Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 73
Filter
1.
Medisur ; 19(3): 518-523, 2021. graf
Article in Spanish | LILACS | ID: biblio-1287333

ABSTRACT

RESUMEN Fundamento: los aneurismas de la vena porta son entidades poco frecuentes, representan aproximadamente el 3% de los aneurismas del sistema venoso. La mayoría de los aneurismas de la vena porta se detectan en pacientes con hígado sano, aunque en algunas ocasiones la hipertensión portal podría favorecer el desarrollo de la patología. Los lugares más comunes son la confluencia venosa esplenomesentérica, la vena porta principal y las ramas de la vena porta intrahepática en los sitios de bifurcación. Objetivo: presentar el caso de un paciente portador de una aneurisma de la vena porta. Presentación del Caso: Paciente femenina, blanca de 49 años de edad con antecedentes de trastornos dispépticos, y en ocasiones, dolor a nivel del hipocondrio derecho. Su examen físico era negativo y la impresión diagnóstica de su médico de asistencia era litiasis vesicular. Durante la realización del examen ultrasonográfico se encuentra como dato positivo una dilatación de tipo aneurismático de la vena porta en el inicio de su trayecto intrahepático de 18 mm de diámetro, y el resto del examen resultó negativo. Conclusiones: Por lo inusual de este caso se decide hacer su presentación.


ABSTRACT: portal vein aneurysms are uncommon, representing approximately the 3% of venous system aneurysms. Most portal vein aneurysms are detected in patients with healthy liver, although on some occasions portal hypertension could favor their development. The most common sites are the splenomesenteric venous confluence, the main portal vein and the branches of the intrahepatic portal vein at bifurcation sites. Objective: to present the case of a patient with a portal vein aneurysm. Case Presentation: A 49-years-old white female patient with a history of dyspeptic disorders, and sometimes pain in the right upper quadrant. Her physical examination was negative and the diagnostic impression from her attending physician was gallstones. During the ultrasound examination, an aneurysmal dilatation of the portal vein at the beginning of its intrahepatic path of 18 mm in diameter was found as a positive finding, being the rest of the examination negative Conclusions: Due to the unusual nature of this case, it was decided to present it.


Subject(s)
Humans , Female , Middle Aged , Portal Vein/pathology , Portal Vein/diagnostic imaging , Aneurysm/diagnostic imaging
2.
Prensa méd. argent ; 105(8): 427-430, sept 2019. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1023136

ABSTRACT

The aim of this study was to analyse a patient dignosed in our hospital as having pylephlebitis. The patient is a 29 years old male, and we must consider that pylophlebitis refers to the septic thrombosis of the portal venous system, associated to some kind of infectious process. Can occur related to acute appendicitis, colonic diverticulitis and cholangitis, among others. Is a rare but close to a significant morbidity and mortality, since it can develop to an abdominal sepsis. The management review of the case reported, is presented (AU)


Subject(s)
Humans , Male , Adult , Appendicitis/complications , Portal System , Portal Vein/pathology , Tomography, X-Ray Computed , Sepsis , Venous Thromboembolism/complications
3.
Acta cir. bras ; 33(9): 785-791, Sept. 2018. graf
Article in English | LILACS | ID: biblio-973499

ABSTRACT

Abstract Purpose: To evaluate the morphological effects of injected sclerosing agents into the liver. Methods: This study was performed on twenty dogs, distributed into five groups: Group 1 (n = 5) - control, Group 2 (n = 5) - injection of 50% glucose solution inside hepatic parenchyma and animals followed during seven days, Group 3 (n = 10) - injection of ethanol inside hepatic parenchyma and animals distribution into two subgroups Subgroup 3A (n = 5) - followed during 24 hours and subgroup 3B (n = 5) - followed during seven days (group 3B), Group 4 (n = 5) - ethanol injection inside left portal vein branch and followed during 24 hours. Livers were macroscopically evaluated, submitted to hepatic arteriography and portography, then histology. Results: All animals in Group 4 died within 23 hours due to diffuse hepatic necrosis. The animals of groups 2 and 3 had a satisfactory evolution. Fibrosis formed in the segment reached by the sclerosant solution and interruption of the contrast flow injected into the portal system. Conclusion: Intrahepatic parenchymal ethanol injection is well tolerated and causes sclerosis restricted to a specific segment; however, intraportal ethanol injection causes massive hepatic necrosis and can lead to death.


Subject(s)
Animals , Male , Dogs , Portal Vein/drug effects , Liver/drug effects , Portal Vein/pathology , Portal Vein/diagnostic imaging , Sclerosing Solutions/pharmacology , Sclerosis/chemically induced , Sclerosis/pathology , Sclerosis/diagnostic imaging , Portography , Liver/pathology , Liver/diagnostic imaging
4.
Yonsei Medical Journal ; : 162-166, 2018.
Article in English | WPRIM | ID: wpr-742488

ABSTRACT

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.


Subject(s)
Adolescent , Chronic Disease , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/diagnostic imaging , Esophageal and Gastric Varices/therapy , Female , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/therapy , Humans , Jejunum/pathology , Portacaval Shunt, Surgical , Portal Vein/diagnostic imaging , Portal Vein/pathology , Portal Vein/surgery , Tomography, X-Ray Computed , Treatment Outcome , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/therapy
5.
J. vasc. bras ; 14(1): 88-93, Jan-Mar/2015. graf
Article in English | LILACS | ID: lil-744464

ABSTRACT

Aneurysms and thromboses of the portal vein are rare pathologies of the portal system that commonly follow an asymptomatic course. The vast majority of cases are diagnosed as incidental findings during imaging studies. Symptoms of aneurysms are the result of mass effects, while thrombosis symptoms are a function of the liver's ability to form a collateral circulation network in the thrombosis. The scant experience with such cases poses a dilemma for patient management and so the vast majority of authors choose an expectant approach with rigorous patient surveillance and only intervene in symptomatic patients. We report one case of an aneurysm of the portal vein and one case of portal vein thrombosis and discuss management and observation of these patients...


O aneurisma e a trombose de veia porta são doenças raras do sistema porta, que comumente cursam sem sintomas. A grande maioria dos pacientes é diagnosticada com achados em exames de imagem. Os sintomas são atribuídos ao efeito de massa, no caso do aneurisma, e relativos à capacidade hepática de formar uma rede de circulação colateral, no caso da trombose. A escassa experiência nesses casos representa um dilema na abordagem desses pacientes e, portanto, a grande maioria dos autores opta por seguimento rigoroso e a intervenção é indicada apenas para os pacientes sintomáticos. Neste trabalho, relatamos um caso de aneurisma de veia porta e outro de trombose da veia porta, propondo o manejo e o acompanhamento desses pacientes...


Subject(s)
Humans , Male , Adult , Aged , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal , Vascular Diseases/diagnosis , Vascular Diseases , Fatty Liver/complications , Venous Thrombosis/surgery , Portal Vein/pathology , Abdomen , Emergency Medical Services/methods , Tomography, X-Ray Computed/methods
6.
Article in English | WPRIM | ID: wpr-83674

ABSTRACT

OBJECTIVE: To retrospectively evaluate relative enhancement (RE) in the hepatobiliary phase of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging as a preoperative estimation of future remnant liver (FRL) function in a patients who underwent portal vein embolization (PVE). MATERIALS AND METHODS: In 53 patients, the correlation between the indocyanine green clearance (ICG-K) and RE imaging was analyzed before hepatectomy (first analysis). Twenty-three of the 53 patients underwent PVE followed by a repeat RE imaging and ICG test before an extended hepatectomy and their results were further analyzed (second analysis). Whole liver function and FRL function were calculated on the MR imaging as follows: RE x total liver volume (RE Index) and FRL-RE x FRL volume (Rem RE Index), respectively. Regarding clinical outcome, posthepatectomy liver failure (PHLF) was evaluated in patients undergoing PVE. RESULTS: Indocyanine green clearance correlated with the RE Index (r = 0.365, p = 0.007), and ICG-K of FRL (ICG-Krem) strongly correlated with the Rem RE Index (r = 0.738, p < 0.001) in the first analysis. Both the ICG-Krem and the Rem RE Index were significantly correlated after PVE (r = 0.508, p = 0.013) at the second analysis. The rate of improvement of the Rem RE Index from before PVE to after PVE was significantly higher than that of ICG-Krem (p = 0.014). Patients with PHLF had a significantly lower Rem RE Index than patients without PHLF (p = 0.023). CONCLUSION: Relative enhancement imaging can be used to estimate FRL function after PVE.


Subject(s)
Adult , Aged , Aged, 80 and over , Embolization, Therapeutic/methods , Female , Gadolinium DTPA , Hepatectomy/methods , Humans , Indocyanine Green/pharmacokinetics , Liver/pathology , Liver Neoplasms/surgery , Magnetic Resonance Imaging/methods , Male , Middle Aged , Portal Vein/pathology , Regression Analysis , Retrospective Studies , Treatment Outcome
7.
Article in English | WPRIM | ID: wpr-83667

ABSTRACT

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


Subject(s)
Adult , Aged , Aged, 80 and over , Biliary Tract Neoplasms/surgery , Cholangitis/etiology , Cholestasis/surgery , Female , Hemobilia/etiology , Humans , Kaplan-Meier Estimate , Liver/blood supply , Liver Neoplasms/surgery , Male , Middle Aged , Palliative Care/methods , Polytetrafluoroethylene , Portal Vein/pathology , Retinal Vein Occlusion/surgery , Retrospective Studies , Stents/adverse effects , Treatment Outcome
8.
JPMI-Journal of Postgraduate Medical Institute. 2013; 27 (2): 213-219
in English | IMEMR | ID: emr-142597

ABSTRACT

The objective of this study was to assess the validity of color doppler sonography in the evaluation of malignant portal vein thrombosis in hepatocellular carcinoma [findings on biphasic spiral computed tomography were used as the gold standard]. This study was conducted in the Department of Diagnostic and Interventional Radiology at Shifa International Hospital, Islamabad from March 2009 to November 2009. A total of 100 patients those who were already diagnosed cases of HCC or those having high suspicion of HCC based on clinical criteria [e.g., chronic hepatitis B or C, liver cirrhosis, increased alpha fetoprotein level [>400ng/dl]] and /or Imaging findings [e.g., sonography, MRI, CT] were included in this study. Color doppler sonography had 80.7% sensitivity and 100% specificity in the detection of arterial flow in the portal vein thrombus [i.e., malignant thrombus] in comparison with biphasic CT [taken as gold standard]. Color doppler sonography is an effective, noninvasive method for evaluating the presence of malignant portal vein thrombosis associated with HCC


Subject(s)
Humans , Carcinoma, Hepatocellular/diagnostic imaging , Sensitivity and Specificity , Cost-Benefit Analysis , Venous Thrombosis/diagnostic imaging , Portal Vein/diagnostic imaging , Portal Vein/pathology , Liver Neoplasms/diagnostic imaging
9.
Article in English | WPRIM | ID: wpr-212597

ABSTRACT

Hepatoportal sclerosis (HPS) is defined as sclerosis of portal areas in the absence of cirrhosis. There is little information about HPS in children in the literature. The aim of this study was to describe the clinical presentation, associated disorders, laboratory characteristics and outcome of children who were diagnosed as HPS. This study included 12 children diagnosed as HPS by the Pathology Department between 2005 and 2011. Data were collected from the gastroenterology clinic charts retrospectively, including demographics, presentation characteristics, laboratory data and recent status of patients. Twelve patients were enrolled (6 girls, 6 boys). The median age of patients was 13.5 yr. Median age at the time of biopsy was 11 yr. Four patients had splenomegaly, 3 had esophageal varices, one had hepatopulmonary syndrome and had been transplanted. Smooth muscle antibody was found positive in 4 patients, without autoimmune hepatitis findings in liver biopsy. One patient had celiac disease and another patient had positive celiac disease serology but pathology findings. Another patient had Turner's syndrome. Mean follow-up time was 39 months (3.3 yr) after biopsy. Hepatoportal sclerosis does not necessarily present with portal hypertension in children.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Gastroenterology , Humans , Hypertension, Portal/complications , Liver/pathology , Liver Diseases/complications , Male , Portal Vein/pathology , Retrospective Studies , Sclerosis/diagnosis
10.
Gut and Liver ; : 696-703, 2013.
Article in English | WPRIM | ID: wpr-209556

ABSTRACT

BACKGROUND/AIMS: We investigated the effects of sorafenib monotherapy on advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) in a clinical setting. METHODS: In total, 143 consecutive patients with unresectable HCC were treated with sorafenib. Among these patients, 30 patients with advanced HCC and PVTT (Vp3 or 4) were treated with sorafenib monotherapy. RESULTS: All patients had a performance status of 1 to 2 (Eastern Cooperative Oncology Group 1/2, 20/10) and Child-Pugh class A or B (A/B, 17/13). Eleven patients had modified Union for International Cancer Control stage IVA tumors, whereas 19 had stage IVB tumors. All patients had PVTT (Vp3, 6; Vp4, 24). Following sorafenib monotherapy, three patients (10.0%) had a partial response with PVTT revascularization, and nine (30.0%) had stable disease, with a disease control rate of 33.3%. The median overall survival was 3.1 months (95% confidence interval [CI], 2.70 to 3.50), and the median progression-free survival was 2.0 months (95% CI, 1.96 to 2.05). Fatigue and hand-foot skin reactions were the most troublesome side effects. CONCLUSIONS: A limited proportion of patients with advanced HCC and PVTT exhibited a remarkable outcome after sorafenib monotherapy, although the treatment results in this type of patient is extremely poor. Further studies to predict good responders to personalized therapy are warranted.


Subject(s)
Adult , Aged , Aged, 80 and over , Anorexia/chemically induced , Antineoplastic Agents/adverse effects , Carcinoma, Hepatocellular/drug therapy , Diarrhea/chemically induced , Disease-Free Survival , Fatigue/chemically induced , Female , Hand-Foot Syndrome/etiology , Humans , Kaplan-Meier Estimate , Liver Neoplasms/drug therapy , Magnetic Resonance Imaging , Male , Middle Aged , Nausea/chemically induced , Neoplasm Invasiveness , Niacinamide/adverse effects , Phenylurea Compounds/adverse effects , Portal Vein/pathology , Proportional Hazards Models , Tomography, Spiral Computed , Venous Thrombosis/drug therapy
11.
Clinics ; 67(6): 609-614, 2012.
Article in English | LILACS | ID: lil-640211

ABSTRACT

OBJECTIVE: The aim of this study was to determine whether and how the diameter of the vein that gives rise to the inflowing vein of the esophageal and gastric fundic varices secondary to posthepatitic cirrhosis, as measured with multidetector-row computed tomography, could predict the varices and their patterns. METHODS: A total of 106 patients with posthepatitic cirrhosis underwent multidetector-row computed tomography. Patients with and without esophageal and gastric fundic varices were enrolled in Group 1 and Group 2, respectively. Group 1 was composed of Subgroup A, consisting of patients with varices, and Subgroup B consisted of patients with varices in combination with portal vein-inferior vena cava shunts. The diameters of the originating veins of veins entering the varices were reviewed and statistically analyzed. RESULTS: The originating veins were the portal vein in 8% (6/75) of patients, the splenic vein in 65.3% (49/75) of patients, and both the portal and splenic veins in 26.7% (20/75) of patients. The splenic vein diameter in Group 1 was larger than that in Group 2, whereas no differences in portal vein diameters were found between groups. In Group 1, the splenic vein diameter in Subgroup A was larger than that in Subgroup B. A cut-off splenic vein diameter of 8.5 mm achieved a sensitivity of 83.3% and specificity of 58.1% for predicting the varices. For discrimination of the varices in combination with and without portal vein-inferior vena cava shunts, a cut-off diameter of 9.5 mm achieved a sensitivity of 66.7% and specificity of 60.0%. CONCLUSION: The diameter of the splenic vein can be used to predict esophageal and gastric fundic varices and their patterns.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Esophageal and Gastric Varices/pathology , Hypertension, Portal/pathology , Liver Cirrhosis/pathology , Portal Vein/pathology , Splenic Vein/pathology , Hypertension, Portal/etiology , Liver Cirrhosis/complications , Multidetector Computed Tomography , Observer Variation , Organ Size , Predictive Value of Tests , ROC Curve
12.
Rev. cuba. med ; 50(4): 453-457, oct.-dic. 2011.
Article in Spanish | LILACS | ID: lil-615457

ABSTRACT

Se presentó un paciente de 73 años de edad, de raza blanca, con ascitis quilosa, acompañada de insuficiencia hepática e hipertensión portal. Se evidenció la presencia de trombosis de la vena porta y varices esofágicas. Se notifica por lo infrecuente de la aparición de ascitis quilosa en pacientes con cirrosis hepática y su posible asociación con trombosis de la vena porta


This is the case of a white patient aged 73 presenting with chylosus ascites and liver failure and portal hypertension. It was evidenced la presence of thrombosis of portal vein and esophageal varices. It is noteworthy the non-frequent of chylosus ascites in patients presenting with liver cirrhosis and its possible association with a portal vein thrombosis


Subject(s)
Chylous Ascites/diagnosis , Liver Cirrhosis/diagnosis , Hypertension, Portal/diagnosis , Portal Vein/pathology
13.
Indian J Pathol Microbiol ; 2011 Jan-Mar 54(1): 25-31
Article in English | IMSEAR | ID: sea-141910

ABSTRACT

Background: Collagen vascular disorders (CVDs) are autoimmune disorders with multisystem involvement. Clinical liver involvement is not a characteristic feature though histological involvement could be frequent. Liver disease in CVDs could be the consequence of various factors. Aim: The aim was to analyze the histological spectrum of liver in collagen vascular disorders (CVDs) at autopsy. Materials and Methods: Thirty-six autopsy livers negative for hepatitis B or C virus were studied in CVD cases with no known association with chronic liver disease or vascular thrombosis or hematological disorder. Cirrhotic and normal livers were used as controls. The paired t-test, one-way ANOVA, and two-sided Dunnett t-test were used for comparison (< 0.05). None of the control cases showed any abnormal vessels. Results: There were 21 systemic lupus erythematosus (SLE), 7 rheumatoid arthritis (RA), 5 systemic sclerosis (SSc), and 3 polyarteritis nodosa (PAN) cases (M:F = 11:25, age range 23-60 years). Histology: Diffuse nodular regenerative hyperplasia of liver (NRHL) was seen in 10 cases, and 6 (5 SLE and 1 RA) had numerous abnormal thin-walled vessels in intermediate- and small-sized portal tracts with no vascular occlusion or inflammation. Moderate sized portal tracts showed more interface and lobular inflammation. The main portal vein and its major branches were normal. None of these six cases had increased transmainases (P>0.05). Most SLE cases had increased transaminases (P<0.05). No evidence of portal hypertension was seen in all except in one RA. Septicemia is known to be associated with raised transaminases. Conclusion: A rare pathology of conglomerate of abnormal vessels in intermediate- and small-sized portal system was observed co-existing with NRHL in CVDs. Raised liver enzyme with interface hepatitis in CVD may not necessarily warrant an overlap, as a similar feature could be observed in septicemia.


Subject(s)
Adult , Autopsy , Collagen Diseases/complications , Collagen Diseases/pathology , Female , Histocytochemistry , Humans , Liver/blood supply , Liver/pathology , Liver Diseases/pathology , Male , Middle Aged , Portal Vein/pathology , Vascular Diseases/complications , Vascular Diseases/pathology
14.
Clinics ; 66(1): 119-124, 2011. ilus, tab
Article in English | LILACS | ID: lil-578607

ABSTRACT

OBJECTIVES: Recent guidelines recommend that all cirrhotic patients should undergo endoscopic screening for esophageal varices. That identifying cirrhotic patients with esophageal varices by noninvasive predictors would allow for the restriction of the performance of endoscopy to patients with a high risk of having varices. This study aimed to develop a decision model based on classification and regression tree analysis for the prediction of large esophageal varices in cirrhotic patients. METHODS: 309 cirrhotic patients (training sample, 187 patients; test sample 122 patients) were included. Within the training sample, the classification and regression tree analysis was used to identify predictors and prediction model of large esophageal varices. The prediction model was then further evaluated in the test sample and different Child-Pugh classes. RESULTS: The prevalence of large esophageal varices in cirrhotic patients was 50.8 percent. A tree model that was consisted of spleen width, portal vein diameter and prothrombin time was developed by classification and regression tree analysis achieved a diagnostic accuracy of 84 percent for prediction of large esophageal varices. When reconstructed into two groups, the rate of varices was 83.2 percent for high-risk group and 15.2 percent for low-risk group. Accuracy of the tree model was maintained in the test sample and different Child-Pugh classes. CONCLUSIONS: A decision tree model that consists of spleen width, portal vein diameter and prothrombin time may be useful for prediction of large esophageal varices in cirrhotic patients.


Subject(s)
Female , Humans , Male , Middle Aged , Decision Trees , Esophageal and Gastric Varices/diagnosis , Liver Cirrhosis/complications , Endoscopy, Gastrointestinal/methods , Organ Size , Platelet Count , Predictive Value of Tests , Prognosis , Portal Vein/pathology , Prothrombin Time/methods , Regression Analysis , Reproducibility of Results , Risk Factors , Statistics, Nonparametric , Spleen/pathology , Splenomegaly/complications
16.
Rev. Soc. Bras. Med. Trop ; 43(2): 129-134, Mar.-Apr. 2010. tab, ilus
Article in English | LILACS | ID: lil-545765

ABSTRACT

INTRODUCTION: Abdominal palpation and ultrasound findings among patients from an endemic area for schistosomiasis in Brazil who had been followed up for 27 years were compared. METHODS: In 2004, 411 patients from Brejo do Espírito Santo, in the State of Bahia, were selected for the present investigation after giving their written informed consent. Based on clinical data, they were divided into three groups: 41 patients with evidence of liver fibrosis in 2004 (Group 1); 102 patients with evidence of liver fibrosis in the past (1976-1989) but not in 2004 (Group 2); and 268 patients without evidence of liver fibrosis at any time during the 27-year follow-up (Group 3). All of the patients underwent abdominal ultrasound in which the examiner did not know the result from the clinical examination. The data were stored in a database. RESULTS: The prevalence of periportal fibrosis on ultrasound was 82.9 percent, 56.9 percent and 13.4 percent in Groups 1, 2 and 3, respectively. In the presence of hard, nodular liver or prominent left lobe and a hard palpable spleen, ultrasound revealed periportal fibrosis in 70.9 percent. However, periportal fibrosis was diagnosed using ultrasound in 25.4 percent of the patients in the absence of clinical evidence of liver involvement. Thus, ultrasound diagnosed periportal fibrosis 3.1 times more frequently than clinical examination did. CONCLUSIONS: Although clinical examination is important in evaluating morbidity due to Manson's schistosomiasis in endemic areas, ultrasound is more accurate in diagnosing liver involvement and periportal fibrosis.


INTRODUÇÃO: Neste estudo, se comparou os achados da palpação abdominal e do ultrassom em pacientes de área endêmica de esquistossomose que foram acompanhados por 27 anos no Brasil. MÉTODOS: Em 2004, 411 pacientes de Brejo do Espírito Santo, no estado da Bahia, após consentimento informado e por escrito foram selecionados para o presente estudo. Baseando-se no exame clínico eles foram divididos em 3 grupos: 41 (Grupo 1) com evidência de fibrose hepática no ano de 2004; 102 (Grupo 2) com evidência de fibrose hepática no passado (1976-1989) mas não em 2004; e 268 (Grupo 3) sem evidência de fibrose hepática em 27 anos de seguimento. Todos foram submetidos a exame ultrassonográfico do abdome em que o examinador não sabia o resultado do exame clínico. Os dados foram armazenados em banco de dados. RESULTADOS: A prevalência de fibrose periportal ao ultrassom foi de 82,9 por cento, 56,9 por cento e 13,4 por cento nos Grupos 1, 2 e 3, respectivamente. Na presença de fígado duro, nodular ou lobo esquerdo proeminente e baço palpável duro, o ultra-som revelou fibrose periportal em 70,9 por cento. Porém, fibrose periportal foi diagnosticada através do ultrassom em 25,4 por cento dos pacientes, na ausência de evidência clínica de envolvimento hepático. Assim, o ultrassom diagnosticou fibrose periportal 3,1 vezes mais frequentemente que o exame clínico. CONCLUSÕES: O exame clínico tem importância na avaliação da morbidade da esquistossomose mansônica em áreas endêmicas, mas o ultrassom mostra-se mais preciso quando se pretende diagnosticar o envolvimento hepático e a fibrose periportal.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Liver Cirrhosis/diagnosis , Palpation , Portal Vein/parasitology , Schistosomiasis mansoni/diagnosis , Splenic Diseases/diagnosis , Brazil , Cross-Sectional Studies , Follow-Up Studies , Liver Cirrhosis/parasitology , Liver Cirrhosis , Portal Vein/pathology , Portal Vein , Schistosomiasis mansoni , Splenic Diseases/parasitology , Splenic Diseases
17.
Afro-Arab Liver Journal. 2010; 9 (1): 1-5
in English | IMEMR | ID: emr-145819

ABSTRACT

Vascular endothelial growth factor [VEGF] is the most potent angiogenic factor known so far and it plays an important role in tumor biology. Elevated level of VEGF has been associated with poor prognosis in many cancers; however significance in hepatocellular carcinoma is still controversial. Was to evaluate serum VEGF level in hepatocellular carcinoma patients with or without portal vein thrombosis [PVT] compared to liver cirrhosis patients and healthy subjects and to study possible relation of other clinical and laboratory findings to VEGF level. Serum VEGF level was measured in 20 cirrhotic patients complicated with HCC and PVT, 20 cirrhotic patients complicated with HCC with no portal vein thrombosis, another 20 cirrhotic patients matched for Child-Pugh score 20 he1thy subjects matched for age and sex. VEGF level was compared across different groups, its level was evaluated hug to tumour size, Okuda stage, Child-Pugh class and etiology of liver disease. Serum VEGF was not significantly different between HCC patients with or without PVT, neither a significant as found between HCC patients and liver cirrhosis patients. Yet VEGF level was significantly higher in all cases of liver cirrhosis compared to control subjects. No significant relation was found between serum VEGF level and any of: tumour size, Okuda stage. Alpha fetoprotein, Child-Pugh class or etiology of liver disease. VEGF level is elevated in patients with liver cirrhosis even prior to the emergence HCC


Subject(s)
Humans , Male , Female , Vascular Endothelial Growth Factors/blood , Portal Vein/pathology , Thrombosis , Liver Cirrhosis , Liver Function Tests
18.
Arab Journal of Gastroenterology. 2010; 11 (3): 124-129
in English | IMEMR | ID: emr-145063

ABSTRACT

Bleeding and thrombotic complications are common problems in patients with chronic liver disease [CLD]. The aim of the present study was to evaluate the level of soluble P [sP]-selectin, and P-selectin glycoprotein ligand-1 [PSGL-1] [CD162] expression on neutrophils among patients with CLD and to clarify the role of their interaction, by measuring the platelet leucocyte aggregates, on the clinical outcome of the haemostatic balance in those patients. We also investigated the hypothesis that the balance between platelet activation and endothelial biological function is impaired. sP-selectin and thrombomodulin [TM] levels were measured by enzyme-linked immunosorbent assay [ELISA] and flowcytometric detection of CD162 was performed. Platelet-leucocyte aggregation [PLA] in whole blood was measured as positive for CD41a and CD45 in 66 CLD patients divided into the portal vein thrombosis group [PVT] [n = 25], the haematemesis group [n = 21] and the haemostatically stable group [n = 20]. sP-selectin was significantly elevated in all patient groups. Decreased surface expression of CD162 on neutrophils was detected in all patients' groups. PLA was statistically significantly increased in the PVT group. TM was statistically significantly increased in the PVT, haematemesis and haemostatically stable groups. PLA may play a role in the unique PVT outcome of the haemostatic balance in a group of patients whose credentials of hyperdynamic portal circulation predispose them to bleeding rather than thrombosis. Consequently, P-selectin-targeted therapy may be used to prevent this complication


Subject(s)
Humans , Male , Female , Middle Aged , Membrane Glycoproteins , Portal Vein/pathology , Hypertension, Portal , Venous Thrombosis/therapy , Hematemesis , Liver Diseases/complications , Chronic Disease
19.
Article in English | WPRIM | ID: wpr-198287

ABSTRACT

OBJECTIVE: We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. MATERIALS AND METHODS: From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. RESULTS: Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). CONCLUSION: This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis.


Subject(s)
Angiography , Antineoplastic Agents/administration & dosage , Carcinoma, Hepatocellular/drug therapy , Catheters, Indwelling/adverse effects , Embolization, Therapeutic , Female , Femoral Artery/surgery , Fluoroscopy , Hepatic Artery , Humans , Infusions, Intra-Arterial , Liver Neoplasms/drug therapy , Male , Middle Aged , Portal Vein/pathology , Radiography, Interventional , Treatment Outcome
20.
Radiol. bras ; 42(3): 199-201, maio-jun. 2009. ilus
Article in English, Portuguese | LILACS | ID: lil-520280

ABSTRACT

Os aneurismas no sistema esplenoportomesentérico são uma entidade clínica rara e de etiologia desconhecida, tendo como fatores contribuintes hipertensão portal, doença hepática crônica e trauma, entre outros. Os autores apresentam os achados de imagem de um caso de aneurisma na junção esplenomesentérica ao nível da emergência da veia porta, em uma paciente de 62 anos de idade sem fatores predisponentes.


Aneurysms in the splenoportomesenteric system constitute a rare entity whose etiology is still to be determined. Predisponent factors include portal hypertension, chronic hepatic disease and trauma, among others. The authors present a case of an aneurysm at the splenomesenteric confluence where it joins the portal vein, in a female, 62-year-old patient with no predisponent factor.


Subject(s)
Humans , Male , Middle Aged , Aneurysm , Aneurysm/complications , Aneurysm , Mesenteric Veins , Portal Vein , Splenic Vein , Portal Vein/pathology , Mesenteric Veins/pathology , Tomography, X-Ray Computed , Ultrasonography, Doppler
SELECTION OF CITATIONS
SEARCH DETAIL