Experimental studies for noninvasive assessment of portal vein pressure based on contrast enhanced subharmonic sonographic imaging / 生物医学工程学杂志

Portal hypertension (PHT) is a common complication of liver cirrhosis, which could be measured by the means of portal vein pressure (PVP). However, there is no report about an effective and reliable way to achieve noninvasive assessment of PVP so far. In this study, firstly, we collected ultrasound images and echo signals of different ultrasound contrast agent (UCA) concentrations and different pressure ranges in a low-pressure environment based on an

Cavernoma portal complicada con biliopatía secundario a enfermedad de Gaucher tipo 1: reporte de un caso peruano / Cavernoma complicated with biliopatia secondary to type 1 Gaucher disease: report of a Peruvian case

La enfermedad de Gaucher, es un trastorno autosómico recesivo de depósito lisosomal que se caracteriza por deficiencia de la beta-glucocerebrosidasa que lleva a la acumulación de glucosilceramida principalmente en células del sistema fagocítico mononuclear causando afectaciones sistémicas. Se presenta paciente varón de 20 años que cursa con dolor crónico en hipocondrio izquierdo con episodios de sangrados desde hace 3 años y sensación de alza térmica, al examen físico se identificó ictericia y esplenomegalia masiva, sin afectación neurológica. Como apoyo al diagnóstico se mostró osteoporosis severa, pancitopenia y como hallazgo inesperado la presencia de trombosis de vena porta con transformación cavernomatosa complicada con biliopatía portal simulando un tumor de klatskin, los estudios de médula y enzimáticos eran compatibles con enfermedad de Gaucher, por lo cual recibió tratamiento con imiglucerasa realizando seguimiento. Es un caso poco frecuente, de gran interés, heterogeneidad en sus manifestaciones clínicas e inéditas por su complicación, constituyendo un desafío llegar a su diagnóstico de esta enfermedad huérfana.

Gaucher disease is an autosomal recessive lysosomal storage disorder characterized by deficiency of beta-glucosidase that would lead to the accumulation of glucosylceramide mainly in cells of the mononuclear phagocytic system causing systemic effectations. We present a patient of twenty years who is suffering from chronic pain in the left hypochondrium with episodes of bleeding for 3 years and sensation of thermal rise, physical examination revealed jaundice and massive splenomegaly, without neurological involvement. Severe osteoporosis, pancytopenia, and the presence of portal vein thrombosis with cavernomatous transformation complicated by portal biliopathy simulating a klatskin tumor, marrow and enzymatic studies were compatible with Gaucher disease, were shown as unexpected findings. he received treatment with imiglucerase, following up. It is a rare case, of great interest, heterogeneity in its clinical manifestations and unpublished by its complication, constituting a challenge to reach its diagnosis of this orphan disease.

Colangiopatía portal: complicación poco frecuente de la hipertensión portal / Portal cholangiopathy: infrequent portal hypertension complication / Colangiopatia do portal: complicação incomum da hipertensão portal

Se describe el caso clínico de una mujer de 62 años en la que se diagnostica una estenosis del colédoco en el contexto de hipertensión portal prehepática (cavernomatosis portal).

We report the case of a 62 years old woman with a choledochal stricture and chronic obstruction of the portal vein (portal cavernomatosis).

Relatamos o caso de uma mulher de 62 anos com diagnóstico de estenose do colédoco no contexto da hipertensão portal pré-hepática (cavernomatose portal).

Liver abscess in a newborn leading to portal vein thrombosis.

We report a male neonate who had liver abscess that resolved with intravenous antibiotics and surgical drainage. However, the child developed complete thrombosis of portal vein with cavernous formation within 16 days of therapy and portal hypertension subsequently. The child is now 2½ years and has extra hepatic portal hypertension but is otherwise asymptomatic.

Sensitivity of serum / ascitic albumin gradient for detection of portal hypertension

SAAG [serum ascitic albumin gradient], is a liable index of portal hypertension and correlates directly with pressure gradient between portal capillaries and peritoneal cavity. Calculation of SAAG is simple and the procedure can be done safely in in-patients as well as out patients. It was a cross-sectional comparative study, of 6 months duration conducted in Medical unit I of Abbasi Shaheed Hospital. There were 50 patients of ages between 15 and 70 years with ascites secondary to chronic liver disease. All patients were investigated for presence of portal hypertension both by detecting portal vein diameter on ultrasound and serum ascitic albumin gradient. Thirty seven [74%] out of 50 patients had portal hypertension on basis of serum ascitic albumin gradient while ultrasound of portal vein confirmed portal hypertension in 35 [70%] patients. Serum ascitic albumin gradient was found 97.14% sensitive in detecting portal hypertension. Serum ascitic albumin gradient is a reliable marker to differentiate ascites into portal hypertensive and non- portal hypertensive etiology

Role of Doppler Ultrasonography in Portal Hypertension / 대한소화기학회지

No abstract availble.

Prognostic significance of hepatic veins waveforms study by doppler ultrasonography in cirrhotic patients with portal hypertension

Doppler Ultrasonographic [U/S] waveform changes in the hepatic veins can be found in chronic parenchymal liver disease, especially in the late stages. In this prospective study, 150 Egyptian bilharzial cirrhotic patients with portal hypertension but without hepatocellular carcinoma [HCC] in addition to 20 age and sex matched apparently healthy control were studied. Diagnosis was confirmed with liver biopsy in 121 patients [those with prolonged prothrombin time 3 seconds more than control and platelet count less than 90000 per mm were excluded]. Doppler wave form patterns in patients were classified into 4 types: [I, II, III and IV], while we found that all the control group was of type I Doppler waveform Prognostic value of the hepatic veins waveforms together with clinical and biochemical parameters were evaluated with their relation to the outcome of our patients. Out of 150 of our patients 112 were male and 38 were females, their ages ranged between 29-65 years [with mean +/- SD = 47.08 +/- 7.70 years]. All were experienced variceal bleeding. Most of the patients [130] were HCV positive. By the end of the follow up period [18 months] 23 [15:3%] patients have died, all due to liver cell failure. A univariate analysis that followed by a multivariate one showed that flat Doppler waveform [type IV] changes in the right hepatic vein with the following characteristics of patients [rebleeding varices, presence of encephalopathy, increase s.billrubin and decrease prothrombin%] were independently related to survival. Doppler U/S study [which is a non-invasive maneuver] of the right hepatic vein has improved the prognostic accuracy in patients with cirrhosis and portal hypertension. Moreover type IV [flat waveform with fluttering] was associated with bad prognosis and poor survival

Role of duplex doppler in evaluation of portal hypertension as a comparative study between bilharzial and non-bilharzial causes

Duplex Doppler has become powerful diagnostic tool in illustrating the morphology and haemodynamics of portal hypertension. We found that the maximum and mean blood flow velocity of the portal vein were less than control group with no significant difference between bilharzial and non bilharzial groups, while blood flow velocity in splenic vein was slower in 13 cases 3 cases. Blood flow volume did not show significant changes. Congestion index was elevated in portal hypertension with no significant difference between bilharzial and non billiarzial groups

Radionuclide hepatic perfusion and ultrasound studies in liver cirrhosis with portal hypertension

This work was carried out on 25 patients having liver cirrhosis [proved by biopsy] with portal hypertension. After complete clinical history, physical evaluation, routine laboratory investigations, and liver function tests, the patients were subjected to ultrasonic and scintigraphic examinations. Ultrasonography failed to reach accurate diagnosis of liver size in 5 patients and of the splenic size in 3 patients. The bright echo pattern of liver cirrhosis was present in 76% of patients only. Portal vein diameter was normal in 20% and dilated in the rest of patients. On the other hand, scintigraphic examination showed reduction in the L/S ratio in 68% in the clearance index in 92%, in the portal fraction in 44% of patients. Increased extra-hepatic colloid distribution in 2 sites was found in 56%, in the spleen in 84% and in the bone marrow in 84% of patients. Diffuse patchy distribution of hepatic uptake was present in all patients