[Relation between sulfobromophthalein Au-198 clearance and scintigraphic aspects in hepatopathies].
Explore the source record for details and available documents.
Alcoholism↗
SEARCH · PubMed Health
Results for “HEPATIC VEIN THROMBOSIS”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[The role of magnetic resonance in the evaluation of diffuse liver diseases].
We discuss in this report the results and limits of MR imaging in the evaluation of non focal hepatic pathology. At present, MR imaging seems to be one of the most important diagnostic steps, in the study of widespread hepatic diseases.
Female↗
[Magnetic resonance in gallbladder carcinoma. Its diagnostic reliability].
The use of magnetic resonance imaging (MRI) to study the liver is currently on the increase. Our study was aimed at evaluating MR diagnostic reliability in the detection and staging of gallbladder carcinomas. Thirty-one patients with gallbladder carcinoma were studied. MRI was performed with a 0.5 T superconductive magnet, using spin-echo (SE) T1- and T2-weighted sequences and gradient-echo (GE) refocusing sequences to evaluate portal system patency. Sixteen patients underwent surgery, while 24 were submitted to angio-CT. MR findings correlated well with angio-CT results. In 4 cases only MRI could not define tumor extent due to the presence of breathing artifacts. In 6 cases the tumor was identified at intracholecystic level, while in 21 cases it involved gallbladder fossa and infiltrated liver parenchyma. In 10 of these patients, the lesion involved also the hepatic hilum, while 7 patients exhibited liver metastases. Twenty patients presented lymphadenopathy at both the hilum and the portocaval space. In 8 patients GE refocusing sequences allowed the evaluation of neoplastic thrombosis of the portal vein. Of 16 patients who underwent surgery, MRI underestimated 2 cases--namely, the presence of micrometastases in one case and tumor spread greater than demonstrated by MRI in the other case. To conclude, in our experience MRI can be considered a valuable diagnostic technique to detect and stage gallbladder carcinomas.
Aged↗
The Sugiura procedure: a prospective experience.
BACKGROUND: The Sugiura procedure, which includes esogastric devascularization, splenectomy, and esophageal transection, aims to suppress esophageal varices without exposing the patient to hepatic encephalopathy, because the operation does not alter hepatic blood flow. METHODS: From May 1978 to March 1989, 39 patients (79% with cirrhosis) with previous variceal bleeding underwent an elective Sugiura procedure. Thirteen of them (33%) had recurrent bleeding despite medical therapy. RESULTS: There were neither operative deaths nor intraoperative complications. Eighteen patients (46%) had 19 postoperative complications, which were severe in 7 cases. During the second postoperative month, 68% of the patients had no visible varices at endoscopy. There was no alteration of liver function at 1 year after operation. Ninety-five percent, 85% and 76% of patients were free of recurrent variceal bleeding at 1, 3, and 5 years, respectively. None of the patients had chronic encephalopathy. One-, 3-, and 5-year survival rates were 95%, 70%, and 70%, respectively. Survival curves were not different in patients with and without cirrhosis. CONCLUSIONS: The Sugiura procedure carries a low operative risk and results in good prevention of recurrent variceal bleeding. Moreover, the liver function remains stable after operation and there is no significant risk of hepatic encephalopathy. This procedure should be reserved for failure of medical therapy.
Adult↗
[A successful treatment using SMANCS-TAE for hepatocellular carcinoma with tumor thrombus in the portal trunk].
A 62-year-old man was admitted to our hospital for treatment of HCC with a thrombus growing from the right branch to the trunk of the portal vein. His hepatic functional reserve was fairly good. Serum levels of AFP and PIVKA-II were elevated to 1,780 ng/ml and 27 AU-ml, respectively. The hepatic arteriogram showed a hypervascular tumor approximately 4 cm in diameter in the right anterior segment and many ill-defined small tumor stains around the main tumor. Portal phase of superior mesenteric arteriogram revealed filling defect in the portal trunk, and no visualization of the right branch of portal vein. SMANCS-Lipiodol was infused via right hepatic artery, and Spongel was infused via right anterior branch of hepatic artery. Three months after the first therapy, the tumor markers normalized. A computed tomography scan showed that the main tumor and the tumor thrombus were markedly decreased in size, whereas the hepatic angiogram revealed tumor stains around the main tumor. SMANCS-Lipiodol was again infused via proper hepatic artery. He has remained well for 16 months after the first treatment. The combination of the arterial infusion of SMANCS-Lipiodol with the selective TAE was very effective for this case, probably because his hepatic functional reserve was fairly good and the left branch of portal vein was patent. It was suggested that SMANCS-Lipiodol with the selective TAE could be one therapy to be considered for a patient like this case.
Carcinoma, Hepatocellular↗
[Value of ultrasound and doppler sonography in chronic hepatitis and liver cirrhosis].
Ultrasound is unquestionably of great importance in the diagnosis of liver diseases due to the technical improvements of the last years. Indications for an ultrasound examination are the primary diagnosis of chronic liver disease and the screening for hepatocellular carcinoma. Apart from the diagnosis of portal hypertension in liver cirrhosis a portal vein thrombosis should be detected or excluded in cases of new or refractory ascites. The Budd-Chiari syndrome is another rare but important indication. There is a considerable improvement in the differential diagnosis of focal liver lesions especially due to contrast-enhanced sonography. Using phase-inversion harmonic sonography it is possible to detect tumor vascularity in a very sensitive manner. The accuracy of contrast-enhanced sonography is comparable with helical-CT or MRT, and contrast-enhanced sonography is very useful in the evaluation of response to ablation therapy of hepatocellular carcinoma.
Budd-Chiari Syndrome↗
Intraoperative assessment of reconstructed vessels in living-donor liver transplantation, using a novel fluorescence imaging technique.
BACKGROUND/PURPOSE: In living-donor liver transplantation (LDLT), hepatic arterial thrombosis and portal venous thrombosis are critical problems that can result in graft loss. Only intraoperative Doppler ultrasound (IDUS) is able to evaluate blood flow in the reconstructed vessels. The aim of this study was to evaluate the utility of a newly developed fluorescence imaging technique using indocyanine green (ICG) for visualizing reconstructed vessels. METHODS: In three patients who had undergone LDLT, IDUS was performed after reconstruction of the portal vein and hepatic artery. Fluorescence images were then recorded, using a SPY system (Novadeq Technologies), which employs ICG as a fluorescent imaging medium activated by light. The ICG (3.75 mg) was injected intravenously, then, 10 s later, the images were recorded for 30 s (first photographic recording). Two minutes later, the same procedure was repeated (second photographic recording), and 40 min later, images were obtained without injection of ICG (third photographic recording). RESULTS: After portal venous reconstruction, IDUS demonstrated a nonphasic and continuous waveform, with a mean velocity of 52.1 cm/s and a mean portal blood flow volume of 69.5 ml/s per kg. After hepatic arterial reconstruction, a pulsatile waveform with a mean peak systolic velocity of 52.4 cm/s and a mean resistance index of 0.76 was obtained. The first photographic recording clearly visualized the blood flow in the reconstructed hepatic artery, without kinking or stenosis, in all three patients. The second photographic recording visualized the flow in the portal vein without stenosis, kinking, or stagnation. The third photographic recording demonstrated the excretion of ICG into bile, thus confirming bile production by the grafts. CONCLUSIONS: Fluorescence imaging can clearly visualize the reconstructed hepatic artery and portal vein and demonstrate the production of bile by a transplanted liver graft. A combination of IDUS and the new system can guarantee the patency of the reconstructed vessels.
Blood Flow Velocity↗
Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis.
A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures.
Acute Disease↗
[Efficacy of hepatic arterial infusion therapy for advanced hepatocellular carcinoma using 5-fluorouracil and cisplatin].
BACKGROUND/AIMS: There has been no standard treatment for advanced hepatocellular carcinoma (HCC) until now. The aim of this study was to evaluate the efficacy of hepatic arterial infusion therapy (HAIT) using 5-fluorouracil (5-FU) and cisplatin (CDDP) for advanced HCC. METHODS: Twenty patients received repeated HAIT using an implanted drug delivery system. Of the 20 patients, eight patients had HCC with portal vein tumor thrombosis (PVTT), eleven patients had residual tumor despite transcatheter arterial chemoembolization (TACE) or percutaneous ethanol injection therapy (PEIT), and one patient had multiple recurrent HCC nodules after surgical resection. The patients were repeatedly treated with an arterial infusion of 5-FU (250 mg/5 hours on day 1-5) and CDDP (10 mg/1 hour on day 1-5) via the drug delivery system at three weekly intervals. RESULTS: Of the 20 patients, three patients were excluded from the study due to death within the first 1 week of treatment or during follow-up before evaluation. The response rate according to tumor size on abdominal CT was 29.4% (5 patients). One of the five patients showed a complete response (CR, 5.9%), three patients showed partial responses (PR, 17.6%), and one patient showed a minor response (MR, 5.9%). Chemotherapy- related side effect, such as grade I-II nausea (n=2), grade II vomiting (n=1), fever (n=1), drug eruption (n=1) and catheter-related complication such as dislodgement of the catheter (n=2), occurred in six patients. CONCLUSIONS: HAIT using the FP regimen is another option for patients having advanced HCC with PVTT or for patients showing an ineffective response to other therapies.
Adult↗
Portal hypertension in children and young adults: sonographic and color Doppler findings.
Portal hypertension is a relatively uncommon pathologic condition in children and young adults in contrast with older adults. The aim of this study is to evaluate the utility of sonography and color Doppler sonography in the diagnosis of portal hypertension in children and young patients and to evaluate the sonographic pattern of each disease. We reviewed 25 such patients who were younger than 30 years old and obtained the following sonographic findings: (1) liver cirrhosis: (a) multiple intrahepatic venovenous shunts in patients with primary Budd-Chiari syndrome and (b) intrahepatic vascular narrowing and nodular coarse parenchymal texture, with multiple very-high-echo spots along the portal vein in patients with Wilson disease; (2) congenital hepatic fibrosis: marked and developed collaterals, wide periportal echogenic band, and a heterogeneous parenchymal texture comprised of multiple high echoes but without portal thrombus; and (3) extrahepatic portal thrombosis: invisible portal lumen except as an echogenic band. Sonography and color Doppler sonography are very useful in diagnosing these portal hypertensive diseases. However, there are no specific sonographic findings, and the role of sonography is limited to follow-up observation of associated secondary hepatobiliary changes in patients with congenital biliary atresia.
Adolescent↗
Could the use of interposition grafts for arterial reconstruction be avoided by more caudate graft placement in living donor liver transplantation?
One of the major challenges in living donor liver transplantation (LDLT) is short and small vessels (particularly the hepatic artery), particularly in segmental liver grafts from living donors. In the present study we report an alternative surgical technique that avoids interpositional vessel grafts or tension on the connection by anastomizing the allograft hepatic vein to the recipient inferior vena cava in a more caudate location. From March 2000 to January 2003, 28 patients (11 women/17 men) underwent 28 LDLT. Until June 2001, the preferred technique for hepatic vein anastomosis was end-to-end anastomosis between the allograft hepatic vein and the recipient hepatic vein (HV-HV) (n = 10). Thereafter an end-to-side anastomosis was performed between allograft hepatic vein and recipient inferior vena cava (HV-IVC) (n = 18). The level of venotomy on the recipient vena cava was decided according to the pre-anastomotic placement of the allograft in the recipient hepatectomy site with sufficient width to have an hepatic artery anastomosis without tension or need for an interposition graft during hepatic artery and portal vein anastomoses. Except the right lobe allograft with anterior and posterior portal branches, all portal and hepatic artery anastomoses were constructed without an interposition graft or tension in the HV-IVC group. Only one hepatic artery thrombosis developed in the HV-IVC group. As a result, this technique may avoid both hepatic artery thrombosis and the use of interposition grafts in living donor liver transplantation.
Anastomosis, Surgical↗
Safety and feasibility of liver-directed ex vivo gene therapy for homozygous familial hypercholesterolemia.
OBJECTIVE: The purpose of this report was to provide detailed information on the safety and feasibility of surgical procedures associated with the first ex vivo liver-directed gene therapy trial for the treatment of vivo gene therapy for homozygous familial hypercholesterolemia (FH). SUMMARY BACKGROUND DATA: Familial hypercholesterolemia is an autosomal dominant disease in which the gene encoding the low density lipoprotein receptor is defective. Patients homozygous for this mutation have extraordinarily high levels of cholesterol and accelerated atherosclerosis and die prematurely of myocardial infarction. The concept of liver-directed gene therapy was based on the report of normalization of cholesterol levels by orthotopic cardiac/liver transplant in a child with homozygous FH. METHODS: Five patients with homozygous FH were selected for inclusion in this trial. The patients underwent hepatic resection and placement of a portal venous catheter. Primary hepatocytes cultures were prepared from the resected liver and transduced with a recombinant retrovirus encoding the gene for the human low density lipoprotein receptor. The genetically modified cells were then transplanted into the liver through the portal venous catheter. RESULTS: Numerous clinical, laboratory, and radiologic parameters were analyzed. Elevations of the hepatic transaminases and leukocyte counts and a decline in hematocrit count were noted. Transient elevations of the portal pressure were observed during cell infusion. No major perioperative morbidity--specifically, myocardial infarct, perioperative hemorrhage, or portal vein thrombosis--or death occurred as a result of this protocol. CONCLUSION: Liver-directed ex vivo gene therapy can be accomplished safely in humans and is appropriate for selected patients.
Adult↗
Posttraumatic Budd-Chiari syndrome treated with thrombolytic therapy and angioplasty.
Injury of the hepatic veins or suprahepatic inferior vena cava is a rare cause of Budd-Chiari syndrome. Treatment of this syndrome has primarily involved hepatic venous decompression with a variety of portosystemic shunts. We report a case of thrombosis of the inferior vena cava after blunt injury managed with interventional radiologic techniques.
Abdominal Injuries↗
A rapidly produced 125I labelled autologous fibrinogen: in vitro properties and preliminary metabolic studies in man.
The properties of fibrinogen extracted by a precipitation method using glycine at ambient temperatures near neutral pH are described. The simple and reproducible method gives a 73% yield of high purity plasminogen-free fibrinogen in 45 minutes from small volumes of plasma. The protein extract was labelled with 125I using chloramine-T under conditions optimal for fibrinogen stability. The extraction procedure, radio-iodination, desalting, and sterilization take only 70 minutes for completion from the time donor blood is received in the laboratory. The methods, using a specially developed extraction vessel and desalting/sterilizing column, can be used in a small hospital laboratory. Autologous fibrinogen can thus be extracted from patients' blood, eliminating the risk of transmitting hepatitis when it is re-administered. The autologous material, which is 97% clottable and contains less than 0-05% free iodide, is being routinely used as a diagnostic tool in the detection of deep vein thrombosis. The high purity of the preparation facilitates metabolic studies and in vitro experimental work. In vivo results show a mean half-life in three normal volunteers of 3-95 days and a catabolic rate of 25-23% per day with the extravascular space estimated as 24-86%. In 30 surgical patients an expected reduced half-life in plasma was determined with a mean of 3-1 days.
Chemical Precipitation↗
Hepatocellular carcinoma in Lebanon: Etiology and prognostic factors associated with short-term survival.
AIM: To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS: An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out. Multivariate analysis was conducted to identify prognostic factors in comparison to Cancer of the Liver Italian Program (CLIP) score. Multiple variables including the etiology of underlying liver disease, the demographic characteristics of patients, and the severity of liver disease evaluated by the Child-Pugh score were studied. Tumor parameters included the time of diagnosis of HCC, alpha-fetoprotein level, number and size of nodules, presence of portal vein thrombosis, and treatment modalities. Death or loss of follow-up was considered as an end-point event. RESULTS: Ninety-two patients (mean 60.5 +/- 22.3 years) were included. Etiology of underlying disease was hepatitis B, C, and alcohol in 67%, 20%, and 23.5% respectively. Child-Pugh class at diagnosis was A, B, and C in 34.8%, 39.3% and 25.8% respectively. Overall survival was 44.8%, 32.8% and 17.6% at 1, 2 and 3 years respectively (mean F/U 40.2 +/- 23.5 mo). Multivariate analysis identified three predictors of early mortality (< 6 mo): bilirubin > 3.2 mg/dL (P < 0.01), HCC as first presentation of liver disease (P = 0.035), and creatinine > 1 mg/dL (P = 0.017). A score based on these variables outperformed the CLIP score by Cox proportional hazard. ROC curve showed both models to be equivalent and moderately accurate. CONCLUSION: HBV is the leading cause of HCC in Lebanon. Independent predictors of early mortality are elevated bilirubin, creatinine and HCC as first manifestation of disease. Prospective validation of a score based on these clinical parameters in predicting short-term survival is needed.
Adult↗
Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: interest for early complications and nutrition.
Hepatic artery thrombosis and early acute rejection are severe complications of orthotopic liver transplantation (OLT). Their rapid detection is most desirable. The purpose of this study was to assess the usefulness of monitoring hepatic artery (HABF) and portal vein (PVBF) blood flows during the first week after OLT. At the end of operation, microprobes were sutured to the vessels, and their connecting tubes were externalized and connected to a pulsed Doppler flowmeter operating at 8 MHz. In 10 patients (ages ranged from 2 to 54 years) of 106, measurements of HABF and PVBF were done during alternative clamping of both vessels and before and after abdominal closure, every 12 hours during 7 days, and at day 7, before and after a 150 gm carbohydrate meal. At day 7 the probes were pulled out by gentle traction without complication, and all patients were allowed to go home. Reciprocal increase of flow during selective clamping was only observed for HABF (+45.8% +/- 47.6%; p less than 0.01). Abdominal closure decreased both HABF and PVBF by 13.8%, p less than 0.01, and 26%, p less than 0.05, respectively. In seven cases no significant variation of HABF and PVBF was observed during 7 days. In two patients with histologically confirmed early acute rejection, a marked decrease of diastolic HABF, without modification in PVBF, was the first manifestation and was rapidly corrected by boluses of steroids. In one patient disappearance of systolic and diastolic HABF led us to diagnose an arterial obliteration caused by a plicature, which was successfully surgically treated in the emergency department. In all patients, after oral ingestion of the carbohydrate meal, and only after this type of diet, a significant and deep decrease (-87%, p less than 0.001) of HABF was observed between 7 and 120 minutes without any change in PVBF. Such an effect was not observed in control patients. We conclude that this Doppler flowmetric technique with implantable microprobes is useful for rapid diagnosis of and strategy in treating early complications and is a new tool for pathophysiologic study of OLT consequences.
Dietary Carbohydrates↗
[Cesarean section using a temporary IVC filter in a pregnant woman with several histories of deep vein thrombosis].
A 31-year-old pregnant woman with a history of several episodes of deep vein thrombosis was scheduled for Caesarian section. The patient had an increased risk of intraoperative pulmonary thromboembolism due to thrombi isolated from deep veins. This is because a thrombus can be formed easily in deep veins by the influence of hypercoagulability in the third trimester and by the disturbance of venous return due to the pressure of the enlarged pregnant uterus. A temporary IVC filter (Filtre Thery, France) was inserted preoperatively. The filter basket was set in the IVC cephalad from the left renal vein and caudad from the hepatic vein. The operation was completed without any trouble. Rehabilitation was safely initiated just after the surgery by insertion of the filter and then the filter was removed on the third postoperative day. We conclude that the preoperative insertion of a temporary IVC filter is a useful technique to prevent intraoperative pulmonary thromboembolism in a patient with a history of deep vein thrombosis.
Adult↗
Long-term effects of distal splenorenal shunt on hepatic hemodynamics and liver function in patients with cirrhosis: importance of reversal of portal blood flow.
We studied 23 patients with cirrhosis who had undergone retroperitoneal distal splenorenal shunt without portal-azygos disconnection more than 2 yr earlier. We investigated the suitability of the Doppler technique (ultrasound + Doppler) to assess the patency and blood flow direction through the portal vein and the distal splenorenal shunt and its correlation with the continuous thermal dilution technique. The study also assessed the influence of the distal splenorenal shunt and time after surgery on portal perfusion and liver function. Ultrasound + Doppler distal splenorenal shunt thrombosis in two patients; however, none was confirmed by continuous thermal dilution. Ultrasound + Doppler flowmetry was possible in 19 patients (83%) (mean, 1.58 +/- 0.53 L/min). Distal splenorenal shunt continuous thermal dilution measurements were performed in all patients (100%), (mean, 1.65 +/- 0.5 L/min). Good correlation was seen between them (r = 0.66). Ultrasound + Doppler of the portal vein showed a hepatopetal flow in 16 patients (69.9%). Hepatic blood flow was significantly higher in patients with hepatopetal flow (p = 0.003). Hepatic clearance and intrinsic hepatic clearance of indocyanine green were significantly lower in patients with hepatofugal flow. Patients with hepatofugal flow had a higher incidence of chronic encephalopathy. None of the patients with a follow-up of less than 4 yr exhibited hepatofugal flow, whereas 7 of the 16 patients with a longer follow-up had hepatofugal flow (43.7%). The difference was statistically significant (p = 0.04). This study suggests that ultrasound + Doppler sonography may provide useful data in the evaluation of the patency and blood flow direction through the portal vein and the distal splenorenal shunt.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗