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PubMed1984

[Assessment of portal blood flow by isotope splenoportography. Methodology and 1st results in cirrhosis].

The authors report a new non-invasive method of portal blood flow (PBF) measurement, after injection of a radiotracer into the spleen. PBF was equal to the product of the radiotracer bolus velocity and the cross-section area of the portal vein as measured by ultrasonography. In 16 patients with cirrhosis, the velocity of the portal blood flow (V) and PBF were determined in 11 cases. In the remaining 5 patients, failures were explained by either a total extrahepatic shunt (3 cases) or difficulties of scanning view analysis (2 cases). Mean values of V and PBF were 8.8 +/- 2.5 cm/s and 579 +/- 193 ml/min respectively, which represent a reduction of 50 p. 100 compared to estimated normal values. This method was also useful to appreciate the fraction of PBF which is supposed to reach the liver cells called the "actual portal blood flow" (APBF). APBF was equal to PBF minus the fraction of blood flowing through intrahepatic shunts and/or the recanalized umbilical vein. In the 16 cases, mean values were 528 +/- 184 ml/min for APBF, 11.9 +/- 1.7 cm for the portal vein diameter, and 53 +/- 34 p. 100 for spleen blood flow fraction going through porto-systemic collateral veins. Significant intrahepatic shunt was observed in one patient only out of 13 without total extrahepatic shunt, i. e., in 8 p. 100 of the cases. The impossibility of measuring PBF when a total extrahepatic shunt is present is a drawback in the use of this new technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1981

Liver tissue perfusion: comparison of radiologic and isotope clearance techniques in a patient with portal hypertension.

A patient with portal hypertension was investigated preoperatively with splenoportography and found to have a large extrahepatic shunt through esophageal varices but poor portal perfusion of the liver. However, intraoperative measurement of the hepatic tissue perfusion using the krypton-85 clearance technique showed it to be essentially normal. Erroneous conclusions about actual hepatic perfusion may be made on the basis of findings on splenoportography alone.

Aged↗
PubMed1979

[Evaluation of liver haemodynamics by spleno-portography in portal hypertension (author's transl)].

In 68 patients arterial and portal blood flow were measured by angiodensitometry in the course of routine, indirect splenoportography. Results were compared with those already published, with investigations of a model and with animal experiments. It was shown that, given certain underlying conditions, reliable results can be obtained even in the presence of a pulsatile flow and incomplete contrast mixing. Compared with other procedures, the method has the advantage of providing a complete picture of liver haemodynamics in the course of routine splenoportography in a simple way and without affecting the patient further. As a result the indications for performing a shunt and the choice of the shunt technique can be more accurately determined.

Blood Flow Velocity↗
PubMed1979

Radiographic and haemodynamic patterns of portal hypertension in hepatosplenic schistosomiasis: selection of surgical procedure.

Twenty-eight patients with hepatosplenic schistosomiasis and portal hypertension were studied. The transumbilical portal pressure, transsplenic portal pressure, and thoracic duct occluded pressure were measured simultaneously and thoracic duct lymph flow estimated. Changes in the splanchnic vasculature were studied radiologically barium swallow, splenoportography, and umbilical portography. The transumbilical-transsplenic portal pressure gradient was found to be of particular value. The gradient was considered to be positive when the transumbilical portal pressure was higher than the transsplenic portal pressure, in such cases the primary generating factor of portal hypertension and/or ascites was most probably of hepatic origin. The gradient was considered to be negative when the transumbilical portal pressure was lower than the transsplenic portal pressure; in such cases the primary generating factor of portal hypertension and/or ascites was most probably of splenic or prehepatic origin. A correlation was found between the type of gradient and the radiographic pattern met with. For instance, in cases with positive gradient the hepatic blood flows, as estimated from the splenoportography, were mostly stage I or II, and showed no retrograde portal vein flow on umbilical portography. While, in cases with negative gradients, the hepatic blood flows were mostly stage III or IV, and showed retrograde portal vein flow on umbilical portography. The type of gradient, the clinicopathological stage, and the radiographic changes in the splanchnic vasculature were taken into account in selecting the surgical procedure to be used in each individual case.

Hemodynamics↗
PubMedDate not supplied

Sonographic features of portal hypertension in schistosomiasis mansoni.

The diagnostic value of real-time sonography in the study of portal hypertension was assessed in 66 patients with hepatosplenic schistosomiasis mansoni, all with Symmers's fibrosis and esophageal varices. Seventy-one individuals without schistosomiasis were selected as controls. The inner diameters of the portal vessels were measured by sonography in all patients and controls: splenoportography was also performed in the schistosomal group. Intra-splenic pressure was over 30 cm of water in 44 of 60 patients with schistosomiasis. The upper limit of normality for portal vessel diameters was set through receiver operating characteristic curve at 12 mm for portal vein, 9 mm for splenic vein at splenic hilus, and 9 mm for superior mesenteric vein. The best discriminative vein for the diagnosis of portal hypertension was the splenic vein followed by the portal vein. A direct correlation was observed between the diameter of the splenic vein, measured by sonography, and the intra-splenic pressure. Except for the paraumbilical and mesenteric veins, more frequently identified by sonography, there was no statistical difference in the frequency of visualization of splanchnic vessels by sonography or splenoportography.

Adolescent↗
PubMed1976

[First clinical experiences with scintiphotosplenoportography].

This paper reports on the clinical applicability and efficiency of Scintiphotosplenoportography (SPSP) by means of 99mTc Pertechnetate. This diagnostic process permits obtaining the following data: actual route and patency of the portal vein, localizing of collaterals, as well as information on the actual speed of portal flow. By determining the time of transit of the radionuclid via the collateral pathways into systemic circulation, additional assessments as to the hemodynamic functional importance of these collaterals can be made. This process is of particular value for the speedy assessment of the patency of a surgically effected portocaval shunt in cases of shunt-bleeders. In patients without cirrhosis, a stop in the filling along the course of the portal vein indicates portal thrombosis. In cases of manifest cirrhosis, however, the lack of an SPSP image for the proximal portal vein and the liver itself, merely points to the existence of extensive caudal collaterals. Traumatization as the result of intrasplenal application of a volume of less than 1 ml (of tracer) remains minimal. In contrast with radiological splenoportography this methods entails practically no risks. However, as a result of the restricted field of view and the relatively coarse power of resolution, the quality obtainable by szintiphotosplenoportography is somewhat inferior to that of X-ray splenoportography.

Aged↗
PubMedDate not supplied

The different manifestation and outcome between pancreatitis and pancreatic malignancy with left-sided portal hypertension.

Left-sided portal hypertension can be induced by isolated splenic venous obstruction due to various etiologies, such as chronic pancreatitis and pancreatic malignancy. The patients may present with bleeding isolated gastric varices and hypersplenism in addition to their pancreatic lesions. In the past 3 years, we have encountered 24 patients with left-sided portal hypertension. They were diagnosed with an abdominal echogram, CT or splenoportography. Twelve patients had histories of acute pancreatitis for a few months to years. Eleven of them were found to have isolated gastric varices. Six of them underwent operation due to hypersplenism or pseudocyst. The postoperative courses were smooth and the gastric varices subsided after splenectomy. The other 12 patients with left-sided portal hypertension were diagnosed as having pancreatic malignancy. Only two of them were found to have isolated gastric varices. Seven of them received operations and only two patients with their tumors located at the pancreatic body and tail could be resected. The other 5 patients were diagnosed with abdominal CT and high serum CA 19-9. We concluded that the patients with left-sided portal hypertension can be suspected by isolated gastric varices without liver cirrhosis. The diagnosis can be confirmed by abdominal CT or splenoportography. The incidence of isolated gastric varices are significantly lower in the patients with pancreatic malignancy than those with chronic pancreatitis. The gastric varices subsided after splenectomy. The prognosis of pancreatic malignancy is poor and most of them are inoperable.

Adenocarcinoma↗
PubMedDate not supplied

Extensive portal and splenic vein thrombosis: differences in hemodynamics and management.

BACKGROUND/AIMS: To assess the incidence of extensive portal and splenic vein thrombosis in patients with extrahepatic portal vein obstruction and determine the differences in presentation, portal hemodynamics and management as compared to patients with portal vein thrombosis alone. METHODOLOGY: 118 patients of extrahepatic portal vein obstruction presenting with variceal hemorrhage, having received no definitive treatment prior to presentation were divided into two groups--with portal and splenic vein thrombosis and with portal vein thrombosis, based on ultrasonography and splenoportography. Collateralization patterns on splenoportography were studied. Results of endoscopic variceal sclerotherapy were compared. RESULTS: Portal and splenic vein thrombosis was seen in 39 patients. Collateralization in case of portal and splenic vein thrombosis, in contrast to portal vein thrombosis, was predominantly left sided (74% vs. 9%, p < 0.0001). Fundal gastric varices were seen more often in patients with portal and splenic vein thrombosis (28% vs. 11%, p = 0.02), developing even after variceal obliteration, though obliteration was achieved in fewer sessions. Surgery for control of variceal bleed was performed more in the portal and splenic vein thrombosis group (33% vs. 15%, p = 0.02), especially for gastric varices (28% vs. 9%, p = 0.006). CONCLUSIONS: Portal and splenic vein thrombosis is present in 33% of patients with extrahepatic portal vein obstruction. Hemodynamic patterns differ, accounting for the preponderance of gastric varices on presentation in patients with portal and splenic vein thrombosis and an increased need for surgery.

Adolescent↗
PubMedDate not supplied

[Selective distal splenorenal shunt, surgery for portal hypertension. Experience of a general hospital].

From 1982 to 1987, twenty patients underwent Distal Splenorenal Shunt. The surgical indication was hemorrhagic portal hypertension: two cases were done on an emergency basis and eighteen electively. In all patients endoscopy was performed, and the bleeding site was documented; splenoportography was done to 70% and the remaining had selective arteriography with venous phase. Portal pressure was measured during splenoportography or during the operation with catheterization of the right gastroepiploic vein. We had a preoperative histopathologic diagnosis in 60% of the cases. The overall preoperative mortality was 10%, with ascites in seven patients, pancreatic pseudocyst in one, chylous retrogastric collection in one and, encephalopathy in one case. The predicted overall survival for a 5-year period is 77%. We think this surgery can be done in the general hospitals of small cities.

Adult↗
PubMed1979

Radiological procedures in portal hypertension.

Radiological diagnosis in portal hypertension is of paramount importance for proper treatment. The site of portal obstruction is determined preoperatively by either direct (splenoportography, transumbilical portography, epiploography, selective percutaneous transhepatic catheterization) or direct (catheterization of the celiac truncus and/or the superior mesenteric artery) methods. After a shunt procedure the examination can best be done with a balloon catheter, by direct catheterization of a shunt or by indirect splenoportography. Recently, the radiologist has started to do the treatment by percutaneous transhepatic injection of a sclerosing agent into the gastric coronary vein. For each different method the advantages and disadvantages, the indications and technical procedure are described and discussed.

Adolescent↗
PubMed1981

[Nuclear-medical methods in hepatology].

The function of polygonal liver cells can be estimated by using liver specific dyes such as labelled BSP or bengalrosa and labelled X-ray contrast media. Various methods are available: clearance with blood counting or external monitoring, whole body clearance and retention measurement. These tests are of value for following the course of liver diseases. Blood flow measurements either with labelled colloids or 133 Xe are mainly used for scientific purposes. Portosystemic shunts can be detected by injection of labelled microspheres in the spleen and lung monitoring or scanning. With the dynamic scintigraphy portosystemic shunts can be visualized ( radionuclide splenoportography). The measurement of the praecordial appearance time after rectal instillation of 133 Xe permits the functional evaluation of a surgical portosystemic shunt. Dynamic scintigraphy makes possible the estimation of the arterial part of liver blood flow after i.v. injection of 99m Tc and this together with the radionuclide splenoportography allows the assessment of disturbed blood flow in patients with portal hypertension. I. v. applied parathyroid hormone increases the arterial hepatic blood flow. Preliminary results indicate that patients with portal hypertension and a good response to parathyroid hormone seem to have a good prognosis after shunt operation. The determination of red cell survival with 51 Cr is helpful in the differential diagnosis of jaundice. The specificity of liver scanning with labelled colloids for malignant diseases can be reasonably increased by additional 67 Ga-scintigraphy. In the diagnosis of hepatoma with both colloid and Galliumscan and the evaluation of alpha-fetoprotein a 90% accuracy can be achieved. The hepatobiliary transport can easily be visualized with 99m Tc labelled IDA-compounds and also in patients with severe jaundice where the X-ray cholangiopathy is impossible. This examination is indicated in patients with bile duct observations (also intrahepatic), after cholecystectomy, for the differential diagnosis of jaundice, for the demonstration of refluxes etc. The most important radioimmunological in vitro methods for the investigation of liver diseases are only briefly described.

Bile Acids and Salts↗
PubMed1997

[Hepatoportal sclerosis. 10 years of experience at the National Institute of Pediatrics].

OBJECTIVE: To assess the frequency and clinical picture of Hepatoportal Sclerosis in a population of Mexican children of the Instituto Nacional de Pediatría, México City. BACKGROUND: Hepatoportal Sclerosis is a disease of unknown etiology. It's diagnosis is difficult. The main clinical presentation is splenomegaly with or without hematemesis (portal hypertension). Splenoportography and liver histology study are the best procedures for diagnosis and must be performed by experts. METHODS: We studied 7/106 children with portal hypertension during a period of 10 years, who were seen at the Instituto Nacional de Pediatría, México city. Inclusion criteria were specific findings of splenoportography and histologic changes in liver biopsy. RESULTS: We found 7/106 children. The main clinical manifestation were splenomegaly and hematemesis. We did not find any previous history of contact with arsenic, vinyl chloride or copper sulfate. In 6/7 children a porto-systemic shunt was performed. Only one received propranolol and sclerotherapy. At the time of this report all children have shown a good clinical course.

Adolescent↗