The authors report 6 cases of portal hypertension with gastrorenal shunt. This shunt did not arise from the left gastric vein, but from the splenic vein. Portal hypertension was related to alcoholic cirrhosis in 3 cases, to extensive portal thrombosis in 2 cases, and to nodular regenerative hyperplasia of the liver in one case. A gastrointestinal hemorrhage revealed portal hypertension and the liver disease in the 3 cases of alcoholic cirrhosis and complicated the course of the disease in the other cases. Hemorrhage was either massive and life-threatening or often recurred. It was related to a rupture of fundic varices in all cases. The fundic varices were not associated with esophageal varices in the 3 cases of cirrhosis. The degree of portal hypertension was above 20 mm Hg, as assessed by the portohepatic gradient (one case), or the pressure gradient between a tributary portal system vein and the inferior vena cava during laparotomy (5 cases). Definitive control of hemorrhage could not be achieved by endoscopic variceal sclerotherapy (2 cases) or percutaneous transhepatic embolization (one case). Portacaval shunt or splenectomy was performed in 5 cases. These findings suggest that spontaneous splenogastrorenal shunt is a clinical and hemodynamic entity which requires specific treatment when associated with gastric variceal bleeding.

Adolescent↗

PubMedDate not supplied

[Gastroduodenal ulcer and psychology].

Ulcers do not necessarily and uniquely constitute a psychogenic disease. Life events may play a role in certain subjects but their occurrence is neither necessary (absence in numerous ulcerous patients) nor sufficient (presence in controls) for triggering ulcerous development. While the actual experiences involved are important, there is no personality type linked to development of ulcers. Some specialists call attention to a tendency to react to conflicts according to a particular pattern (dependence-independence, passivity-hyperactivity); others refer to various modes of personality breakdown ot to the accentuation of certain personality traits. At the present time there is no satisfactory explanation of the mechanism governing the links between psychological disturbances and gastroduodenal anatomical lesions. The role of psychotherapy in the treatment of ulcers is poorly understood.

Duodenal Ulcer↗

PubMedDate not supplied