Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: DrugBank:APRD00530 (Portal)
4,208 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1001 cases of spleno-renal shunts taken from 26 publications were selected after a literature review. The great majority of these were retrospective and had a very poor follow-up. The operative mortality levels were acceptable (4,5%) and the portal pressure decreased considerably. Nevertheless it has been shown that in 30,3% of the cases, thrombosis of the anastomosis developed. Recurrence of bleeding occurred in 16% of a population in which permeability of the anastomosis had not been controlled and it could be estimated that it goes up to 52% for the group with thrombosis of their anastomosis. Portal systemic encephalopathy varies with age, being 17% for people below 38,5% above 44 years of age.
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PMID:[Results of spleno-renal anastomosis in the treatment of portal hypertension due to mansoni schistosomiasis. Apropos of a review of the literature]. 697 Oct 87

Five hundred four Shunt procedures have been done at Emory University Hospitals between 1971 and 1981 to decompress bleeding esophageal varices. This paper reviews how far the experiences of a prospective randomized study (55 patients) of distal splenorenal shunts against total shunts is supported by the nonrandomized experience (449 patients), and outlines our current methods of management dictated by this experience. The overall operative mortality for 348 selective shunts is 4.1% and for 156 nonselective shunts, 14.1%. The five-year survival following Selective shunt is 59%, and following nonselective shunt is 49%: more than half the selective shunt patients are alive, in contrast to the median survival of 44.5 months for patients having nonselective shunts. Following Selective shunt, the survival in nonalcoholic patients is significantly better than the median survival of alcoholic patients of 57 months. Encephalopathy, reported at three years after surgery in the randomized patients was significantly (p < 0.001) lower after selective shunt (12%) compared to nonselective shunt (52%): in the same population at seven years, all patients with patent nonselective shunts have clinical or subclinical encephalopathy, but only 30% of the selective shunt patients have subclinical encephalopathy. Shunt patency, immediately after surgery, is 93% following selective shunt, with only two documented late thromboses: nine of nine patients, at a mean of seven years, retain patency in the randomized study. Shunt occlusion increases with time after interposition nonselective shunts: seven of 13 are occluded at a mean follow-up of seven years in the randomized study. Portal venous perfusion is retained in 93% of patients seven to ten days after selective shunt, but in no patient with a patent nonselective shunt. Late portal perfusion is maintained in nine of the eleven patients in the randomized group studied at a mean of seven years after selective shunt. Restoration of portal perfusion has led to clearing of encephalopathy and improvement in hepatic function in six patients. The following conclusions are made: (1) selective shunts can be done with low operative mortality, and long-term patency with excellent control of bleeding; (2) hepatic portal venous perfusion has been maintained after selective shunt for ten years, and this is vital for preventing encephalopathy and maintaining hepatic function; (3) long-term survival after selective shunt is better than any reported series for nonselective shunt; and (4) selective shunts are the operative procedure of choice for variceal decompression and nonselective shunts should rarely be performed for elective decompression.
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PMID:Ten years portal hypertensive surgery at Emory. Results and new perspectives. 707 51

Acute hepatic ischaemia was induced in pigs by means of a portacaval shunt with hepatic artery ligation after 24 hours. Despite significant elevation in blood ammonia, fatty acids, aspartate aminotransferase, cerebrospinal fluid glutamine and ammonia, and brain tissue glutamine, ammonia and tryptophan, the experimental animals remained awake and alert and indistinguishable from sham-operated controls. The molar ratio of branched-chain to aromatic amino acids fell sharply in the arterial blood, but showed a terminal attempt at compensation in muscle venous samples. Portal and muscle venous insulin levels were elevated, and glucagon values rose in all circulation segments in the experimental group. The failure to induce coma in these pigs, despite the presence of many of the classical biochemical features, suggests that the syndrome of encephalopathy comprises several stages, and that the pig may be an important model in which to define these.
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PMID:Acute hepatic ischaemia in the pig- the changes in plasma hormones, amino acids and brain biochemistry. 725 Aug 93

Ninety children with portal hypertension were treated by portal diversion. Fifty-two had cavernous transformation of the portal vein and 38 had an intrahepatic block from various causes. There were 59 central splenorenal shunts, 19 mesocaval, 11 portacaval and one distal splenorenal. In 61 peripheral shunts the veins used for the anastomosis were less than 10 mm in diameter. There was no operative mortality in children with extrahepatic block. One child with cystic fibrosis died postoperatively. Thrombosis of the shunt occurred in five children (5.6 per cent) and was responsible for recurrent bleeding in two. Four children with a thrombosed shunt underwent succesful reoperation and one is awaiting another anastomosis. No late complications occurred in the 52 children with extrahepatic block, while encephalopathy developed in four children with intrahepatic block. These figures confirm our earlier results in the management of portal hypertension in childhood and suggest that portal diversion is the treatment of choice. Several precautions have permitted lowering of the rate of thrombosis whichever shunt is performed. Portal diversion should be indicated following the first episode of hemorrhage in children with extrahepatic block. In patients with intrahepatic block, congenital hepatic fibrosis and cystic fibrosis are good indications as are in general the hepatic diseases with no or mild activity.
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PMID:Portal diversion for portal hypertension in children. The first ninety patients. 740 58

Transjugular intrahepatic portosystemic shunt-stent (TIPS) was performed in 5 patients with cirrhosis and portal hypertension. Bleeding varices occurred in 4 patients and refractory ascites in one. We used 2 Wallstents and 3 Strecker stents. Shunt patency, recurrent variceal hemorrhage and ascites were evaluated. The shunts were created from a transjugular approach between the hepatic and portal vein, with diameters of 10 mm. Portal pressure was adequately decreased in all cases. The hospital stay, following TIPS was 3 days. Complete variceal decompression was identified endoscopically in 3 patients, and partial in one. Four shunts were patent by ultrasound and color Doppler at 1 to 6 months of follow up. One patient presented encephalopathy and one died at third day after TIPS. Initial results suggest that TIPS is an effective method of portal decompression for treatment of variceal hemorrhage and refractory ascites. The main complication was encephalopathy and only one patient died.
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PMID:[The transjugular intrahepatic portosystemic stent-shunt (TIPS) in the management of portal hypertension. A preliminary report]. 771 59

In 18 consecutive patients receiving the transjugular intrahepatic portosystemic stent shunts (TIPSS), 15 were male and 3 female. The patients aged from 34 to 66 years had liver cirrhosis with portal hypertension and esophageal varices. Twelve had recurrent bleedings from raptured gastroesophageal varices. Shunts were established in 16 of the 18 patients and no operative death was noted. Portal vein pressure was reduced from 3.98 +/- 0.24 kPa before shunting to 2.40 +/- 0.16 kPa after shunting. Doppler ultrasound examination revealed that the maximum blood flow velocity in the main portal vein increased from 14.0 +/- 4.5 cm/sec to 48.0 +/- 16.5 cm/sec. The mean follow-up time in the successful cases was 4.5 months (range 2-8 months). The shunt patency was determined with color Doppler ultrasound in 15 patients: occlusion in one and no accites in 4. Varices disappeared in 8 patients and became less evident in 7. No patients had recurrence of varices bleeding or encephalopathy during follow-up. The results suggest that TIPSS is a safe and effective method for portal decompression in the treatment of variceal hemorrhage, and that portal vein puncture is largely dependent on understanding the three-dimensional relationships between hepatic and portal veins. To achieve an adequate portal decompression, we recommend that a stent of 12 mm in diameter be used in severe cases.
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PMID:Transjugular intrahepatic portosystemic stent shunts. Preliminary results in 18 patients. 780 46

Transjugular intrahepatic portosystemic stent shunt (TIPSS) was carried out in 50 cases of liver cirrhosis with portal hypertension. An average Child-Pugh score in these cases was 10.33 +/- 2.34. Except for 5 cases with portal vein occlusion, the technical success rate of in 45 cases was 95.6%. Acute variceal bleeding was immediately controlled. Portal pressure was reduced by 1.36 +/- 0.48 kPa. Esophageal varices and ascites disappeared. The shrink of spleen, the reducing of body weight were also observed in a week following TIPSS. The velocity of blood flow in stents was 85.61 +/- 35.83 cm/s. Follow-up of 1-9 months found norebleeding and ascites. The velocity of blood flow in stents was 83.83 +/- 34.74 cm/s. Three patients died of liver failure and variceal rebleeding within a month after TIPSS. Slight encephalopathy was observed in 6 cases.
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PMID:[Preliminary report on portal hypertension treated by transjugular intrahepatic portosystemic stent shunt]. 788 70

This investigation sought to determine the effects of splenectomy, devascularization and esophageal transection on portal venous pressure and portal perfusion in cirrhotic patients with a previous history of hemorrhage from esophageal varices. From June 1988 to June 1991, 54 patients with liver cirrhosis underwent this nonshunting procedure for esophageal varices. Of these patients, 24 patients (20 men and four women, 39 to 68 years of age, all in Child's class A) were examined for portal pressure before, during and after the nonshunting operations. Portal venous perfusion was assessed from the venous phase of the superior mesenteric arteriogram preoperatively and one year after surgery in 16 of these 24 patients. There was no significant change (p > 0.05) in cardiac output and systemic blood pressure after the operation. The portal venous pressure before surgery was 28.4 +/- 8.0 mmHg with a range from 18 to 44 mmHg. A statistically significant decrease (p < 0.05) in the portal pressure was observed after ligation of the splenic artery (26.6 +/- 8.9 mmHg), splenectomy (24.8 +/- 8.0 mmHg), and devascularization with transection (23.4 +/- 7.5 mmHg). No correlation between the portal pressure change and splenic weight was noted (p > 0.05). Postoperative portal perfusion remained the same or even improved in 15 of these 16 patients. Only in one patient was the portal perfusion worse after the operation; this patient developed encephalopathy about 18 months later. In conclusion, a significant reduction in portal pressure is noted after nonshunting procedures but a persistent, relatively high portal pressure is maintained. Good postoperative portal perfusion can also be maintained.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of splenectomy, devascularization and esophageal transection on portal venous pressure and portal perfusion in cirrhotic patients with bleeding esophageal varices. 790 68

We studied the clinical and procedural results of transjugular intrahepatic portosystemic stent shunts (TIPSS) procedures in 16 patients, of whom 13 were male, 3 female, with mean age of 48 years (range 24-66). All patients had cirrhosis with portal hypertension and varices. Twelve patients had recurrent bleeding for gastroesophageal varices. The results showed that shunts were successful in 14 of the 16 patients, and that no death was due to the procedure. Portal vein pressure was reduced from 3.98 +/- 0.24 kPa before shunting to 2.40 +/- 0.16 kPa after shunting. Doppler ultrasound revealed that the maximum blood flow velocity in the main portal vein increased from 14.0 +/- 4.5 cm/s to 48.0 +/- 16.5 cm/s. The mean follow-up time in the successful cases was 4.5 months (range, 2-7.5). The shunt patency was determined with color Doppler ultrasound in 13 patients, and occlusion of the tract was found in one. Mild ascites resolved in 4 patients; varices disappeared in 7 patients and abated in 6. No bleeding or encephalopathy was noted during the follow-up. The results suggested that TIPSS is an safe and effective method for portal decompression in the treatment of variceal hemorrhage, and that the key to TIPSS is understanding of the 3-dimensional relationships between hepatic and portal veins. To achieve an adequate shunt, we recommend that stent with 12 mm in diameter should be used.
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PMID:[Transjugular intrahepatic portosystemic stent shunts]. 792 50

Distal splenorenal shunt (DSRS) has been studied extensively over the past 25 years to define its role in management of variceal bleeding. The operative technique of the shunt has not changed, but more aggressive attempts at portal-azygos disconnection have been studied for their effect on maintenance of portal perfusion. Control of variceal bleeding is achieved in about 90% of patients. Portal flow to the liver is maintained in > 90% of patients with nonalcoholic etiology of portal hypertension and in 50% to 84% of patients with alcoholic cirrhosis depending on the degree of portal-azygos disconnection. Encephalopathy and liver failure do not seem to be accelerated by DSRS but depend on the severity of the underlying liver disease. Reported survival likewise depends on the etiology of portal hypertension and the severity of liver disease: > 90% survival can be achieved in portal vein thrombosis and patients with cirrhosis and normal liver function, but 50% to 60% 3- to 5-year survivals are reported for patients with more advanced disease. DSRS offers one treatment modality for management of variceal bleeding that must fit into an overall strategy for these patients. Full evaluation is the key to allow selection of patients for pharmacotherapy, sclerotherapy, variceal decompression, or liver transplantation.
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PMID:Role of distal splenorenal shunt for long-term management of variceal bleeding. 804 24


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