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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report the clinical and laboratory results of 65 orthotopic allotransplantations of the liver in the pig. The operative mortality (8 cases) was nil in the last 23 transplantations. Vascular filling without blood transfusion, blood alkalinisation and precautions to avoid hypothermia, seem essential to reduce early mortality. The various causes of secondary mortality are studied, using certain preventive measures. Thus, deaths due to gallbladder or hepatic ischemia have become rare by conserving end-to-end anastomosis on the hepatic artery and taking certain precautions. The grafts were rejected only in incompatible pigs in the SLA system, but were not rare in this group (13/43) and sufficient to cause death in one case out of two. Gastric ulcers were frequent, even after vagotomy, but vagotomy protects fairly well against ulcer hemorrhage. However, ulcers almost always accompany a disease which is alone sufficient to cause death. Cholangitis appears less frequent after cholecysto-jejunal anastomosis on an excluded omega loop. The mortality from extra-hepatic causes was severe (12 cases), in particular due to mechanical complications at the level of the small intestine. Laboratory analyses showed a definite rise in SGOT transaminase levels and, above all, alkaline prosphatase levels in cases of rejection compared with cases of biliary obstruction or hepatic necrosis.
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PMID:[65 orthotopic transplantations of the liver in the pig. Clinical and laboratory results (author's transl)]. 32 65

In this report, our objectives are to introduce the term "ischemic cholangitis" as an etiologic designation and to describe its manifestations. Herein we use the label "ischemic cholangitis" as a collective term for ischemic bile duct necrosis, cholangitis caused by ischemia but without necrosis, and biliary fibrosis as a manifestation of ischemic damage. The condition was observed in 12 allografts, either at the time of retransplantation (9 cases) or at autopsy (3 cases). Ischemic cholangitis involved primarily perihilar extrahepatic and intrahepatic bile ducts. The findings included duct necroses (eight cases), strictures (four cases), and cholangiectases (four cases); some of these features coexisted. In addition, complicating ascending cholangitis and cholangitic abscesses were noted in three cases. Ischemic cholangitis was caused by hepatic artery thrombosis (in nine patients) or stenosis (in one) or by occlusion of parabiliary arteries by fibrointimal proliferations, probably attributable to old thromboses (in two, in conjunction with associated foam cell arteriopathy in one). Biopsy specimens before retransplantation or autopsy were obtained in 11 patients, only 1 of whom had an infarct as direct evidence of ischemia. Nine patients had evidence of biliary obstruction or bile flow impairment; in two cases, specimens were normal or nondiagnostic relative to cholangitis. Features of cellular rejection associated with the manifestations of bile flow impairment and ischemia were noted in five cases. Thus, biopsy features that suggest biliary obstruction, with or without cellular rejection, may be a manifestation of ischemic cholangitis. We conclude that ischemic cholangitis is an important cause of cholestatic graft failure but that this type of cholangitis is difficult to diagnose because of its misleading biopsy manifestations.
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PMID:Ischemic cholangitis in hepatic allografts. 143 89

Between August 1985 and December 1990, 198 liver transplantations were performed. Among 18 patients, 20 biliary strictures were identified, which were categorized as anastomotic (n = 6), nonanastomotic central hilar (n = 8), and nonanastomotic peripheral (n = 6). Pretransplant disease, hepatic artery patency, presence of acute or chronic rejection, and donor cold ischemia times were tabulated for each case. Among the six patients with peripheral strictures, three had sclerosing cholangitis prior to transplantation. Three patients with nonanastomotic strictures experienced chronic rejection. The mean cold ischemia time for patients with nonanastomotic strictures was 9.75 hours versus 8.1 hours for nonstrictured transplants (P = .025). Balloon dilation was performed in 13 patients; follow-up longer than 6 months was available for nine patients. Dilation was successful in four cases. Among the five failures, only one patient has needed surgery. An association was noted between nonanastomotic biliary strictures and prolonged donor cold ischemia time, between peripheral nonanastomotic strictures and pretransplant sclerosing cholangitis, and between nonanastomotic strictures and chronic rejection. Percutaneous balloon dilation was found useful in the treatment of the strictured transplant.
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PMID:Biliary strictures in hepatic transplantation. 179 20

A retrospective review of the abdominal CT scans of 26 children with extrahepatic biliary atresia was performed, and the results were correlated with available surgical and pathologic data. Associated congenital anomalies or acquired abnormalities were identified in these patients. Congenital anomalies included polysplenia, venous anomalies and bowel stenosis. Acquired abnormalities developed secondary to cirrhosis, portal hypertension, intrahepatic biliary duct dilatation, and hepatic ischemia. Despite frequent episodes of ascending cholangitis in these children, no hepatic abscesses were identified by CT or by pathologic examination. In conclusion, abdominal CT scanning of children with extrahepatic biliary atresia can define congenital and acquired abnormalities and provide important anatomic data for the surgeons before liver transplantation.
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PMID:Post-operative abdominal CT scanning in extrahepatic biliary atresia. 267 95

A 68 years old female patient was admitted with thoracic pain and fever (40.0 degrees C). A coronary heart disease was known. The liver was enlarged, the cholestatic enzymes elevated without bilirubinaemia. In the blood culture gram-negative bacilli was found. Our diagnosis: septic cholangitis, coronary ischemia. She was better by antibiotic therapy, the fever fell. Few days later she suddenly died. Autopsy demonstrated a serious arteriosclerosis of the aorta, an aneurysm on the aortic arc with chronic bleeding in the environmental tissue with inflammation and coronary arteriosclerosis. The liver was normal.
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PMID:[Thoracic dissecting aortic aneurysm. Contribution to the differential diagnosis of increased enzymes indicating cholestasis, fever and thoracic pain]. 289 6

One of 55 patients transplanted for sclerosing cholangitis during the cyclosporin-steroid era (March 1980-June 1986) developed intrahepatic biliary strictures in the absence of allograft rejection within the 1st year posttransplantation. Although many causes underlie biliary pathology in the postoperative period (i.e., arterial injury, ischemia, chronic rejection, cholangitis), recurrent disease remains a possibility.
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PMID:Intrahepatic bile duct strictures after human orthotopic liver transplantation. Recurrence of primary sclerosing cholangitis or unusual presentation of allograft rejection? 307 71

Ischemia is increasingly recognized as a cause of cholangiopathy. The aim of this study was to report a case of association of paroxysmal nocturnal hemoglobinuria with abrupt-onset cholangiopathy. Anomalies resembling sclerosing cholangitis were documented in a patient suffering from recurrent biliary pain. None of the conditions that have been associated with primary sclerosing cholangitis or other forms of cholangiopathy was present, but shortly thereafter, paroxysmal nocturnal hemoglobinuria occurred. Hepatic vein thrombosis later complicated the course of the disease. Because the fortuitous coincidence of these uncommon conditions is unlikely, this case indicates that paroxysmal nocturnal hemoglobinuria is a cause of ischemic cholangiopathy. Other thrombogenic conditions may also be implicated in some instances of apparently idiopathic cholangiopathy.
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PMID:Cholangitis associated with paroxysmal nocturnal hemoglobinuria: another instance of ischemic cholangiopathy? 755 5

Sclerosing cholangitis defined by cholangiographic criteria may occur after orthotopic liver transplantation. In this retrospective study, we analyzed failed grafts and antecedent serial biopsies of 24 patients who developed this type of nonanastomotic biliary strictures. Sclerosing cholangitis was histologically diagnosed if there was a combination of periductal fibrosis and features of large bile duct obstruction. The condition was observed in all but one available failed allografts. This later showed ischemic-type lesions without periductal fibrosis. Liver biopsy specimens were nondiagnostic relative to sclerosing cholangitis, although 85% of the patients had evidence of large bile duct obstruction. Numerous associated factors may explain the pathogenesis of secondary sclerosing cholangitis: an immunologically related etiologic factor (10 recipients of ABO-incompatible allografts) and compromised arterial blood flow that likely resulted from hepatic artery thrombosis (12 patients), focal arterial fibrointimal hyperplasia (three patients), chronic ductopenic arteriopathic rejection (three patients) and/or preservation-related ischemia (four patients). Sclerosing cholangitis may be a significant cause of graft failure that often has misleading biopsy manifestations. From a practical standpoint, cholestasis with evidence of large bile duct obstruction warrants cholangiographic assessment of the biliary tree.
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PMID:Sclerosing cholangitis following human orthotopic liver transplantation. 780 40

Two cases of sclerosing cholangitis after oily arterial chemoembolization are reported. In one patient angiocholitis with liver abscesses, in the other patient gradual cholestasis were the main clinical features. In both cases, endoscopic retrograde cholangiogram showed a stricture of the common hepatic bile duct and, in one case, irregularities of intrahepatic biliary tree. Histologic examination of the liver in the two patients pointed out the involvement of small bile ducts and arteriolar endarteritis obliterans. Ischaemia is likely to be the main mechanism of these two cases of sclerosing cholangitis as well as in those described after FUDR intra-arterial chemotherapy. The prevalence of sclerosing cholangitis after arterial oily chemoembolization is probably underestimated because of a non specific clinical presentation and need to be precise by further study.
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PMID:[Secondary sclerosing cholangitis and chemo-embolization with lipiodol]. 801

Hepatic arterial infusion chemotherapy using 5-FU is effective for colorectal cancer, but there are increasing reports of complications, for example, liver abscess, bile duct necrosis and sclerosing cholangitis. We encountered two cases of liver cell necrosis around the Glisson's sheath which were discovered by CT-scan. At the first operation, liver metastasis was present and a resection of the main tumor and metastatic lesion was performed. Hepatic cannulation was done in one case at the same time as the operation, and another at a different time. The metastatic lesion was well controlled and the blood serum CEA was within normal limits. It was pointed out that the mechanism of the liver cell necrosis was due to ischemia or toxicity of the anticancer drug. In two cases, the destruction of the second or third branch of bile duct was remarkable, because of the high 5-FU levels in the proximal part of the liver cells. One mechanism involved the laminar flow of the artery. Percutaneous transhepatic drainage was effective for the biloma around the Glisson's sheath.
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PMID:[Two cases of intrahepatic biloma during hepatic arterial infusion chemotherapy proved by CT-Scan]. 837 56


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