Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The course of pregnancy in 1 patient with chronic active hepatitis (CAH) and cirrhosis, and another with extrahepatic portal vein obstruction (EHPVO) is described. The management of pregnancy in these diseases associated with portal hypertension is discussed and risks of pregnancy are compared. The patient with CAH presented with anovulatory cycles, and ovulation occurred following immunosuppressive therapy. Both women experienced massive upper gastrointestinal bleeding from esophageal varices. Bleeding was difficult to control and required variceal ligation in 1. Both patients manifested features suggesting cerebral edema indicating the need for caution with fluid and electrolyte therapy. Recovery of the woman with CAH after termination of pregnancy was slow. Review of literature demonstrated that variceal bleeding occurred in 43% of women with EHPVO compared to 23% of those with CAH and cirrhosis. Additional complications including hepatocellular failure (24%) occurred in patients with CAH but not in EHPVO. The management of pregnancy in portal hypertension and advice for contraception or sterilization are discussed.
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PMID:Pregnancy in cirrhotic and noncirrhotic portal hypertension. 30 21

Following a mesocaval interposition shunt in three patients with cirrhosis of the liver, bleeding esophageal varices recurred in two and left sided portal hypertension partially persisted in one patient. Angiographic and pressure studies of the portal system demonstrated effective decompression of the greater splanchnic venous system but continued lesser splanchnic venous hypertension. Recurrent variceal hemorrhage ceased following splenectomy done as an emergency. In contrast to a standard portacaval shunt, it is suggested that after an interposition mesocaval shunt, altered jet streaming of mesenteric blood flow may divert gastrosplenic venous drainage away from the interposition shunt with persistence of lesser splanchnic venous hypertension. Recognition of this entity and of the need for splenectomy is advocated.
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PMID:Left sided segmental portal hypertension following mesocaval interposition shunt. 30 66

This paper presents the preliminary results with the SPTU stapling gun for oesophageal transection in the treatment of bleeding oesophageal varices. Porta-systemic shunt was contraindicated in all 12 patients treated, 10 of whom had cirrhosis. Anastomotic leakage and recurrent bleeding were not problems, but stricture formation was, 4 of the 11 survivors requiring dilatation. The average period of follow-up is only 7 months, but early results encourage further trial of the method for the increasing numbers of 'shunt rejects'.
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PMID:Treatment of bleeding varices by oesophageal transection with the SPTU gun. 30 65

Clinical and histological signs of small nodular liver cirrhosis with portal hypertension were present in a 36-year-old man, three-and-a-half years after a seven-week course of treatment of psoriasis vulgaris with high doses of vitamin a (70 X 10(6) IU orally). Although there is no increase in serum level of vitamin A now, increased deposits of vitamin A in the perisinusoidal lipid storage cells (Ito cells) are still demonstrated by fluorescencespectrophotometry and under the electron microscope. Fundectomy with resection of the terminal oesophagus was necessary because of bleeding from oesophageal varices.
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PMID:[Small-nodular liver cirrhosis with marked portal hypertension due to vitamin A intoxication resulting from psoriasis treatment (author's transl)]. 30 61

During a 15-year period 81 patients with bleeding oesophageal varices were admitted to our department. Nearly 90% had liver cirrhosis, 21% were alcoholics. 67 portosystemic shunts were performed in 63 patients, in 11 of these as an emergency shunt. Overall operative mortality in electively shunted patients was 10.7%. Even in those with the most severe liver insufficiency (Child's group C) operative mortality was below 20%. Operative mortality in elective cases was closely correlated to peroperative bleeding. Only 1 of 45 patients needing less than 10 units of blood peroperatively died, while mortality in the multitransfused group was 45.5%. Both patients surviving urgent shunt surgery were operated on early, i.e. before they had received 5 units of blood.
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PMID:Operative results in portal hypertension with bleeding oesophageal varices. 30 99

Morbidity and mortality data from patients with bleeding esophagogastric varices treated with portosystemic shunts relate to the clinical status of the patient and to control of hemorrhage both in the immediate postoperative period as well as later. To obtain comparable data following selective infusion of pitressin into the superior mesenteric artery (SMA), records of 23 consecutive patients with cirrhosis, diagnosed by endoscopy as bleeding from varices and treated with SMA pitressin infusions, were reviewed. Twenty-four infusions were performed and hemorrhage was controlled in 12. Fourteen of the 23 patients subsequently underwent portosystemic shunts. Pitressin infusion controlled hemorrhage preoperatively in seven of these, and five survived one year or longer. The remaining seven, in whom bleeding was not controlled by pitressin, died postoperatively. One of the nine patients not undergoing a portosystemic shunt survived more than eight weeks after pitressin infusion. Vascular complications occurred in seven of 17 who died. These complications and the delay between institution of pitressin and operative therapy to control variceal hemorrhage appears to be a factor in the high mortality rate. Portosystemic shunt remains the best therapy for uncontrolled hemorrhage and to prevent recurrent bleeding from esophageal varices.
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PMID:Survival following infusion of Pitressin into the superior mesenteric artery to control bleeding esophageal varices in cirrhotic patients. 30 64

Four patients with Felty's syndrome developed massive upper gastrointestinal bleeding due to oesophageal varices. The underlying hepatic pathology in all 4 was nodular regenerative hyperplasia. This appears to be a difficult histological diagnosis to make, having been initially reported as normal on percutaneous biopsy or as fibrosis or cirrhosis on wedge biopsy. This series brings the total number of cases reported in the English literature of this association to 12, suggesting a definite symptom complex. The portal hypertension seems to be due to a combination of increased splenic blood flow and postsinusoidal resistance. The clinical importance of this syndrome is that the appropriate therapy for bleeding oesophageal varices appears to be shunt procedure such as a splenorenal shunt with splenectomy, which should be well tolerated.
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PMID:Oesophageal variceal bleeding in Felty's syndrome associated with nodular regenerative hyperplasia. 30 26

56 consecutive patients with portal hypertension were studied with percutaneous transhepatic portography and the results were correlated to clinical findings and the number of upper gastrointestinal haemorrhages and the size of the individual bleeding. An abundance of collateral paths was noted in most patients. No regularity in development of these collaterals was found. It was not correlated to liver disease etiology, sex or liver function parameters. Portal pressure was not correlated to the size or amount of collaterals. In four patients with liver cirrhosis hepato-fugal flow in one segment of the liver was noted proving that portal flow through the liver is not uniform in this disease. The size of the haemorrhages was only correlated to presence of hepato-fugal flow in the main stem of the portal vein. It was not correlated to the estimated size of the oesophageal varices or to portal pressure. Percutaneous transhepatic portography seems to be of little help in selecting "high risk bleeders" in portal hypertension. Other factors may be of greater help in this task as indicated by the findings in this investigation that patients with alcohol cirrhosis had larger haemorrhages than those with cirrhosis of another etiology and that patients with none or few bleeding episodes had higher thrombocyte count than those with several haemorrhages.
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PMID:Correlation between percutaneous transhepatic portography and clinical findings in 56 patients with portal hypertension. 30 34

The distal splenorenal end-to-side anastomosis (Warren shunt) decompresses esophageal varices while maintaining high portal hypertension and avoiding reduction of portal venous blood inflow to the liver. The Warren shunt was performed in seven consecutive patients with portal hypertension, including post-necrotic cirrhosis, portal thrombosis, and schistosomiasis, all with recurrent esophageal bleeding. Five shunts remained patent and two thrombosed. There was no mortality. If long-term follow-up evaluations indicate its effectiveness in preventing esophageal hemorrhage, the distal selective splenorenal shunt would be the more physiologic and safer procedure in children with portal hypertension.
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PMID:Distal splenorenal shunt in children. 30 95

Personal experience with respect to the diagnosis and treatment of bleeding oesophageal varices in patients with cirrhosis is described. Diagnosis is directed both to the establishment of the site of bleeding and the disease responsible and to the evaluation of risk in view of the possibliity of portal decompression. Treatment is aimed at stopping bleeding and at lowering this risk so that as many patients as possible can be operated with an acceptable degree of surgical risk.
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PMID:[Experience in the treatment of bleeding esophageal varices]. 30 22


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