ABSTRACT
PURPOSE: To evaluate the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in treatment of variceal hemorrhage. MATERIALS AND METHODS: Forty-five patients with cirrhosis underwent TIPS placement for treatment of acute (n = 12) or recurrent (n = 33) variceal hemorrhage. Shunts were created with Strecker stents. RESULTS: Shunts were established by deployment of stents in 42 patients. The portosystemic pressure gradient decreased from an average of 20.4 mm Hg +/- 5.4 to 9.2 mm Hg +/- 4.1. Complications included hepatic failure (n = 1), acute shunt thrombosis (n = 2), right jugular vein thrombosis (n = 1), bacteremia (n = 1), and stent misplacement (n = 1). Acute bleeding was controlled in 12 patients. The 30-day mortality rate was 2%; four other patients have since died. During follow-up (mean, 8.9 months), variceal bleeding recurred in six patients. Hepatic encephalopathy developed in six patients. Shunt stenosis or occlusion requiring further intervention occurred in 20 patients. CONCLUSION: TIPS are safe and effective in treatment of variceal hemorrhage; however, secondary interventions are often required to preserve shunt function.
Subject(s)
Esophageal and Gastric Varices/complications , Gastrointestinal Hemorrhage/surgery , Portasystemic Shunt, Surgical , Stents , Constriction, Pathologic , Female , Gastrointestinal Hemorrhage/etiology , Humans , Liver Cirrhosis/complications , Male , Middle Aged , Portasystemic Shunt, Surgical/adverse effects , Portography , Postoperative Complications , Radiography, Interventional , Stents/adverse effectsABSTRACT
Presentation of one case of bacterial acute focal nephritis (acute lobe nephrosis) in a parenterally drug-abuser, HIV-infected male. From the clinical point of view, the picture was interpreted as acute hepatitis, and the lesion was detected by ultrasound techniques. A right side location, relative lack of urological symptoms and coexistence of a chronic liver disease contributed to the diagnostic error. Failure of initial response to therapy with antibiotics coincided with the lesion migration. Eventually, the case evolved favourable with conservative treatment.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Nephritis/microbiology , AIDS-Related Opportunistic Infections/microbiology , Acute Disease , Adult , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/etiology , Bacterial Infections/microbiology , Diagnosis, Differential , Hepatitis/diagnosis , Humans , Male , Nephritis/diagnosis , Nephritis/drug therapy , Nephritis/etiology , Substance-Related Disorders/complicationsABSTRACT
We report a complicated case of renovascular hypertension from bilateral atherosclerotic renal artery stenosis in a solitary functioning kidney. Percutaneous transluminal angioplasty (PTA) was performed after diagnostic arteriography. Hypertension remitted only after surgical removal of the nonfunctioning kidney. In our view, PTA is the procedure of choice even in the solitary kidney.
