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J Karani

Publications and source records attributed to J Karani.

63 records · Page 4Linked to original sources
PubMed1989

Mesoatrial shunt: a surgical option in the management of the Budd-Chiari syndrome.

The Budd-Chiari syndrome, arising from hepatic venous outflow obstruction, is frequently complicated by inferior vena caval occlusion or obstruction. Satisfactory decompression of the liver by either portacaval or mesocaval shunts may therefore prove impossible or be prone to failure from shunt thrombosis. The mesoatrial shunt which allows the portal vein to drain directly into the right atrium has previously been advocated in this situation. Five patients with the Budd-Chiari syndrome and caval occlusion and/or obstruction have had mesoatrial shunts constructed using externally supported polytetrafluoroethylene grafts. A single thoracoabdominal incision, incorporating a median sternotomy, was found to provide a satisfactory approach. All patients recovered well with resolution of ascites, diminution in liver size and improvement in inferior vena caval pressure gradients. Furthermore, all shunts have remained patent, as determined by Doppler flow studies and contrast-enhanced computed tomographic scanning, during follow-up periods ranging from 9 to 16 months. If these results are supported by longer term studies, the mesoatrial shunt may become the surgical treatment of choice in patients with hepatic vein occlusion and the Budd-Chiari syndrome associated with inferior vena caval obstruction.

Adolescent↗
PubMed1989

Adoptive immunotherapy administered via the hepatic artery and intralesional interleukin-2 in hepatocellular carcinoma.

We assessed the feasibility of using lymphokine-activated killer cells (adoptive immunotherapy) with infusions of interleukin-2 when given regionally in three patients with unresectable primary hepatocellular carcinoma (PHC). In 2 patients, 2 cycles, which included a bolus of LAK (10(7) to 10(8) cells followed by a 4-hourly infusion of IL-2 were administered via selective arterial catheterization of the hepatic artery. One further patient received 3 cycles of IL-2 alone by direct intralesional and perilesional injections. Minimal toxicity was observed and side effects such as fever were comparable to those observed with systemic infusions of IL-2 alone. Serial alpha-fetoprotein (AFP) levels initially fell but subsequently rose within 2 to 4 weeks of therapy. AFP levels had not reached pre-treatment values at 4 months in 2 patients, 1 of whom was alive and well at 15 months follow-up.

Carcinoma, Hepatocellular↗
PubMed1989

Lipiodol enhanced CT scanning in assessment of hepatocellular carcinoma.

We studied 20 patients with computed tomography (CT) following the intra-arterial injection of Lipiodol. Comparison with conventional CT, angiography and plain abdominal radiographs revealed additional satellite tumours in four patients. Technical difficulties occurred in selective hepatic arterial catheterisation and in satisfactory delivery of Lipiodol to all segments of the liver in a third of our patients. Plain abdominal radiographs following Lipiodol injection are inadequate in our experience in assessing tumour mass and distribution; we failed to demonstrate retention of Lipiodol by tumour tissue for longer than a few weeks in any case. The pattern of Lipiodol uptake within the tumour is not related to histology but to the vascular supply and size of the tumour. Our findings do not accord with the Japanese experience and this small study suggests that Lipiodol enhanced CT should be reserved for patients with small tumours in non-cirrhotic livers who are being considered for resection of their tumour. Such patients are likely to be encountered rarely in UK practice.

Adult↗
PubMed1989

Budd-Chiari syndrome: shunt selection and post-operative assessment.

Radiological investigation of patients with the Budd-Chiari syndrome is helpful in making the diagnosis and to determine the most suitable method of surgical decompression of the portal venous system where this is indicated. The radiological findings in four patients with Budd-Chiari syndrome who were treated by meso-atrial shunt operations are described. The key pre-operative investigation is inferior vena cavography with pressure measurements. Postoperatively shunt patency is most reliably assessed by dynamic CT scanning. Doppler ultrasound studies may detect flow within the shunt but patency may be inferred by observing reversal of blood flow within the portal vein.

Adolescent↗
PubMed1989

Variceal haemorrhage in hereditary haemorrhagic telangiectasia.

Hepatic in involvement in hereditary haemorrhagic telangiectasia can lead to cirrhosis and occasionally to portal hypertension and variceal haemorrhage. The ultrasonographic, arteriographic and histological findings are described in a patient with this complication. Hepatic artery embolisation proved unsuccessful in arresting repeated haemorrhage which was eventually controlled by hepatic artery ligation. Porto-systemic venous shunting, an apparently logical approach to management, would probably have aggravated the problem.

Hemorrhage↗
PubMed1988

Assessment of portal vein patency: comparison of arterial portography and ultrasound scanning.

The accuracy of ultrasound assessment of portal vein patency has been defined by comparing it with the results of arterial portography in 115 cases. The accuracy of arterial portography was confirmed in 21 cases where orthotopic liver transplantation was performed and used as a 'bench-mark' against which to assess the ultrasound findings. Ultrasound correctly assessed portal vein patency in 87.5% of patients. It was more accurate in assessing patency (90%) than occlusion (68%). Ultrasound correctly assessed portal vein patency in 90% of cases of cirrhosis and hepatic malignancy. Difficulties occurred in children with biliary atresia particularly following the Kasai operation (37.5% accuracy). In the absence of previous surgery to the portal vein or biliary system, ultrasound is comparable to arterial portography and can be used as the sole means of assessment.

Adolescent↗
PubMed1986

Ultrasound scanning and 99mTc sulphur colloid scintigraphy in diagnosis of Budd-Chiari syndrome.

Ultrasound scanning and 99mTc sulphur colloid scintigraphy are widely used in the diagnosis of the Budd-Chiari syndrome and have been compared at the time of presentation in 18 patients in whom the diagnosis was subsequently confirmed by histology and hepatic venography. Ultrasound was diagnostic in 16 (87%). The findings seen most often included hepatic vein abnormalities, caudate lobe hypertrophy with decreased reflectivity and compression of the inferior vena cava. Additional information not shown by scintigraphy included intracaval tumour, or thrombosis, and concomitant portal vein thrombosis. Although scintigraphic abnormalities were present in all patients, only in three (17%) was the 'classical' appearance of increased uptake and/or enlargement of the caudate lobe present. In one patient with nonspecific abnormalities on ultrasound, scintigraphy gave a positive diagnosis and it is in such cases that scintigraphy should continue to be used.

Adolescent↗
PubMed1985

Internal biliary drainage and local radiotherapy with iridium-192 wire in treatment of hilar cholangiocarcinoma.

Curative surgery is not possible in the vast majority of patients who present with hilar cholangiocarcinoma. Palliative therapy to relieve jaundice, either at laparotomy or percutaneously, is therefore necessary. The mean survival of these patients is of the order of 8.5 months (Wheeler et al., 1981). We report a significant increase in mean survival to 16.8 months in patients treated with internal biliary drainage when combined with local irradiation to the tumour with iridium-192.

Adenoma, Bile Duct↗