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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results of a prospective series using the mesocaval interposition shunt (MIS) over a period of 13 years is reviewed: 100 patients were selected for the operation using strict criteria and in 98 cases the operation was performed electively. Selection criteria included liver volume between 1000-2500 mL, portal perfusion between 15-30%, no active liver disease and no stenosis of hepatic artery or coeliac axis as well as a good functional CHILD-PUGH classification (A-B). In all the cases preoperative sclerotherapy was performed so many times as needed by each individual patient with the goal of controlling the active bleeding episodes at admission and of diminishing the pre and postoperative bleeding probability. Intraoperative postshunt measurements showed residual portal perfusion in all studied patients. Early mortality was 10% and the follow up mortality 38.8%. Main causes of death were liver failure and hepatocellular carcinoma. Five and ten years survival rates were 63.9% and 35.1% respectively. The total encephalopathy rate was 12.2%. Rebleeding was observed in 5.5% of the cases and long term shunt patency rate among survivors was 90%. Angiography and sequential scintigraphy showed residual portal perfusion in 75% of cases soon after operation, in 60% after 6 months and 38% after 2 years, showing the tendency of the derivation to diminish the portal perfusion rate in the late postoperative period. The results show that MIS still has a place in the treatment of portal hypertension and that it is an excellent alternative choice to the selective shunts and the devascularization procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:100 meso-caval interposition-shunts for recurrent variceal hemorrhage in portal hypertension. A prospective study. 263 Nov 66

Blood flow directions of the portal trunk, splenic vein, and superior mesenteric vein were studied using an ultrasonic Doppler duplex system in 146 healthy adults, 132 patients with liver cirrhosis, 76 with hepatocellular carcinoma, 32 with idiopathic portal hypertension, 134 with chronic hepatitis, 18 with acute hepatitis, and 142 with other diseases. Spontaneous hepatofugal flow in one or more of the three vessels examined was detected in 14 patients. Spontaneous hepatofugal flow in the portal trunk was detected in three patients with liver cirrhosis. In two of these three patients, the hepatofugal flow in the portal trunk disappeared after medication. This is interesting, since hepatofugal flow may, in fact, be more common than we suspected in patients who, because of the severity of their disease, are not able to undergo invasive examination. Postoperative hepatofugal flow in the portal system was detected in 20 of 71 cases: 15/17 patients after interposition mesocaval shunting, 2/17 after distal splenorenal shunting, 2/31 after splenectomy, and 1/6 after splenic artery occlusion with steel coils. In more than half the cases of interposition mesocaval shunting (9/17 patients), blood flow in the portal trunk was hepatofugal. However, hepatopetal blood flow in the portal trunk was maintained in most cases of distal splenorenal shunting (13/17), showing the merits of this technique as a selective portosystemic shunt operation.
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PMID:Analysis of hepatofugal flow in portal venous system using ultrasonic Doppler duplex system. 266 38

Results of 287 transthoracoabdominal esophageal transections (Sugiura procedure), 125 transthoracic esophageal transections, 48 transabdominal esophageal transections, and 58 other nonshunting operations performed during the past 25 years were analyzed. Overall operative mortality rate was 5.0% (26/518); however, it was observed only in patients with liver cirrhosis (7.0%) and was higher in emergency cases (23.3%) and patients classified Child C (17.1%). Two hundred two patients died during the follow-up period, which lasted 24 years; 33 patients died of rebleeding, 89 of hepatic failure, 65 of hepatoma, and 35 of other causes. Cumulative survival rates of patients after non-shunting operations differed significantly according to the nature of the original diseases and the severity of liver damage. The cumulative survival rate at 10 years in patients with extrahepatic portal obstruction was 90.7%, 77.6% in idiopathic portal hypertension, and 33.0% in liver cirrhosis and at 20 years, 85.6%, 37.9%, and 8.1% respectively. The cumulative survival rate at 5 years in patients classified Child A was 88.7%, 77.7% in Child B, and 39.5% in Child C, and at 10 years, 73.4%, 45.3%, and 14.1%, respectively. Esophageal transection can be performed safely and is recommended in patients classified Child A or B. Patients in Child C should be treated by endoscopic sclerotherapy and other conservative measures.
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PMID:Twenty-five-year experiences with esophageal transection for esophageal varices. 281 21

From January 1st, 1975, up to January 1st, 1986, a meso-caval interposition shunt was performed in 86 patients (electively with one exception), using a 16 or 18 mm lumen Dacron prosthesis. The criteria for selection for operation were a liver volume of 1000-2500 ml, a residual portal perfusion of 15 to 30%, exclusion of an activity of the liver process and stenosis of the hepatic artery or coeliac trunk. The cause of portal hypertension was liver cirrhosis in 77 patients (89.5%), prehepatic block in five (4.5%), liver fibrosis in three patients (3.5%), and myeloproliferative disease in one patient (1%). The study represents a prospective assessment and included 52 men and 32 women with a mean age of 43 years. Intraoperative flow measurement demonstrated a residual portal perfusion in all 17 patients measured after the shunt. In-hospital mortality was 8%, late mortality 39%; the fate of four patients is unknown. The main causes of death were liver failure and hepatocellular carcinoma. The rate of encephalopathies over the whole period was 10.5%. The actual survival rate was over 70% for five and over 50% for ten years. Postoperative angiographic studies confirmed by sequential scintigraphy demonstrated a residual portal perfusion in 75% of the patients postoperatively, 60% after six months and in 38% after two years. Thus it could be demonstrated that the meso-caval interposition shunt is converted to a total shunt in the long term. The total shunt patency rate was 90%. The meso-caval interposition shunt is certainly no ideal procedure but is useful in the selective or semiurgent management of patients with liver cirrhosis and portal hypertension.
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PMID:Prognosis after meso-caval interposition shunt. Experience of eighty-six consecutive cases over a period of ten years. 296 34

Four patients with hepatocellular carcinoma, shunting of blood from the hepatic artery to the portal vein, and hyperkinetic portal hypertension were treated by transcatheter embolization of the hepatic artery. In three acutely bleeding patients variceal hemorrhage was controlled by the embolization. Following embolization hepatofugal portal venous flow became hepatopetal in all four patients. No serious complications were encountered. When hepatoma is complicated by arterioportal shunting and hyperkinetic portal hypertension, occlusion of the fistula by transcatheter embolotherapy can reduce the portal pressure.
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PMID:Hepatoma, arterioportal shunting, and hyperkinetic portal hypertension: therapeutic embolization. 298 75

A case of hepatocarcinoma on cirrhosis with portal hypertension is described. The anatomy of splenorenal anastomoses and their ultrasound and CT scan imaging characteristics are reviewed, and the interest of differential diagnosis from adrenal masses emphasized. Its importance is enhanced by the fact that the portal hypertension may be unrecognized as in the present case. Diagnostic effectiveness of ultrasound and CT scan imaging is discussed.
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PMID:[Left adrenal pseudomass. Apropos of a case of splenorenal anastomosis by the vein of the left pillar of the diaphragm]. 303 Dec 88

Fourteen patients had mesenteric, portal, or splenic venous thrombosis that was diagnosed primarily by contrast-enhanced CT. The group included five patients with coagulopathy, three with pancreatic carcinoma, two with cirrhosis and portal hypertension, one with pancreatitis, and one with hepatocellular carcinoma. In two patients, no etiology was determined. In all cases, CT easily identified low-density venous thrombosis, which frequently involved more than one vein. In four patients, all three splanchnic veins were involved; five patients had occlusion of two veins. In five patients, only one vein was involved. Additional CT findings included ascites, collateral veins, hepatomegaly, and splenomegaly. No venous wall enhancement was found. CT also was helpful in defining the cause of thrombosis in six of 14 patients. Mesenteric edema and/or bowel wall thickening was not identified. None of the patients had classic clinical evidence of splanchnic venous occlusion, and none died primarily of that disease. The major morbidity suffered by these patients stemmed from complications of splanchnic venous occlusion, and nine patients ultimately required sclerotherapy, splenectomy, and portal decompression. We conclude that CT is useful in the diagnosis of splanchnic venous thrombosis. Our experience suggests that mesenteric, splenic, and/or portal venous thrombosis may occur more commonly than has been previously thought and that the disease in many cases is not life threatening.
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PMID:Thrombosis of the splanchnic veins: CT diagnosis. 325 38

Gastrointestinal bleeding due to portal hypertension is a severe complication in patients with cirrhosis. Recurrent hemorrhage occurs in 75% of patients at 2 years, and medical treatment aims to induce a permanent decrease in portal pressure. A controlled study demonstrated that continuous administration of propranolol significantly decreased the risk of recurrent gastrointestinal bleeding in selected cirrhotic patients in good health. This efficacy was not found in unselected patients. The risk of recurrent gastrointestinal bleeding correlates with the development of hepatocellular carcinoma and poor compliance. Sclerotherapy of esophageal varices consists in obstruction of the varicosities. It has been demonstrated that esophageal sclerotherapy significantly reduces recurrent gastrointestinal bleeding, although a number of complications may occur.
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PMID:[Prevention of recurrent hemorrhage due to portal hypertension]. 348 12

Mesocaval interposition shunt, using a 14 or 16 mm Dacron prosthesis, was electively performed on 86 patients (male/female ratio 52/34, aged 15-73, mean 43 years) with portal hypertension mainly due to liver cirrhosis. The selection criteria included liver volume 1,000-2,500 ml, residual portal perfusion 15-30%, no active liver disease and no stenosis of hepatic artery or celiac trunk. Intraoperative measurements showed residual portal perfusion in all studied patients. The early mortality was 8% and the follow-up mortality (1-11 years) 39%. The main causes of death were liver failure and hepatocellular carcinoma. The actuarial survival rate was c. 70% after 5, and greater than 50% after 10 years. The total encephalopathy rate was 10%. Angiography and sequential scintigraphy showed residual portal perfusion in 75% of cases soon after operation, in 60% after 6 months and 38% after 2 years. Reduction of residual portal perfusion was not associated with rising encephalopathy rate. Mesocaval interposition shunt thus was converted to total shunt during long-term follow-up. Overall shunt patency was 90%. Mesocaval interposition shunt has a place in elective or semiurgent management of portal hypertension.
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PMID:Prospective evaluation and long-term results of mesocaval interposition shunts. 349 39

Two types of modified distal splenorenal shunt with expanded polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc., Elkton, Md.) interposition were performed in 18 consecutive patients with esophageal or esophagogastric varices. There were 12 men and six women ranging in age from 32 to 76 years. The causes of portal hypertension were cirrhosis of the liver in 15 patients, chronic hepatitis in two, and idiopathic portal hypertension in one. In five patients the left gastric vein branched off from the splenic vein; bilateral gastric venous decompression was achieved by preserving the splenic vein. Porta-azygos disconnection was routinely performed by confirming repeated intraoperative direct splenoportography. The operations were elective in seven and were emergencies in five patients. Six patients underwent a prophylactic shunt; all patients had "red color signs" endoscopically, and three of them had concomitant hepatocellular carcinoma. Postoperative morbidity was minimal and there was no mortality. Shunt patency was confirmed angiographically in all patients 14 to 56 days after surgery. The varices disappeared or significantly improved in all patients. No patients had variceal bleeding postoperatively. Hepatic encephalopathy was transiently seen in one (the oldest) patient.
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PMID:Modified distal splenorenal shunt with expanded polytetrafluoroethylene interposition. 406 65


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