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1.
Scand J Gastroenterol ; 53(9): 1107-1113, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30270689

RESUMO

OBJECTIVES: The clinical relevance of spontaneous portosystemic shunts detected by ultrasound is insufficiently investigated. The aim of this retrospective study was to assess the frequency and clinical relevance of spontaneous portosystemic shunts in patients with liver cirrhosis. METHODS: We evaluated portosystemic shunts, liver cirrhosis and spleen size by ultrasound in 982 patients with liver cirrhosis and correlated these with laboratory results, clinical data and the incidence of clinical endpoint deaths, liver transplantation and the development of HCC during the follow-up period (mean 1.26 ± 1.53 years [range 0-7.2 years]). RESULTS: Portosystemic shunts were detected in 34% of the patients. These patients had a higher rate of alcohol-related cirrhosis (37% vs. 30%, p = .003), a higher MELD score (p < .001) and Child-Pugh grade (p < .001), as well as more frequent hepatic encephalopathy (p < .001) and oesophageal varices (p < .003). The most frequent portosystemic shunt in this cohort was an umbilical vein shunt (69%) followed by splenorenal (16%), mesenteric (7%) and combined/other shunts (8%). Patients with umbilical vein shunts had a higher rate of alcohol-related cirrhosis (p = .041) and suffered more frequently from Child B/C stages (p = .03), hepatorenal syndrome (p = .03), massive ascites (p = .001) and spontaneous bacterial peritonitis (p = .011). CONCLUSIONS: Patients with portosystemic shunts that are detected by ultrasound should be monitored carefully as these patients are associated with advanced liver disease and multiple clinical risk factors.


Assuntos
Encefalopatia Hepática/complicações , Hipertensão Portal/diagnóstico por imagem , Cirrose Hepática/fisiopatologia , Baço/diagnóstico por imagem , Ultrassonografia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/complicações , Criança , Varizes Esofágicas e Gástricas/complicações , Feminino , Humanos , Hipertensão Portal/etiologia , Modelos Lineares , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
2.
Dev Dyn ; 236(10): 2952-61, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17879316

RESUMO

Lymphangioma is a disfiguring malformation of early childhood. A mouse lymphangioma model has been established by injecting Freund's incomplete adjuvant (FIA) intraperitoneally, but has not been compared with the human disease. We show that, in accordance with studies from the 1960s, the mouse model represents an oil-granuloma, made up of CD45-positive leukocytes and invaded by blood and lymph vessels. Several markers of lymphatic endothelial cells are expressed in both mouse and human, like CD31, Prox1, podoplanin, and Lyve-1. However, the human disease affects all parts of the lymphovascular tree. We observed convolutes of lymphatic capillaries, irregularly formed collectors with signs of disintegration, and large lymph cysts. We observed VEGFR-2 and -3 expression in both blood vessels and lymphatics of the patients, whereas in mouse VEGFR-2 was confined to activated blood vessels. The experimental mouse FIA model represents a vascularized oil-granuloma rather than a lymphangioma and reflects the complexity of human lymphangioma only partially.


Assuntos
Modelos Animais de Doenças , Linfangioma , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Animais , Biomarcadores/metabolismo , Endotélio Linfático/patologia , Adjuvante de Freund , Granuloma/metabolismo , Granuloma/patologia , Humanos , Lactente , Linfangioma/irrigação sanguínea , Linfangioma/metabolismo , Linfangioma/patologia , Vasos Linfáticos/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Receptor 3 de Fatores de Crescimento do Endotélio Vascular/metabolismo
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