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Biomedical subjects

D N Redhead

Publications and source records attributed to D N Redhead.

At least 19 recordsLinked to original sources
PubMed1995

Transjugular intrahepatic portasystemic stent-shunt in the treatment of variceal haemorrhage.

The transjugular intrahepatic portasystemic stent-shunt (TIPSS) is a side-to-side portocaval shunt, performed by interventional radiological methods, linking the hepatic and portal veins through the liver parenchyma with an expandable metal stent. The technique can be performed successfully in over 90 per cent of patients. The procedure-related mortality rate is about 1 per cent, mainly from intraperitoneal bleeding. The main indications for TIPSS insertion are control of acute variceal bleeding in patients with cirrhosis that is refractory to sclerotherapy and recurrent variceal haemorrhage despite sclerotherapy or band ligation. TIPSS insertion is followed by variceal rebleeding in about 10-20 per cent of cases, encephalopathy in 10-20 per cent, transient deterioration of liver function in 25-35 per cent and subsequent shunt dysfunction over a 6-12-month period in 15-60 per cent. The final place of TIPSS insertion in the management of portal hypertension is being evaluated in controlled studies, but its use in the treatment of uncontrolled variceal haemorrhage seems assured.

Esophageal and Gastric Varices↗
PubMed1995

Analysis of prognostic variables in the prediction of mortality, shunt failure, variceal rebleeding and encephalopathy following the transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage.

BACKGROUND/AIMS: The aim of this study was to analyse prognostic variables predicting mortality, shunt insufficiency, variceal rebleeding and encephalopathy following transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage. METHODS: Sixty-eight patients with cirrhosis who successfully underwent transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage were studied. Mean age was 54.8 years (s.e. 1.5); 41 were males and 27 were females. Mean Child score was 8.3 (s.e. 0.3). Cirrhosis was alcohol related in 47. The patients have been followed up for a mean of 10.8 (s.e. 1.1) months. The univariate association between 30 prognostic variables and post-treatment encephalopathy was tested by the Chi-squared or Wilcoxon rank-sum tests and multiple logistic regression was used to test the significance of factors adjusted for one another. Cox's proportional hazard regression was used to test the univariate and multivariate significance of the other three outcomes. RESULTS: Transjugular intrahepatic portosystemic stent-shunt was performed successfully in 89.5% of patients. Twenty-two patients have died and eight have been transplanted. Fourteen patients died within 30 days of transjugular intrahepatic portosystemic stent-shunt and death was predicted independently by hyponatraemia (p < 0.001) and by severe liver disease (Child C, p < 0.001). Eight patients died during follow up and survival in the long term was predicted independently by the presence of encephalopathy (p < 0.001) prior to transjugular intrahepatic portosystemic stent-shunt (p < 0.001). Shunt insufficiency was predicted by an initial portal pressure gradient of greater than 18 mmHg (p < 0.01). None of the variables analysed predicted variceal rebleeding. Encephalopathy following transjugular intrahepatic portosystemic stent-shunt was only predicted indepedently by its presence prior to transjugular intrahepatic portosystemic stent-shunt (p < 0.001). CONCLUSIONS: The results of this study suggest that patients with severe liver disease and hyponatraemia are liable to die early, and the presence of encephalopathy prior to transjugular intrahepatic portosystemic stent-shunt independently determines long-term survival. Patients in these groups should be considered high risk and worked up for orthotopic liver transplantation early. Shunt function in patients with an initial portal pressure gradient of > 18 mmHg requires close supervision. Encephalopathic patients should have smaller shunts and prophylactic measures to prevent worsening encephalopathy.

Esophageal and Gastric Varices↗
PubMed1995

Case report: inferior vena caval thrombosis following severe liver trauma and perihepatic packing--early detection by intraoperative ultrasonography enabling treatment by percutaneous mechanical thrombectomy.

Patients with severe liver trauma present a major challenge in management. We report the successful treatment of a patient presenting with a severe liver injury. The detection of major inferior vena caval thrombosis by intraoperative ultrasonography enabled the use of a percutaneous thrombectomy device to facilitate dissolution of the thrombus.

Adult↗
PubMed1995

The role of duplex and colour Doppler ultrasound in the follow-up evaluation of transjugular intrahepatic portosystemic stent shunt (TIPSS).

Transjugular intrahepatic portosystemic stent shunt (TIPSS) is an effective means of controlling acute variceal haemorrhage. Shunt occlusion or stenosis occurs in up to 30% of patients within 6 months. It is important to detect these patients and intervene to prevent rebleeding. We have compared non-invasive Doppler ultrasound with the portal pressure gradient (PPG) at portography at 3 month follow-up in 23 patients. All patients with a shunt peak velocity greater than 90 cm s-1 (7 of 17 analysable results) had normal shunt function at portography (PPG < 12 mmHg). Portography may therefore be avoided in this group, although the majority of patients will still require portography for TIPSS follow-up assessment.

Blood Flow Velocity↗
PubMed1995

Case report: computed tomography features of complete splenic infarction, cavitation and spontaneous decompression complicating pancreatitis.

Splenic infarction is a rare complication of pancreatitis. We present the case of a 34-year-old woman, who had undergone previous drainage of a pancreatic pseudocyst, and who represented with left upper quadrant pain. Absence of enhancement of the splenic parenchyma during contrast enhanced computed tomography (CT) allowed confident diagnosis of complete splenic infarction. A later CT scan revealed splenic cavitation with spontaneous decompression into the stomach. The aetiology of these unusual complications of pancreatitis is discussed.

Acute Disease↗
PubMed1995

A comparative study of emergency transjugular intrahepatic portosystemic stent-shunt and esophageal transection in the management of uncontrolled variceal hemorrhage.

OBJECTIVES: Transjugular intrahepatic portosystemic stent-shunts (TIPSS) have been shown to reduce portal hypertension consistently and have recently been reported to arrest active variceal hemorrhage. This retrospective and nonrandomized study compares the results of TIPSS with esophageal transection (ET) and devascularization in patients with uncontrolled variceal hemorrhage admitted to a single center with an interest in variceal bleeding. PATIENTS AND METHODS: Two hundred and sixty cirrhotic patients have been referred with variceal bleeding over the past 7 yr. In 41 patients (15.8%), hemorrhage was uncontrolled despite two treatments with sclerotherapy. Thirty-eight patients were eligible for analysis. Nineteen were considered for ET and 19 for TIPSS. Patients in the two groups were well matched for age, sex, etiology of liver disease, and its severity and complications. They have been followed for 13 patient years (TIPSS-7, longest 20 months; ET-6, longest 23 months). Data for survival and rebleeding were analyzed by the Kaplan-Meier method on an intention-to-treat basis. RESULTS: Seven of the 19 were considered unfit for surgery, and 12 underwent esophageal transection and devascularization. TIPSS was undertaken successfully in 17 patients, the Palmaz stent being used in 4 and the Wallstent in 13. Successful TIPSS reduced the mean portal pressure gradient from 22.2 (SE 1.2) to 9.7 (SE 0.7) mm Hg (p < 0.001). Mortality within 30 days of the initial bleed was 42% in the TIPSS group compared with 79% in the ET group (p < 0.05). Rebleeding occurred in 15.6% patients with TIPSS, compared with 26.2% in the ET group. Encephalopathy in the two groups of patients was not significantly different (TIPSS 25% and ET 22%). TIPSS was followed by active infection in 20% compared with 36% after ET. CONCLUSIONS: This study shows that the overall mortality in this group of patients is high whatever the type of treatment used. TIPSS can be performed successfully on these patients who are often not suitable for surgery. Mortality rates were significantly lower in patients treated by TIPSS. Compared with ET, TIPSS should be regarded as the preferred mode of treatment for uncontrolled variceal hemorrhage in patients with cirrhosis.

Case-Control Studies↗
PubMed1995

Relationship between directly measured portal pressure gradient and variceal hemorrhage.

OBJECTIVE: It is commonly believed that variceal hemorrhage in patients with cirrhosis and portal hypertension does not occur below a portal pressure gradient (PPG) of 12 mm Hg. The aim of this study was to assess the relationship between directly measured portal pressure gradient and variceal hemorrhage. METHODS: The procedure of insertion of the transjugular intrahepatic portosystemic stent-shunt (TIPSS) for variceal hemorrhage provides access to the portal vein and allows direct measurement of the portal pressure. Right atrial, inferior vena caval, and portal pressure were recorded, and the PPG was calculated (portal pressure-inferior vena caval pressure) in 48 patients undergoing TIPSS for variceal hemorrhage. RESULTS: PPG was reduced from a mean of 21.4 (6.4) before TIPSS to 10.6 (3.1) mm Hg after the procedure. Seven patients (14.7%) had a baseline portal pressure gradient of < 12 mm Hg. CONCLUSION: The results of this study do not support the concept of a discrete bleeding threshold.

Atrial Function, Right↗
PubMed1994

Caval filters.

Explore the source record for details and available documents.

Humans↗
PubMed1994

The acute and chronic effects of isosorbide-5-mononitrate on portal haemodynamics in cirrhosis.

The effects of acute and chronic administration of isosorbide-5-mononitrate on portal and systemic circulation was studied in patients with cirrhosis and portal hypertension. Acute administration reduced the mean arterial pressure and hepatic venous pressure gradient (18.4 +/- 0.9 to 16.5 +/- 0.9 mmHg), whilst having a variable effect on azygos blood flow. The hepatic venous pressure gradient fell consistently only in patients in whom the azygos blood flow increased acutely. With chronic administration no reduction in mean arterial and hepatic venous pressure gradient was identified before rechallenge, despite a marked and consistent reduction in azygos flow (540 +/- 89 to 306 +/- 60 ml/min). Rechallenge with isosorbide-5-mononitrate in patients on chronic nitrate therapy reproduced the haemodynamic effects identified with acute administration, lowering mean arterial and hepatic venous pressure gradient (19 +/- 1.5 to 16.0 +/- 1.8 mmHg) with a variable effect on azygos flow. The wedged hepatic venous pressure was significantly lower than pretreatment values (19.9 +/- 1.6 compared with 23.4 +/- 2.1 mmHg). We conclude that acute nitrate administration lowers the hepatic venous pressure gradient, either by reducing portal venous inflow or by reducing portal-collateral resistance. Chronic administration reduces portal-collateral flow without consistently lowering the hepatic venous pressure gradient. No evidence of nitrate tolerance or tachyphylaxis was observed.

Adult↗
PubMed1994

Cholecystobronchocolic fistula: a late complication of biliary sepsis. Case report of diagnosis and management.

A case of a 48 year old woman presenting with bilioptysis due to a cholecystobronchocolic fistula is reported. Bilioptysis is a rare complication of biliary fistulae, with a high mortality due to chemical pneumonitis. Bronchospasm and rapid respiratory failure may ensue if aggressive management is not adopted. The site of fistulation is established by cholangiography, preferably by the percutaneous transhepatic route. Continued biliary drainage can lead to closure of these fistulae, or allow sufficient improvement in clinical condition to allow definitive surgery to be performed electively.

Adult↗
PubMed1994

Transjugular intrahepatic portosystemic stent-shunt (TIPSS): long-term follow-up.

We assessed the long-term efficacy of transjugular intrahepatic portasystemic stent-shunt (TIPSS) in 64 patients. Insertion was successful in 56 patients (87.5%). The reasons for its use were: variceal bleeding (49); ascites (6); portal hypertensive gastropathy (6); hypersplenism (2); and embolization of a spontaneous shunt (1). Fourteen patients were Childs A, 20 Childs B and 28 Childs C cirrhotics. Two patients were non-cirrhotic; one with amyloidosis and one with non-cirrhotic portal fibrosis. Patients were followed clinically and radiologically (Doppler ultrasonography and routine portography at 6 months). During 33 patient-years of follow-up, 22 died, 12 during index admission (two were procedure-related) and nine were transplanted. Twenty-five patients are alive, with a mean survival of 7.1 (SD 7) months. Variceal rebleeding occurred in 10 patients (22.7%), one of whom died, and was always associated with shunt insufficiency (shunt thrombosis 2, hepatic vein stenosis (HVS) 1, intimal hyperplasia (IH) 4, dislocated stent 1, inadequate stent 2). Clinical encephalopathy was induced in seven patients (17.1%) following TIPSS. All responded to medical therapy, but two required reduction in shunt size. Ascites improved after TIPSS in 36 patients (87.8%), but reaccumulated in seven (17.5%), associated with shunt dysfunction in five (SBP 2, IH 3, HVS 2). Fatal sepsis occurred in two patients, and 14 other episodes of infection required antibiotics. TIPSS is a useful treatment for variceal bleeding, resistant ascites and portal hypertensive gastropathy. Shunt dysfunction and sepsis occur frequently, and regular surveillance is necessary.

Female↗
PubMed1993

Transjugular intrahepatic portasystemic stent shunting for control of acute and recurrent upper gastrointestinal haemorrhage related to portal hypertension.

The insertion of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was evaluated in 22 patients with recurrent upper gastrointestinal haemorrhage related to portal hypertension (bleeding from oesophageal varices 10, gastric varices six, portal hypertensive gastropathy six). TIPSS was successfully performed electively in 15 patients and as an emergency in three patients. Twelve patients have had no further admissions with bleeding after TIPSS. Single episodes of bleeding were noted in six patients after TIPSS associated with shunt thrombosis (two), intimal hyperplasia within the shunt (two), and shunt migration (one). Another patient presented with reaccumulated ascites suggesting poor shunt function but died from massive variceal haemorrhage before further assessment could be performed. There was one death related to the procedure. Two patients developed encephalopathy after TIPSS, in one patient this was controlled by the insertion of a smaller diameter stent within the existing TIPSS. Several complications arose in earlier patients that have not recurred after modification of the initial technique. TIPSS can be life saving and is effective in controlling variceal haemorrhage and rebleeding from oesophageal or gastric varices and portal hypertensive gastropathy. Larger and longer term studies are required, however, to define the role of TIPSS in the overall management of such patients.

Acute Disease↗
PubMed1992

Transjugular intrahepatic portosystemic stent shunt (TIPSS): early clinical experience.

Transjugular intrahepatic portosystemic stent shunt (TIPSS) is a new percutaneous technique for reducing portal venous pressure. We attempted TIPSS in six patients with recurrent bleeding for oesophageal or gastric varices between July 1991 and January 1992 with success in five. There have been no deaths. One patient re-bled after TIPSS. His portal pressure was found to be elevated persistently indicating an inadequate shunt. Following further dilatation of the shunt, portal pressure fell to a satisfactory level and bleeding has not recurred. No bleeding episodes have occurred in the other patients following successful TIPSS. Our series contributes to the growing body of experience which suggests that TIPSS is a safe and effective treatment for recurrent variceal bleeding.

Aged↗
PubMed1991

Transcatheter hepatic arterial therapy for symptomatic liver malignancy.

Transcatheter hepatic arterial chemoembolization was performed in ten patients with symptomatic unresectable liver malignancy. Nine patients experienced control of symptoms for 52-100% of the duration of their survival, although one patient died 10 days after the procedure. No objective evidence of decrease in tumour size was seen at review but three cases showed selective decrease in tumour vasculature or tumour necrosis.

Aged↗