The anatomy of the left inferior phrenic vein is poorly understood. It can be exposed by transecting the left triangular ligament and clearing the hepatic veins. We inspected twenty embalmed specimens that were injected with Rhodorsil. Generally, the vein has its origin above the diaphragm near the apex of the heart. After traversing the diaphragm, the vein receives two collateral veins, in front of the left triangular ligament. One is located anteriorly and to the right of the vein, the other one is situated behind and to the left. The phrenic vein continues laterally, passing posteriorly to the triangular ligament, or rarely, when the coronary ligamentum is wider than usual, the vein will pass through it as well. In 74% of the case, the vein terminates into the left side of the left hepatic vein. Three dissections appeared to be very interesting: --in one, the vein followed the free margin, then the hepatic margin of the triangular ligament, receiving accessory hepatic veins, --in another, the vein joined the right inferior phrenic vein in front of the inferior vena cava, --in the third one, the vein followed the left inferior phrenic artery, to join the left suprarenal vein, then terminating in the left renal vein.

Adult↗

PubMedDate not supplied

Impact of transjugular intrahepatic portosystemic shunt on orthotopic liver transplantation.

Transjugular intrahepatic portosystemic shunt (TIPS) is being increasingly utilized prior to liver transplantation for portal hypertensive bleeding refractory to sclerotherapy or as initial management of variceal bleeding. The impact of TIPS on subsequent orthotopic liver transplantation (OLT) is uncertain. The purpose of this study was to analyze the effect of TIPS on OLT in terms of operative transfusion requirements, operative time, length of hospital stay, and graft and patient survival. The results in 17 patients undergoing TIPS for control of initial or recurrent variceal bleeding prior to OLT between June 1991 and December 1992 were compared to two other groups undergoing transplantation: 32 control patients with a history of variceal bleeding not treated by TIPS and 11 patients with a previous surgical portosystemic shunt. Compared with control and surgical shunt patients, patients who underwent TIPS had less transfusion requirement for packed red blood cells and fresh frozen plasma during OLT. The operative time and hospital stay of the TIPS patients were slightly, but not significantly, less. In contrast to patients having TIPS, the patients with a history of a previous surgical shunt had an increased requirement for packed red blood cells, longer operative time, and longer stay in the intensive care unit and hospital. Two patients had recurrent variceal bleeding after TIPS; one patient was found to have an occluded stent, and the other patient (with a patent stent) responded to sclerotherapy. Of the 14 patients with ascites, 8 patients improved and 6 patients had complete resolution after TIPS. There were no major complications related to TIPS, although 3 patients had new or recurrent hepatic encephalopathy that was easily manageable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Jugular and carotid lymph node dissection for thyroid cancer].

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Carotid Arteries↗