC is an uncommon but potentially fatal complication of sickle cell disease (SCD, with a high death rate, observed mainly in patients with homozygous sickle cell anemia. Herein, we describe a case of severe SCIC treated successfully with aggressive manual exchange transfusion (ET. The patient was admitted with enlarged liver and signs of hepatic failure, such as hyperbilirubinemia and coagulopathy. There was no evidence of viral hepatitis or biliary obstruction. We performed several sessions of ET in order to reduce the percentage of HbS to levels inferior to 30%, which was successfully accomplished. The patient had a complete recovery of hepatic function. This case has shown that ET is an effective treatment of SCIC and should be introduced early on the onset of this severe complication.

  9. Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests

    DEFF Research Database (Denmark)

    Lauridsen, M M; Schaffalitzky de Muckadell, O B; Vilstrup, H

    2015-01-01

    based vs. paper and pencil). To compare results of the Continuous Reaction time (CRT) and the Portosystemic Encephalopathy (PSE) tests in a large unselected cohort of cirrhosis patients without clinically detectable brain impairment and to clinically characterize the patients according to their test...... results. The CRT method is a 10-minute computerized test of a patient's motor reaction time stability (CRTindex) to 150 auditory stimuli. The PSE test is a 20-minute paper-pencil test evaluating psychomotor speed. Both tests were performed at the same occasion in 129 patients. Both tests were normal......Minimal hepatic encephalopathy (MHE) is a frequent complication to liver cirrhosis that causes poor quality of life, a great burden to caregivers, and can be treated. For diagnosis and grading the international guidelines recommend the use of psychometric tests of different modalities (computer...

  10. Usefulness of computed tomography (CT) in the diagnosis of portosystemic collaterals in liver cirrhosis

    International Nuclear Information System (INIS)

    Tsukune, Yoshihiko

    1984-01-01

    This study assesses the usefulness of computed tomography (CT) in the diagnosis of portosystemic collaterals in liver cirrhosis. Seventy-eight patients with liver cirrhosis underwent both CT and angiography. Comparison was made between CT and angiography on eleven types of collaterals, and many of them were demonstrated on CT scans better than angio. Especially, esophageal varices, paraesophageal varices, umbilical pathway and caput medusa were diagnostic on CT scans. Gastrorenal collaterals, splenorenal collaterals, retroperitoneal pathway are also well demonstrated. Dilatation of azygos systems and small veins in the liver surface are only observed on CT scans. However, coronary varices and short gastric varices are well diagnostic in angiography. But considering all types of collaterals, it was stressed that angiography can be eliminated by CT in evaluation of collaterals in liver cirrhosis. (author)

  11. Ventriculoperitoneal shunt infection in Haji Adam Malik Hospital, Medan

    Science.gov (United States)

    Dharmajaya, R.

    2018-03-01

    Installation of ventriculoperitoneal shunts (VP) represented a substantial progress in the neurosurgical management of hydrocephalus in children. However, infection is the most commonpostoperative complication of aventriculoperitoneal shunt. It is important because it is related to substantial morbidity and mortality, and exerts a negative impact on the quality of life of patients. We retrospectively analyzed all 20 cases of shunt infection from 2013 to 2016. The types of infections found were exposed shunts15 cases (75%), and 5 cases of ventriculitis (25%). Length of infection time which calculated from the beginning of surgery was 350.20 days or 11 months. The most common pathogen types are S. epidermidis followed by P. aeruginosa, E. coli, and A. baumanii. There were many risk factors for shunt infection, but the interesting fact was the level of pre-operative albumin. There was a significant difference between low albumin levels (<3.0) and normal albumin (≥3.0) levels against the risk of exposure shunt, p = 0.015. It means there is asignificant difference between low pre-operative albumin and normal level for the risk of theexposed shunt.

  12. Predictive Model for Permanent Shunting in Cryptococcal meningitis.

    Science.gov (United States)

    Phusoongnern, Woralux; Anunnatsiri, Siriluck; Sawanyawisuth, Kittisak; Kitkhuandee, Amnat

    2017-11-01

    Cryptococcal meningitis may have long-term morbidity and requires a permanent cerebrospinal fluid shunt. This study aimed to evaluate the risk factors and create a predictive model for permanent shunt treatment in cryptococcal meningitis patients. This was a retrospective analytical study conducted at Khon Kaen University. The study period was from January 2005 to December 2015. We enrolled all adult patients diagnosed with cryptococcal meningitis. Risk factors predictive for permanent shunting treatment were analyzed by multivariate logistic regression analysis. There were 341 patients diagnosed with cryptococcal meningitis. Of those, 64 patients (18.7%) were treated with permanent shunts. There were three independent factors associated with permanent shunt treatment. The presence of hydrocephalus had the highest adjusted odds ratio at 56.77. The resulting predictive model for permanent shunt treatment (y) is (-3.85) + (4.04 × hydrocephalus) + (2.13 × initial cerebrospinal fluid (CSF) opening pressure (OP) > 25 cm H 2 O) + (1.87 × non-human immune deficiency vrus (HIV)). In conclusion, non-HIV status, initial CSF OP greater than or equal to 25 cm H 2 O, and the presence of hydrocephalus are indicators of the future necessity for permanent shunt therapy.

  13. Leakage Inductance Calculation for Planar Transformers with a Magnetic Shunt

    DEFF Research Database (Denmark)

    Jun, Zhang; Ouyang, Ziwei; Duffy, M. C.

    2013-01-01

    The magnetic shunt is generally inserted in a planar transformer to increase the leakage inductance which can be utilized as the series inductor in resonant circuits such as the LLC resonant converter. This paper presents a calculation methodology for the leakage inductance of the transformer...... with a magnetic shunt by means of the stored magnetic energy in the primary and secondary sides of the transformer using the magnetomotive force (MMF) variation method, as well as the stored energy in the shunt based on the reluctance model. The detailed calculation method is described. Both the FEA simulation...

  14. Leakage Inductance Calculation for Planar Transformers with a Magnetic Shunt

    DEFF Research Database (Denmark)

    Zhang, Jun; Ouyang, Ziwei; Duffy, Maeve C.

    2014-01-01

    The magnetic shunt is generally inserted in a planar transformer to increase the leakage inductance which can be utilized as the series inductor in resonant circuits such as the LLC resonant converter. This paper presents a calculation methodology for the leakage inductance of the transformer...... with a magnetic shunt by means of the stored magnetic energy in the primary and secondary sides of the transformer using the magnetomotive force (MMF) variation method, as well as the stored energy in the shunt based on the reluctance model. The detailed calculation method is described. Both the FEA simulation...

  15. Spinal cord arteriovenous shunts: from imaging to management

    International Nuclear Information System (INIS)

    Rodesch, G.; Lasjaunias, P.

    2003-01-01

    Spinal cord arteriovenous shunts (SCAVSs) are either fistulas or niduses that can be separated in four different groups according to their localization and relationship to the dura. Paraspinal AVSs are located outside the spine and are responsible for neurological symptoms because of cord compression by ertatic veins, venous congestion or arterial steal. Epidural shunts are located in the epidural space and drain in epidural veins with secondary intradural congestion. Dural shunts are embedded in the dura, produce a cord venous myelopathy after draining through veins that either pierce the dura far from a nerve root or accompany a nerve root. Intradural shunts affect the cord, the roots or the filum. Additionally, they can be classified according to their potential relationships with genetics, vascular biological features and angiogenesis into genetic hereditary lesions (hereditary hemorrhagic telangiectasia), genetic non-hereditary lesions (multiple lesions with metameric links) and single lesions (AVMs or micro AVFs). MRI and MRA are able to visualise SCAVS early after the onset of clinical symptoms. The type of shunt and its localization may remain difficult to be precise. Angiography remains the gold standard for analysis of the anatomical, morphological and architectural features necessary for therapeutic decisions in both paediatric and adult populations. In our series, embolisation is chosen in first intention whatever the type of shunt responsible for the clinical symptoms and glue is preferably used. In paraspinal, dural or epidural arteriovenous shunts, the goal of treatment should be complete closure of the shunt. A complete cure by embolization is rather easily achieved in paraspinal lesions. Failure of endovascular therapy in dural or epidural shunts must bring the patient to surgery. The prognosis of most intradural shunts seems better than previously thought, even after haemorrhage. In intradural spinal cord arteriovenous shunts, embolisation

  16. CONTROLLED SHUNT REACTORS FOR ELECTRIC NETWORKS

    Directory of Open Access Journals (Sweden)

    Dolgopolov A.G.,

    2011-12-01

    Full Text Available The article presents results of the research and design of controlled shunt alternative current reactors (CSR. The analysis of domestic and foreign experience of the development and deployment of CSR is performed, the effectiveness of their applications in power systems is assessed and results of the tests of samples CSR-220 kV and above are shown. Constructive features of CSR circuit are described; technical characteristics of the CSR-220, 500 kV are given. The prospects for widespread introduction of CSR for the control of power systems regimes are shown. The application of CSR in combination with other control devices such as FACTS allows, based on high-voltage lines of high capacity, creating controlled transmission lines of new generation, which corresponds to all necessary requirements with time-developing power systems and its associations.

  17. Extracorporal albumin dialysis (MARS) improves cholestasis and normalizes low apo A-I levels in a patient with benign recurrent intrahepatic cholestasis (BRIC)

    NARCIS (Netherlands)

    Sturm, E; Franssen, CFM; Gouw, A; Staels, B; Boverhof, R; de Knegt, RJ; Stellaard, F; Bijleveld, CMA; Kuipers, F

    The familial cholestatic diseases Benign Recurrent Intrahepatic Cholestasis (BRIC) and Progessive Familial Intrahepatic Cholestasis type 1 (PFIC1) are characterized by intermittent or permanently elevated plasma bile salt levels, therapy-resistant extreme pruritus and peculiar biochemical

  18. Effects of an interatrial shunt on rest and exercise hemodynamics

    DEFF Research Database (Denmark)

    Kaye, David; Shah, Sanjiv J; Borlaug, Barry A

    2014-01-01

    BACKGROUND: A treatment based on an interatrial shunt device has been proposed for counteracting elevated pulmonary capillary wedge pressure (PCWP) in patients with heart failure and mildly reduced or preserved ejection fraction (HFpEF). We tested the theoretical hemodynamic effects...... of the conditions tested. CONCLUSIONS: The interatrial shunt reduced left-sided cardiac output with a marked reduction in PCWP. This approach may reduce the propensity for heart failure exacerbations and allow patients to exercise longer, thus attaining higher heart rates and cardiac outputs with the shunt compared...... of this approach with the use of a previously validated cardiovascular simulation. METHODS AND RESULTS: Rest and exercise hemodynamics data from 2 previous independent studies of patients with HFpEF were simulated. The theoretical effects of a shunt between the right and left atria (diameter up to 12 mm) were...

  19. Epidural haematoma: pathophysiological significance of extravasation and arteriovenous shunting

    International Nuclear Information System (INIS)

    Habash, A.H.; Sortland, O.; Zwetnow, N.N.

    1982-01-01

    35 patients with epidural bleeding operated on at Rikshospitalet, Oslo, during the period 1965 - 1980 had preoperative angiography with visualization of the external carotid artery. Twenty-one patients had extravasation of contrast medium from meningeal arteries. Seventeen of the 21 had also shunting of contrast medium from meningeal arteries to meningeal or diploic veins, while 20 of the 21 also had bled from a ruptured meningeal artery at operation. It was further found that of 20 patients who deteriorated after trauma 18 had an epidural arteriovenous shunt or extravasation. Conversely, of 15 patients who improved after trauma 12 had no evidence of a shunt. The strong correlation between the clinical course and the occurrence of extravasation supports previous experimental and clinical data, indicating the epidural arteriovenous shunt to be a major factor in the pathophysiology and the outcome of epidural bleeding. (author)

  20. Multicenter evaluation of temporary intravascular shunt use in vascular trauma.

    Science.gov (United States)

    Inaba, Kenji; Aksoy, Hande; Seamon, Mark J; Marks, Joshua A; Duchesne, Juan; Schroll, Rebecca; Fox, Charles J; Pieracci, Fredric M; Moore, Ernest E; Joseph, Bellal; Haider, Ansab A; Harvin, John A; Lawless, Ryan A; Cannon, Jeremy; Holland, Seth R; Demetriades, Demetrios

    2016-03-01

    The indications and outcomes associated with temporary intravascular shunting (TIVS) for vascular trauma in the civilian sector are poorly understood. The objective of this study was to perform a contemporary multicenter review of TIVS use and outcomes. Patients sustaining vascular trauma, requiring TIVS insertion (January 2005 to December 2013), were retrospectively identified at seven Level I trauma centers. Clinical demographics, operative details, and outcomes were abstracted. A total of 213 injuries (2.7%; 94.8% arterial) requiring TIVS were identified in 7,385 patients with vascular injuries. Median age was 27.0 years (range, 4-89 years), 91.0% were male, Glasgow Coma Scale (GCS) score was 15.0 (interquartile range, 4.0), Injury Severity Score (ISS) was 16.0 (interquartile range, 15.0), 26.0% had an ISS of 25 or greater, and 71.1% had penetrating injuries. The most common mechanism was gunshot wound (62.7%), followed by auto versus pedestrian (11.4%) and motor vehicle collision (6.5%). Shunts were placed for damage control in 63.4%, staged repair for combined orthopedic and vascular injuries in 36.1%, and for insufficient surgeon skill set in 0.5%. The most common vessel shunted was the superficial femoral artery (23.9%), followed by popliteal artery (18.8%) and brachial artery (13.2%). An argyle shunt (81.2%) was the most common conduit, followed by Pruitt-Inahara (9.4%). Dwell time was less than 6 hours in 61.4%, 24 hours in 86.5%, 48 hours in 95.9%, with only 4.1% remaining in place for more than 48 hours. Of the patients, 81.6% survived to definitive repair, and 79.6% survived overall. Complications included shunt thrombosis (5.6%) and dislodgment (1.4%). There was no association between dwell time and shunt thrombosis. The use of a noncommercial shunt (chest tube/feeding tube) did not impact shunt thrombosis but was an independent risk factor for subsequent graft failure. The limb salvage rate was 96.3%. No deaths could be attributed to a shunt

  1. Hepatic and colonic perforation by an abandoned ventriculoperitoneal shunt

    Energy Technology Data Exchange (ETDEWEB)

    Thipphavong, Seng; Kellenberger, Christian J.; Manson, David E. [Department of Diagnostic Imaging, Hospital for Sick Children,University Ave., M5G 1X8, Toronto, Ontario (Canada); Rutka, James T. [Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario (Canada)

    2004-09-01

    We report a case of an abandoned distal limb of a ventriculoperitoneal shunt that resulted in hepatic as well as colonic perforation in a 12-year-old girl. Although it is common practice at the time of shunt revision to leave a retained distal catheter in the peritoneal cavity, we suggest this can result in perforation of solid as well as hollow viscera. (orig.)

  2. Transluminal angioplasty of a stenotic surgical splenorenal shunt

    International Nuclear Information System (INIS)

    Beers, B. van; Roche, A.; Cauquil, P.

    1988-01-01

    A stenosis of a side-to-side splenorenal shunt was treated by percutaneous angioplasty two years after the performance of the shunt. After dilatation, there was a fall of the splenorenal pressure gradient from 28 to 17 cm H 2 O and good transanastomotic flow was re-estabilshed. As in other arterial and venous territories, angioplasty may be an interesting alternative to surgery. (orig.)

  3. Ventriculo-Peritoneal Shunt Infections in Infants and Children

    Directory of Open Access Journals (Sweden)

    Kamal HM

    2008-01-01

    Full Text Available Objective: To determine the rate and the type of ventriculoperitoneal (VP shunt infections in infants and children admitted to King Fahad Hofuf hospital of Al-Ahsaa area at the Eastern Province of Saudi Arabia.Methods: From mid 2003 to end of 2006; VP shunt infection episodes were reviewed. Once infection was suspected, a cerebrospinal fluid (CSF sample was taken and empirical antibiotics were recommended. Once infection was confirmed, VP shunt was removed and external ventricular drainage (EVD was inserted until CSF became sterile after which a new shunt was inserted.Results: 25.9% of patients with VP shunts had infections which represents 29.3% of the procedures. 40% of infected patients had recurrent episodes. 59.1% of infections occurred throughout the first two months following insertion. Single pathogen was isolated in each episode. Pseudomonas auerginosa represented 50% of isolated pathogens compared with 18.2% with Staphylococcus epidermidis.Conclusions There is a high incidence of VP shunt infections in King Fahad Hofuf hospital when compared with other international centres. Gram negative organisms are the most common cause of the infection.

  4. Non-Oriental primary intrahepatic lithiasis: experience with 48 cases.

    Science.gov (United States)

    Herman, Paulo; Bacchella, Telesforo; Pugliese, Vincenzo; Montagnini, André L; Machado, Marcel Autran C; da Cunha, José Eduardo M; Machado, Marcel C C

    2005-07-01

    An experience with the diagnosis and treatment of patients with non-Oriental primary intrahepatic lithiasis (PIHL) is described. A group of 48 native Brazilian patients with symptomatic PIHL were studied, and the patients' characteristics, diagnoses, treatment protocols based on the presentation of the disease, prognostic factors, and late results were analyzed. Liver resection was performed in patients with an irreversible lesion, such as parenchymal atrophy or biliary stenosis; and biliary drainage procedures were employed in patients with bilateral disease. Late results were considered good when no postoperative symptoms were observed and poor if there was pain recurrence or cholangitis. Overall good results were observed in 73.4% of the patients. Good late results were observed in 94.1% and 62.1% of the patients with unilateral and bilateral stones, respectively. None of the analyzed parameters (gender, age, previous biliary surgery, bilirubin level, serum leukocyte counts, prothrombin activity, previous history of cholangitis, stone location) predicted poor late results, but the risk for patients with bilateral stones to develop late complications was 7.2 times higher than for those with unilateral disease. Non-Oriental PIHL is a rare disease, and the patients' characteristics are similar to those of patients with Oriental PIHL. We believe that personalized treatment based on the presentation of the disease led to the high incidence of good late results in this series.

  5. Diagnosis and therapy of intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Paus, T C; Schneider, G; Van De Vondel, P; Sauerbruch, T; Reichel, C

    2004-07-01

    Intrahepatic cholestasis of pregnancy (ICP) is characterized by the occurrence of pruritus mostly in the third trimenon. Diagnosis is based on the presence of pruritus and elevated levels of serum bile acids in the absence of pruritic skin diseases. There is strong evidence of a genetic predisposition for ICP. Numerous studies have investigated the association of known cholestasis genes such as ABCB4 (also designated MDR3), ABCB11 ( BSEP) and ATP8B1 ( FIC1) with ICP. The results of these studies implicate a heterogeneous etiology of this syndrome. ICP increases the risk of preterm delivery and fetal loss. Furthermore, intense pruritus may necessitate premature induction of labor with its known higher frequency of complications for mother and child. Therefore, ICP pregnancies should be managed as high-risk pregnancies. Pharmaceuticals to alleviate pruritus or improve cholestasis like antihistamines, phenobarbital, anion exchange resins, dexamethasone or S-adenosylmethionine are not widely accepted because of questionable efficacy or side effects. Recent randomized studies have shown beneficial effects of ursodeoxycholic acid (UDCA) on laboratory data and pruritus in patients with ICP. Improved knowledge about the diagnostic classification of different types and pathophysiological mechanisms of ICP may allow for a more targeted treatment of this disease in future.

  6. Primary liver tumors. Hepatocellular versus intrahepatic cholangiocellular carcinoma

    International Nuclear Information System (INIS)

    Wengert, G.J.; Bickel, H.; Breitenseher, J.; Ba-Ssalamah, A.

    2015-01-01

    Hepatocellular carcinoma (HCC) and intrahepatic cholangiocellular carcinoma (ICC) are the most commonly occurring and important primary liver tumors. Originating from one pluripotent liver stem cell both tumor entities can occur in a cirrhotic liver and also in patients without cirrhosis. Several risk factors have been identified as causative for both carcinomas; therefore, tumor screening is advantageous, especially for high-risk patients who could be diagnosed in an early stage to allow curative treatment. Surgical resection, interventional procedures and transplantation are available as curative treatment options when diagnosed in time. Common characteristic features and morphology in cross-sectional imaging by ultrasound (US), multidetector computed tomography (CT) and magnetic resonance imaging (MRI) as well as screening aspects are presented and discussed. Recent findings show a better understanding of the carcinogenesis model of both liver tumors originating from one pluripotent liver stem cell. Further developments of modern cross-sectional imaging modalities, especially MRI in combination with diffusion-weighted imaging and intravenous administration of hepatocyte-specific contrast agents enable early detection, exact differentiation, staging and treatment evaluation of HCC and ICC In this article we discuss modern, multiparametric imaging modalities, which allow a complete and reliable diagnosis of the majority of these tumor entities. Contrast-enhanced MRI, using hepatocyte-specific contrast agents, is currently the most accurate procedure for the noninvasive diagnosis and treatment evaluation of HCC and ICC. (orig.) [de

  7. Side-to-side aorto-GoreTex central shunt warrants central shunt patency and pulmonary arteries growth.

    Science.gov (United States)

    Barozzi, Luca; Brizard, Christian P; Galati, John C; Konstantinov, Igor E; Bohuta, Lyubomyr; d'Udekem, Yves

    2011-10-01

    Central shunts may be associated with a high rate of thrombosis and pulmonary artery distortion. Between January 2000 and April 2010, 68 consecutive patients underwent side-to-side aorto-Gore-Tex central shunts (W.L. Gore & Associates, Flagstaff, AZ). Median age at surgery was 31 days (8 to 122). Cardiac morphologies were tetralogy of Fallot (33), pulmonary atresia with collateral dependent lung circulation (20), and other (15). Shunt sizes ranged from 3 to 6 mm. The procedure was performed on cardiopulmonary bypass in 43 patients (63%). Six patients died during hospital stay (9%) of low output syndrome (3), sepsis (2), and stroke (1). Only one shunt needed early redo. Follow-up was 100% complete. After a median follow-up of 236 days (116 to 340), there were 7 late deaths related to sudden death (3), sepsis (2), reoperation (1), and lack of growth of pulmonary arteries with a patent shunt (1). Repair was completed in 42 patients and still pending in 12. Only one patient needed a late redo shunt (221 days). A larger shunt was performed in 5 patients after a median of 139 days (130 to 258). In the 45 patients who had serial assessment of pulmonary arteries sizes, Nakata index increased from 83 ± 62 mm(2)/m(2) to 153 ± 83 mm(2)/m(2) over a median period of 227 days (146 to 330), with equal growth observed in both pulmonary arteries (p Gore-Tex anastomosis seems to reliably warrant shunt patency and harmonious growth of pulmonary arteries. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Intrahepatic cholangiocarcinoma in a transplant liver--selective internal radiation therapy followed by right hemihepatectomy: report of a case.

    Science.gov (United States)

    Sperling, Jens; Justinger, Christoph; Schuld, Jochen; Ziemann, Christian; Seidel, Roland; Kollmar, Otto

    2014-07-01

    Intra- or extrahepatic cholangiocarcinomas are the second most common primary liver malignancies behind hepatocellular carcinoma. Whereas the incidence for intrahepatic cholangiocarcinoma is rising, the occurrence of extrahepatic cholangiocarcinoma is trending downwards. The treatment of choice for intrahepatic cholangiocarcinoma remains liver resection. However, a case of liver resection after selective internal radiation therapy in order to treat a recurrent intrahepatic cholangiocarcinoma in a transplant liver is unknown in the literature so far. Herein, we present a case of a patient undergoing liver transplantation for Wilson's disease with an accidental finding of an intrahepatic cholangiocarcinoma within the explanted liver. Due to a recurrent intrahepatic cholangiocarcinoma after liver transplantation, a selective internal radiation therapy with yttrium-90 microspheres was performed followed by right hemihepatectomy. Four years later, the patient is tumor-free and in a healthy condition.

  9. Intrahepatic biliary cysts after hepatic portoenterostomy in four children with biliary atresia

    International Nuclear Information System (INIS)

    Ishii, K.; Matsuo, S.; Hirayama, Y.; Taguchi, T.; Yakabe, S.; Ikeda, K.; Hirata, T.; Kawanami, T.

    1989-01-01

    We report our experience with 4 cases of cystic dilatation of intrahepatic bile ducts following hepatic portoenterostomy for biliary atresia. Two of the cases did not achieve satisfactory bile excretion and all four cases developed recurrent cholangitis after hepatic portoenterostomy. The attacks of cholangitis seemed to be associated with the presence of intrahepatic cysts. Although one case resulted in death from hepatic failure, three other cases are now outpatients. Patients who develop recurrent cholangitis following hepatic portoenterostomy, should be examined to exclude the presence of intrahepatic biliary cysts. Ultrasonography, computed tomography and percutaneous transhepatic cholangiography were all effective in detecting cysts and provided valuable information for planning treatment. Percutaneous transhepatic or surgical drainage of the bile ducts was effective in reducing jaundice, and recurrent cholangitis. (orig.)

  10. Diastolic dysfunction in cirrhosis

    DEFF Research Database (Denmark)

    Møller, Søren; Wiese, Signe Skovgaard; Halgreen, Hanne

    2016-01-01

    stiffness of the cirrhotic heart may decrease the compliance and result in DD. The prevalence of DD in cirrhotic patients averages about 50 %. It can be evaluated by transmitral Doppler echocardiography, tissue Doppler echocardiography, and cardiac magnetic resonance imaging. There seems to be a relation...... between DD and the severity of liver dysfunction and the presence of ascites. After liver transplantation, DD worsens the prognosis and increases the risk of graft rejection, but DD improves after few months. Insertion of a transjugular intrahepatic portosystemic shunt increases left ventricular diastolic...

  11. Successful Management of Neobladder Variceal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Atwal, Dinesh; Chatterjee, Kshitij, E-mail: kchatterjee@uams.edu [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Osborne, Scott [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Kakkera, Krishna; Deas, Steven [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Li, Ruizong [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Erbland, Marcia [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States)

    2016-10-15

    Hematuria from a neobladder can occur due to a variety of pathologies including tumors, stones, and fistulas. Variceal bleeding in a neobladder is a very rare condition with only one case reported in literature. We present a case of a patient with cirrhosis and portal hypertension and an ileocolic orthotopic neobladder presenting with hematuria. Computed tomographic angiography showed dilated varices around the neobladder which were successfully embolized. To the best of our knowledge, this is the first report case of variceal bleeding in a neobladder successfully managed with the combination of TIPS (transjugular intrahepatic portosystemic shunt) procedure and embolization.

  12. The heart and the liver

    DEFF Research Database (Denmark)

    Møller, Søren; Dümcke, Christine Winkler; Krag, Aleksander

    2009-01-01

    Cardiac failure affects the liver and liver dysfunction affects the heart. Chronic and acute heart failure can lead to cardiac cirrhosis and cardiogenic ischemic hepatitis. These conditions may impair liver function and treatment should be directed towards the primary heart disease and seek...... against the heart failure. Transjugular intrahepatic portosystemic shunt insertion and liver transplantation affect cardiac function in portal hypertensive patients and cause stress to the cirrhotic heart, with a risk of perioperative heart failure. The risk and prevalence of coronary artery disease...

  13. Emergency TIPS in a Child-Pugh B patient

    DEFF Research Database (Denmark)

    Trebicka, Jonel

    2017-01-01

    Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis such as variceal bleeding and refractory ascites, but it also bears the risk of liver failure, overt hepatic encephalopathy (HE) and cardiac decompensation. Variceal bleeding may be controlled using...... translocation. Both these processes mediate an impaired immunological and hemodynamic response, thereby facilitating the development of acute-on-chronic liver failure (ACLF) and/or death. Similarly, in patients with refractory ascites, TIPS should be used early in treatment to prevent acute kidney injury (AKI...

  14. Two Anomalies in One: A Rare Case of an Intrahepatic Gallbladder with a Cholecystogastric Fistula

    Directory of Open Access Journals (Sweden)

    Mohammad F. Ali

    2017-03-01

    Full Text Available The gallbladder can be situated in a variety of anomalous positions. An intrahepatic gallbladder – the second most common ectopic location of the gallbladder – is one that is completely embedded within the liver parenchyma. Described in the literature as early as 1935, intrahepatic gallbladders predominantly result from a developmental anomaly but in some instances have been reported to be secondary to chronic inflammation. The significance of an intrahepatic gallbladder lies in the fact that 60% of the cases are associated with gallstones and may present a challenge for the general surgeon during cholecystectomy and other biliary operations in addition to causing misdiagnosis on imaging. Intrahepatic gallbladders are unusual, but the incidence of an intrahepatic gallbladder with a cholecystogastric fistula is rare. Cholecystogastric fistulas commonly are a complication of long-term cholelithiasis or chronic cholecystitis with subsequent gallstone ileus. Herein, we present the case of an 80-year-old man who presented with 2 months of progressive weakness, fatigue, decreased appetite, and intermittent right-sided abdominal pain, and was found to have a markedly distended and irregular intrahepatic gallbladder measuring 12.2 × 11.5 × 13.4 cm on CT, as well as a cholecystogastric fistula on esophagogastroduodenoscopy. During esophagogastroduodenoscopy, the gallbladder was entered directly via the fistulous tract. The patient was on i.v. antibiotics with tube feeds via a nasojejunal tube initially, followed by p.o. which he tolerated. He was eventually discharged with referral for surgical evaluation. Given the potential for cholelithiasis and fistulation, physicians should have a high index of suspicion and recommend timely endoscopic and/or surgical management to avoid future complications.

  15. Biochemical Characterization of P4-ATPase Mutations Associated with Intrahepatic Cholestatic Disease

    DEFF Research Database (Denmark)

    Gantzel, Rasmus; Vestergaard, Anna Lindeløv; Mikkelsen, Stine

    The cholestatic disorders progressive familial intrahepatic cholestasis type 1 (PFIC1, also referred to as Byler’s disease) and benign recurrent intrahepatic cholestasis type 1 (BRIC1) are caused by mutation of the P4-ATPase ATP8B1. The substrate of ATP8B1 is very likely to be phosphatidylserine ...... in the transmembrane domain will contribute with important information in elucidation of the phospholipid transport mechanism of P4-type ATPases. 1. Folmer, D.E., R.P.J. Oude Elferink, and C.C. Paulusma, Biochim. Biophys. Acta (2009) 1791. 628-635....

  16. Differential intrahepatic phospholipid zonation in simple steatosis and nonalcoholic steatohepatitis.

    Directory of Open Access Journals (Sweden)

    Julia Wattacheril

    Full Text Available Nonalcoholic fatty liver disease (NAFLD occurs frequently in a setting of obesity, dyslipidemia and insulin resistance, but the etiology of the disease, particularly the events favoring progression to nonalcoholic steatohepatitis (NASH as opposed to simple steatosis (SS, are not fully understood. Based on known zonation patterns in protein, glucose and lipid metabolism, coupled with evidence that phosphatidylcholine may play a role in NASH pathogenesis, we hypothesized that phospholipid zonation exists in liver and that specific phospholipid abundance and distribution may be associated with histologic disease. A survey of normal hepatic protein expression profiles in the Human Protein Atlas revealed pronounced zonation of enzymes involved in lipid utilization and storage, particularly those facilitating phosphatidylcholine (PC metabolism. Immunohistochemistry of obese normal, SS and NASH liver specimens with anti-phosphatidylethanomine N-methyltransferase (PEMT antibodies showed a progressive decrease in the zonal distribution of this PC biosynthetic enzyme. Phospholipid quantitation by liquid chromatography mass spectrometry (LC-MS in hepatic extracts of Class III obese patients with increasing NAFLD severity revealed that most PC species with 32, 34 and 36 carbons as well as total PC abundance was decreased with SS and NASH. Matrix assisted laser desorption ionization-imaging mass spectrometry (MALDI-IMS imaging revealed strong zonal distributions for 32, 34 and 36 carbon PCs in controls (minimal histologic findings and SS that was lost in NASH specimens. Specific lipid species such as PC 34:1 and PC 36:2 best illustrated this phenomenon. These findings suggest that phospholipid zonation may be associated with the presence of an intrahepatic proinflammatory phenotype and thus have broad implications in the etiopathogenesis of NASH.

  17. Radiation therapy for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Otsuka, Masaaki; Ohara, Kiyosi; Takada, Yasutsugu; Ueda, Takanori; Murata, Souichirou; Ushijima, Ryou; Adachi, Shinya; Todoroki, Takesi

    2003-01-01

    The intrahepatic recurrence rate after curative hepatectomy for hepatocellular carcinoma (HCC) is high, and management of recurrence is thus important for long-term survival. The use of radiation therapy has been relatively uncommon in the treatment of recurrent HCC. Eight patients underwent radiation therapy for recurrent HCC 12-98 months after hepatectomy. Five of them were treated with protons (250 MeV; 68.8-84.5 Gy), and three were treated with X-rays (6 MV; 60 or 70 Gy). One patient received radiation therapy twice for another lesion with a 79-month interval. The target tumors were 1.2-4.5 cm. All patients also underwent transcatheter arterial embolization or other regional therapy. Although transient ascites was found in three patients after radiation therapy, no patient died as a result of the irradiation. Seven patients died 9 months to 4 years (median 1 year 6 months) after radiation therapy. Re-recurrence was observed in the irradiated liver in two patients (local control 78%). Four patients died of lung metastasis after radiation therapy. The median survival time was 3 years 3 months (range 1 year 1 month to 8 years 6 months) after recurrence. Multimodality therapy is necessary for the management of recurrence. Radiation therapy could be beneficial when other therapies present some difficulty regarding application or are performed incompletely. It must be emphasized that radiation therapy should be considered in addition to other regional therapies for the treatment of recurrent or re-recurrent HCC, and that radiation therapy can be repeated in selected patients. (author)

  18. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Kawakita, Tetsuya; Parikh, Laura I; Ramsey, Patrick S; Huang, Chun-Chih; Zeymo, Alexander; Fernandez, Miguel; Smith, Samuel; Iqbal, Sara N

    2015-10-01

    We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45-8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47-14.08, respectively). In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Atrial Septal Aneurysm with Right-to-Left Interatrial Shunting

    Science.gov (United States)

    Chidambaram, Mala; Mink, Steven; Sharma, Sat

    2003-01-01

    Interatrial shunting in the presence of an atrial septal aneurysm is an uncommon but well recognized abnormality. Previous case reports have demonstrated that elevated right atrial pressure secondary to pulmonary embolism or right ventricular infarction may cause right-to-left interatrial shunting in the presence of an atrial septal aneurysm. We describe a unique situation in which an atrial septal aneurysm was associated with a right-to-left shunt secondary to severe systemic hypotension and normal right atrial pressure. In this patient, we used midodrine, an oral alpha-1 agonist, to increase systemic arterial pressure, decrease the severity of the shunt, and treat the severe hypoxemia. This case establishes that right-to-left interatrial shunting can result from a decrease in left ventricular afterload with normal right atrial pressure. Oral alpha-1 agonist therapy can be used successfully to treat patients such as ours and possibly others with similar functional abnormalities. (Tex Heart Inst J 2003;30:68–70) PMID:12638676

  20. Intrahepatic cholangiocarcinoma with intrahepatic biliary lithiasis arising 47 years after the excision of a congenital biliary dilatation: report of a case.

    Science.gov (United States)

    Yamashita, Suguru; Arita, Junichi; Sasaki, Takashi; Kaneko, Junichi; Aoki, Taku; Beck, Yoshihumi; Sugawara, Yasuhiko; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2012-04-01

    We report a case of intrahepatic cholangiocarcinoma with biliary lithiasis arising 47 years after surgery for a congenital biliary dilatation (CBD). A 62-year-old woman was admitted for the investigation of a liver tumor. She had undergone a choledochoduodenostomy at the age of 15 years for CBD and resection of an extrahepatic bile duct with choledochojejunostomy because of cholangitis at the age of 55 years. An enhanced computed tomography (CT) revealed a liver tumor 50 mm in diameter in the S6 region with surrounding lymph node swelling and intrahepatic metastatic lesions in the S8 region. A drip infusion cholangiographic CT showed biliary lithiases in the left liver. An extended right hepatectomy and lymph node dissection was considered but was abandoned because of suspicions of liver functional insufficiency as a result of biliary lithiasis. She underwent biliary lithotomy through a percutaneous transhepatic cholangioscopy and subsequent systemic chemotherapy.