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Biomedical subjects

D N Redhead

Publications and source records attributed to D N Redhead.

62 records · Page 4Linked to original sources
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↗
PubMedDate not supplied

The role of selective visceral angiography in the management of pancreatic and periampullary cancer.

A prospective study was undertaken to evaluate selective visceral angiography (SVA) in the management of patients with pancreatic and periampullary cancer. Over a 30-month period 52 patients with potentially resectable pancreatic or periampullary cancer underwent SVA; 4 patients had obvious angiographic evidence of widely disseminated disease and were not subjected to laparotomy while 2 further patients were eventually considered too frail for resection. The remaining 46 patients (median age 58 years, range 37-73 years, males 26, females 20) had no evidence of disseminated disease on ultrasonography and/or CT scanning and had both SVA and surgery and form the basis of this study. Vascular anomalies were detected in 16/46 (35%) patients. Hepatic metastases were wrongly diagnosed by angiography in 7 out of 9 patients (77%). SVA correctly predicted resectability or irresectability in 28/46 patients (overall predictive value 61%). Of the 27 patients who proved to have irresectable disease at operation, 11 were correctly identified by SVA (sensitivity 41%). Of the 13 patients reported to have irresectable disease, 2 underwent resection (false-positive rate 15%). Of the 33 patients reported to have resectable disease, 16 were irresectable (false-negative rate 48%). Overall there was a poor relationship between resectability and the angiographic features. On the basis of these data, SVA cannot be considered a sufficiently accurate means of assessing resectability. Its use for this purpose in patients with pancreatic and periampullary cancer is not justified.

Adult↗
PubMedDate not supplied

Transjugular intrahepatic portosystemic stent shunt.

The transjugular intrahepatic portosystemic stent shunt (TIPSS) is essentially a side-to-side portocaval shunt performed by interventional radiological methods which connects the hepatic vein to the portal vein via the liver parenchyma. It can be performed successfully in 85% to 95% patients. The procedure mortality is low (1% to 2%) and is mainly from intraperitoneal bleeding. Major indications for TIPSS are in patients in whom sclerotherapy for bleeding varices has failed, those who have recurrent variceal haemorrhage after sclerotherapy or band ligation and in patients with refractory ascites, hypersplenism and portal gastropathy. It has also been used in some patients with the Budd-Chiari syndrome, portal vein thrombosis and cirrhotic hydrothorax. TIPSS is followed by variceal rebleeding and encephalopathy in about 10% to 20% of cases, deterioration in liver function in about 25% to 35% and shunt dysfunction in 15% to 60%. Further research should be directed at developing newer types of stents to prevent shunt dysfunction.

Algorithms↗