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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Distal esophageal varices are most frequently associated with portal hypertension, while varices of the upper esophagus are occasionally observed in patients with vena caval obstruction. One hundred and nineteen cases of upper esophageal varices (downhill varices) have been reported in the literature. We report 6 cases (4 men and 2 women), with vena caval obstruction. Upper gastrointestinal hemorrhage occurred in one patient. Endoscopy showed varices in the proximal third of the esophagus in 5 patients and in the proximal half of the esophagus in the other patient. Superior vena cavogram demonstrated total or partial occlusion of the vena cava in 6 cases, with opacification of the right azygos vein in 4 cases and thrombosis of this vein in one case. Superior vena caval obstruction was secondary to malignant lymphoma in 2 cases, to malignant thymoma in 2 cases, to malignant thyroid tumor in one case and to anaplastic bronchogenic carcinoma in one case. Clinical symptoms of vena caval obstruction are present in 91.4 p. 100 of the cases in the literature. Upper gastrointestinal hemorrhage are observed in 7.6 p. 100 of cases. It is generally agreed that the predominant factors involved in the determination of the downward extension of varices along the esophagus are the level of superior vena caval obstruction and its duration. Because of the risk of digestive hemorrhage and of the topographic meaning of the degree of extension, upper esophageal varices should be routinely searched in patients with vena caval hypertension.
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PMID:[Upper esophageal varices. Study of 6 cases and review of the literature]. 665 76

It is known that portasystemic shunts in the treatment of portal hypertension causes in the long term a high rate of complications in children. The most severe are encephalopathy, postoperative hepatic failure in intrahepatic hypertension and occlusion or poor functioning of the shunts. The incidence of the last mentioned complication is high in children, especially in those operated in their early years of life. The most severe danger of portal hypertension is the haemorrhage from bleeding esophageal varices. During the last few years the technique of esophagogastric devascularization with esophageal transection and ligation of varices (Sugiura's procedure) has given a very high percentage of success in the long term. The Authors report their experience with Sugiura's procedure in 9 children with portal hypertension (average age at operation of four and half years). In six cases there was a prehepatic and in the other three an intrahepatic hypertension. The follow-up varied from six months to seven and half years with an average of almost four years. In all the children the surgical treatment was successful with the complete disappearance of haemorrhage and esophageal varices. For their own experience and for Sugiura's long-term results, the Authors think that Sugiura's procedure offers the most effective alternative to portasystemic shunts in the surgical treatment of portal hypertension, especially in early childhood.
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PMID:[Portal hypertension and bleeding esophageal varices in children. Esophageal transection with paraesophagogastric devascularization versus shunting procedures (author's transl)]. 697 41

Involvement of the splenic venous outflow tract by pancreatic disease can cause localized splenic venous hypertension and esophageal varices. Resolution of this problem resides in splenectomy and distal pancreatectomy or perhaps splenectomy alone. Although this phenomenon most commonly arises from thrombosis of the splenic vein by adjacent pancreatitis, we report a case arising from nonocclusive obstruction of the splenic vein by an adjacent pancreatic pseudotumor.
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PMID:Left-sided portal hypertension from pancreatic pseudotumor. 698 47

We report the case of a patient with transient hypertension in relation to acute veno-occlusive disease of the liver. Ascites and esophageal varices, both transient, occurred in this patient and a transient elevation of the gradient between wedged and free hepatic venous pressures was observed.
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PMID:Transient intrahepatic portal hypertension. A case report. 721 16

A 27-year-old patient, originally from Martinique, presented with a progressive hepatic granulomatosis with hepatomegaly, splenomegaly, and non-icteric cholestasis, associated with bronchial granulomatosis lesions. The sarcoidosis regressed rapidly after high doses (60 mg/day) of prednisone. Portal hypertension developed later and provoked a severe hematemesis from rupture of esophageal varices. Signs of pulmonary arterial hypertension were then observed, and the diagnosis confirmed by pressure tests after catheterization, and angiography. A portocaval shunt caused the esophageal varices to subside, but the pulmonary arterial hypertension, resistant to corticotherapy, was rapidly fatal. In the case reported, the pulmonary arterial hypertension, independent of any parenchymatous lesion, was attributed to fibrosis of the arterial walls. The association of portal and pulmonary arterial hypertension with sarcoidosis is a very rare occurrence, and the pathogenesis of this association remains a debatable subject.
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PMID:[Sarcoidosis and portal and pulmonary arterial hypertension: a case report (author's transl)]. 722 52

Several procedures have been developed to obtain decompression of protal hypertension for bleeding esophageal varices. In recent years, the distal splenorenal shunt has become popular becuase it causes less encephalopathy than the standard portacaval or mesocaval shunts. A criticism of the distal splenorenal shunt has been the technical difficulty of dissecting the splenic vein and obtaining adequate exposure. We have facilitated some of these difficulties by exposing a retroperitoneal approach and by the use of a Smith ring retractor.
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PMID:A simplified method and approach to the distal splenorenal shunt. 735 68

Monitoring treatment efficacy in patients with portal venous hypertension has been limited by the difficulty of direct or indirect assessment of portal vein pressure. The majority of currently available haemodynamic tests, such as hepatic vein wedge pressure or azygos vein flow measurement by thermodilution catheter, are invasive which has restricted their application. We describe a non-invasive cine phase contrast magnetic resonance technique for quantitative measurements of bulk volume flow and for demonstrating flow changes during the cardiac cycle in the azygos vein. The technique was used to analyse the azygos vein flow in seven adult volunteers and five patients with biopsy-confirmed chronic liver disease, portal hypertension and endoscopically proven oesophageal varices. In the volunteers the mean volume flow rates varied between 81 and 241 ml/min with a mean for the group of 171 ml/min. The patients had a significantly higher mean volume flow rate of 628 ml/min (p < 0.01), with a range of 339 to 945 ml/min. These preliminary results suggest that cine phase contrast magnetic resonance angiography is a practical non-invasive method for measuring absolute azygos vein flow, and may provide a non-invasive method of monitoring portal hypertension.
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PMID:Non-invasive measurement of azygos venous blood flow using magnetic resonance. 766 58

We investigated the long-term results and ongoing management issues of 39 Japanese children who underwent liver transplantation in Brisbane, Australia. Whole liver grafts were used in 15 patients (Wh group) and reduced-size grafts were used in 24 patients (Re group). The 1-year and 3-year survival rates were 74% and 60%, respectively, and all cases of late mortality which occurred after 6 months were due to infection. Statistical analysis showed no differences between the Wh and Re groups with regard to late mortality or liver function tests, although 4 of 24 (16.7%) patients from the Re group developed a recurrence of esophageal varices. Three patients treated with cyclosporine developed lymphoproliferative disorders following transplantation, but none of the patients developed severe nephrotoxicity or hypertension. Although a "catch-up" gain in weight was observed, poor growth in height was displayed, and there were no differences between the Wh and Re groups in this regard. Thus, we conclude that late complications of liver transplantation in children are common and further studies are necessary to evaluate the ongoing growth problems.
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PMID:The management and long-term results of Japanese pediatric liver transplant recipients. 805 10

Thirty-two patients with portal venous hypertension and endoscopically proved esophageal varices who were being evaluated for possible liver transplantation were studied with cine phase-contrast magnetic resonance (MR) imaging. Flow measurements in the main portal vein were obtained and associated with the presence of variceal hemorrhage within 2 years before the MR examination. Low (hypodynamic) flow was present in 22 patients, while high (hyperdynamic) flow was present in 10 patients. The presence of variceal hemorrhage was significantly associated with a high portal venous flow rate (P = .001), high variceal grade (P = .030), and Child class A or B (P = .003); however, only portal venous flow (P = .006) and variceal grade (P = .044) were found to be associated with variceal hemorrhage in a multiple logistic regression analysis. The portal venous flow rate was significantly higher among patients with Child class A or B disease compared with those with class C disease (median, 24.6 vs 8.0 mL/min.kg; P = .004).
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PMID:Evaluation of portal venous hypertension with cine phase-contrast MR flow measurements: high association of hyperdynamic portal flow with variceal hemorrhage. 835 26

The influence of alcohol on portal vein haemodynamics was assessed prospectively in 30 patients (20 men, 10 women; mean age 54.3 [34-70] years) with nutritional-toxic cirrhosis of the liver (Child-Pugh stages A-C) and portal vein hypertension. During the period of observation hepatic vein occlusion pressure as an indirect measure of portal vein pressure was repeatedly determined. In addition, the size of oesophageal varices and the Child-Pugh stage were monitored. After complete alcohol abstinence of one year, portal vein pressure fell from 23.11 to 12.43 mm Hg (-46%, P < 0.001), the Child-Pugh score from 8.08 to 7.2 (-10.9%, not significant), and the size of oesophageal varices was reduced from grade 1.33 to grade 0.79 (-40%, P < 0.02). On resuming alcohol abuse, portal vein pressure increased by an average of 10 mm Hg (+60%, P < 0.001) to its previous level of 25 mm Hg. The portal vein pressure has thus proved to be a sensitive gauge of alcohol abstinence or abuse. Lasting, absolute alcohol abstinence is essential in nutritional-toxic liver cirrhosis.
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PMID:[The effect of alcohol on portal vein hemodynamics in nutritional-toxic liver cirrhosis]. 842 61


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