Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038002 (splenomegaly)
 9,873 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From 1960 to 1981, 31 children, 18 boys and 13 girls, have been treated at Ste-Justine Hospital for extra-hepatic portal hypertension. Age at the onset of gastro-intestinal bleeding 3 1/2 months and 13 years. Splenomegaly with hypersplenism, hematemesis and melena have been the most frequent clinical manifestations. Percutaneous splenoportography be coelio-mesenteric arteriography confirmed the diagnosis of cavernomatous transformation of the portal vein. Among the 31 children, 28 bled from their varices, the 3 others did not to date. Among the 28 patients with active bleeding complication, 7 have been treated conservatively, 11 had sclerotherapy (sclerosing injections of varices). On the surgical point of view, 7 had ligation of varices with intra-thoracic transposition of the spleen in 5 of them. Portosystemic shunts were performed in 10 patients, 3 central spleno-renal and 7 cavo-mesenteric shunt. Each of these 28 patients had an average of 9,5 episodes of gastro-intestinal bleeding, 8.7 hospitalizations, and received 7.5 liter of blood. Medical treatment, sclerotherapy, ligature of varices and intra-thoracic transposition of the spleen are palliative measures. Nevertheless the procedures are time and life savers, allowing improvement and development of natural porto-systemic shunts. Follow up of unshunted patients on a period of 8 to 17 years revealed a decreasing frequency and intensity of the hemorrhagic manifestations. Operative risks and morbidity of recurrent bleeding should be the guidelines for surgery. Natural course of illness and possible neuro-psychiatric consequences of a porto-caval shunt should also be considered.
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PMID:[Portal hypertension of extra-hepatic origin in children (author's transl)]. 697 8

Forty-three patients with spontaneous bacterial peritonitis (SBP) between 1973 and 1978 were identified. Criteria for SBP included a positive ascites culture and polymorphonuclear cell concentration greater than 250 cells per mm3. Chronic liver disease was documented by varices in 91%, severe histologic fibrosis or cirrhosis in 94%, splenomegaly in 91%, and past hospitalization for liver disease in 57% of the patients. SBP was detected within 7 days of admission in 17 patients (40%) and within 35 days in 38 patients. Single organisms were isolated from 38 patients and multiple organisms from 5 patients. Twenty-six of 43 patients survived the episode of SBP, but only 13 survived the hospitalization. Analysis of the survival curve from the onset of SBP revealed a rapid death rate and a slow death rate set of patients. Rapid death (less than or equal to 7 days from SBP onset) correlated with a lack of prior hospitalization for liver disease (p less than 0.001), hepatomegaly (p less than 0.001), increased serum bilirubin (p less than 0.005), serum creatinine (p less than 0.05), and peripheral white blood cell concentrations (p less than 0.05). Survival during hospitalization was associated with prior hospitalization with liver disease (p less than 0.001) and chills during the episode of SBP (p less than 0.001). The 43 patients were divided into Group 1 patients on the basis of a serum bilirubin greater than 8 mg% and/or serum creatinine greater than 2.1 mg%; Group 2 patients had lower values. Survival was greater in Group 2 patients with advanced, relatively quiescent liver disease compared to Group 1 patients for both the episode of SBP (91 vs. 29%; p less than 0.001) and for hospitalization (50 vs. 9%; p less than 0.05). Death in Group 2 patients was related to inadequate antibiotic therapy (p less than 0.05), nonhepatic factors, and new onset of renal failure. Although SBP in the setting of severe acute liver injury has a dismal prognosis, SBP with minimal acute liver injury has a relatively good prognosis for hospital survival even with advanced chronic liver disease. Long-term survival is also possible since 4 of 9 patients with prolonged follow-up have survived 3 years.
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PMID:Spontaneous bacterial peritonitis. 709 41

Of sixty eight patients with tropical splenomegaly syndrome (TSS), 12 had asymptomatic oesophageal varices (OV). All 12 had massive splenomegaly (Hackett's stage 4 or 5). Eight of the 12 were multiparous females, mainly of Rwandese origin. Endoscopic appearance of the varices suggested that TSS varices were not likely to bleed. None of the patients with the varices had abdominal collaterals belonging to the portal system.
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PMID:Tropical splenomegaly syndrome: who gets oesophageal varices? 770 41

Splenectomy and splenic embolization have been advocated as definitive therapy in cirrhotic patients bleeding from varices. While splenomegaly is commonly associated with portal hypertension, no clear hemodynamic link between portal pressure and splenic enlargement has yet been established. In an effort to clarify the hemodynamic significance of splenomegaly in portal hypertensive patients the relationship between spleen size and portal pressure was retrospectively reviewed and the contribution of splenic inflow to portal hypertension prospectively studied. In 50 consecutive cirrhotic variceal bleeders studied angiographically, there was no correlation between spleen size and corrected sinusoidal pressure. Portal pressure was then prospectively measured before and after splenic vein clamping in 12 cirrhotic patients undergoing distal splenorenal shunt. No significant pressure drop occurred following elimination of splenic venous flow. On the basis of these data, there would appear to be no firm hemodynamic basis for splenectomy or splenic embolization alone in the unselective management of cirrhotic patients with variceal bleeding.
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PMID:Splenomegaly and variceal bleeding--hemodynamic basis and treatment implications. 772 Dec 48

Endoscopic injection sclerotherapy (EIS) combined with percutaneous transhepatic obliteration was performed in 63 cirrhotic patients with esophageal varices. In all patients, esophageal varices were completely disappeared after EIS. To investigate risk factors for recurrence of esophageal varices after EIS, hemodynamic changes in the portal system before and after EIS were studied by portal vein catheterization and ultrasonography. In patients in whom portal pressure rose after EIS, recurrence of varices was observed in high incidence (p < 0.05). Furthermore, variceal recurrence appeared frequently in patients with progressive splenomegaly after EIS (p < 0.05). During post-EIS course, new appearance or increase in size of non-variceal portosystemic collaterals was detected by ultrasonography in 22% of the patients. In these patients, variceal recurrence rate was low (p = 0.09). In patients with shunts around the splenic hilum, variceal recurrence rate was lower compared with the patients with paraumbilical vein (p < 0.05). Prognostic factors for variceal recurrence were analysed using multiple regression model. It was suggested that the absence of non-variceal portosystemic collaterals was the most risky factor. In conclusion, observation of portal hemodynamics is considered to be useful for the long-term management of patients with esophageal varices treated with EIS.
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PMID:[Study of the changes in portal hemodynamics after endoscopic injection sclerotherapy with reference to the variceal recurrence]. 772 64

Ultrasound is now widely used in the diagnosis of liver diseases. Applications of ultrasound in the diagnosis of liver cirrhosis are reviewed in this paper. Characteristic findings of liver cirrhosis in ultrasound are nodular liver surface, round edge, and hypoechoic nodules in liver parenchyma which represent regenerative nodules of cirrhotic liver. Detection of hypoechoic nodule more than 10 mm is important in the early diagnosis of hepatocellular carcinoma. Detection of splenomegaly, ascites, and portosystemic collaterals is possible by ultrasound. Evaluation of portosystemic collaterals is beneficial in the management of esophagogastric varices and portosystemic encephalopathy. Ultrasound is useful in the non-invasive diagnosis and long-term management of cirrhotic patients.
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PMID:[Ultrasonography in the diagnosis of liver cirrhosis]. 811 12

The most common etiogenic disease of portal hypertension that we experience is liver cirrhosis, which accounts for 84% of all cases. In patients with portal hypertension, congestion by portal blood due to cirrhosis causes a rise in portal pressure and development of collateral circulation between the portal system and the postcaval system is observed. Esophageal varices are associated with higher mortality than any other symptom of portal hypertension and are an important consideration in treatment. When emergency endoscopic examination and diagnosis show esophageal variceal bleeding, the varices must be constricted directly using a Sengstaken-Brakemor tube. If hemostasis is maintained, medical and surgical procedures can be performed after the recovery of body strength. Endoscopic Injection Sclerotherapy (EIS) has recently been widely carried out to prevent variceal bleeding and its application is increasing. However, treatment with EIS alone is not sufficient in terms of long-term efficacy, and surgical treatment is effective, especially in patients with gastric varices or splenomegaly. For Child A and B groups, both with good liver function, non-shunting operation, especially, the SUGIURA procedure, shows a marked effectiveness on varices. For group Child C, EIS is selected. The newly-developed Transjuglar Intrahepatic Portasystemic Shunt (TIPS), is being used, recently. For hepatic insufficiency, liver transplantation is expected to be one of the method for future treatment. Cirrhosis is also commonly accompanied by hepatoma, and this must be taken into consideration in treatment.
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PMID:[Etiology and management of esophageal varices]. 811 15

A consecutive series of 36 children with bleeding from oesophageal varices secondary to extrahepatic portal hypertension was successfully treated by endoscopic injection sclerotherapy and followed up over a mean period of 8.7 years after variceal obliteration. There were no deaths from portal hypertension or its treatment and morbidity related to oesophageal sclerotherapy was minimal. Endoscopic injection sclerotherapy alone proved safe and effective in controlling variceal bleeding from portal hypertension in over 80% of the children. Recurrent variceal bleeding developed in 10 (31%) patients but half of these were effectively treated by further sclerotherapy. Gastric variceal bleeding unresponsive to sclerotherapy necessitated successful portosystemic shunt surgery in four (13%) patients. Two children required splenectomy for painful splenomegaly. In most children injection sclerotherapy is the best treatment for the primary management of bleeding oesophageal varices, reserving portosystemic shunting or other surgical procedures for those with bleeding from gastrointestinal varices.
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PMID:Longterm outcome after injection sclerotherapy for oesophageal varices in children with extrahepatic portal hypertension. 830 79

A 58-year-old white man had bleeding varices in the gastric fundus due to portal hypertension attributable to histologically proven hepatic sarcoid involvement with a giant splenomegaly and with an angiographically demonstrated significant flow toward the liver. Treatment with corticosteroids and beta-blockade (30 mg propranolol daily) resulted in no rebleeding for over one year follow-up.
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PMID:Bleeding varices due to portal hypertension in sarcoidosis. Favorable effect of propranolol and prednisone. 843 72

The clinical, biochemical and histological features of 102 consecutively referred patients with chronic hepatitis C virus infection were analysed. Demographic, epidemiological, biochemical, haematological and histological details were catalogued for each patient. The mean follow-up was 49 +/- 6 months. Liver biopsies were obtained from 92 patients; a second biopsy was obtained from 35 patients. The average known duration of infection was 8.6 +/- 0.7 years. The most common risk factors that could be identified were past blood transfusion, surgery or intravenous drug abuse. Twenty-four of the 27 patients (85%) with past blood transfusion had received blood in countries outside of northern Europe. In contrast, 12 of the 16 former drug users were northern European. Patients were frequently diagnosed incidentally; one-quarter had no symptoms of liver disease and were generally asymptomatic or had presented with non-specific complaints and were found to have abnormal serum aminotransferase levels after routine screening. The mean serum aminotransferase levels were not significantly different in those presenting with fatigue compared to those diagnosed incidentally. The most common physical sign in these patients was a palpable liver, which was present in 52%. The mean serum albumin concentration in patients older than 40 years was significantly lower than that in younger patients. Splenomegaly and endoscopic evidence of varices was also more common in older patients. Cirrhosis was present in 37% of patients at presentation: 20% showed progression on rebiopsy, and 5% developed cirrhosis within 4 years of initial presentation. Of those treated, 27% showed histological improvement. Histological severity did not correlate with duration of disease, but did correlate with age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical, biochemical and histological features in 102 patients with chronic hepatitis C virus infection. 846 87


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