PURPOSE: To assess the usefulness of percutaneous transluminal angioplasty (PTA) and expandable metallic stent (EMS) placement for treatment of Budd-Chiari syndrome (BCS). METHODS: Thirty-two patients with BCS were treated by PTA alone or by PTA and EMS placement. Among the 32 patients, a membranous obstruction was found in 24 and a segmental stenosis or occlusion in 8 patients. The follow-up period for PTA was 38-68 months (mean 52.2 months); for EMS it was 20-36 months (mean 24.3 months). RESULTS: Twenty-one patients underwent PTA as the primary treatment. Of these, one patient died of disseminated intravascular coagulation shortly after the procedure; 20 had good to excellent initial angiographic and clinical results. Of the 20, restenosis or reocclusion developed in 10 patients (48%), all before 27 months; 8 patients (38%) became symptomatic, and 2 remained symptom-free for a total recurrent obstruction rate of 50%. The EMS group of 17 patients included 11 patients who underwent primary stenting and 6 patients with secondary stenting after recurrence following primary PTA; restenosis was demonstrated in only 2 patients (12%). CONCLUSIONS: We conclude that PTA alone produces excellent short-term results and about 50% sustained patency after 2 years in patients with BCS; therefore it should remain the procedure of first choice. Stents should be reserved for primary or secondary PTA failures.

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PubMedDate not supplied

Partial splenic embolization for hypersplenism concomitant with or after arterial embolization of hepatocellular carcinoma in 30 patients.

PURPOSE: To study the value of partial splenic embolization (PSE) for the treatment of hypersplenism in patients undergoing embolization of hepatocellular carcinoma (HCC). METHODS: Transcatheter hepatic arterial embolization (THAE) combined with PSE was performed in 30 patients with HCC complicating liver cirrhosis, portal hypertension, and hypersplenism. Gelfoam sponge was used as the embolic material for PSE and limited to 100-150 pieces. RESULTS: More than 50% of splenic parenchyma was infarcted in 27 patients. Leukopenia and thrombocytopenia were corrected by PSE in 25 of 27 patients with hypersplenism. In 26 patients with esophageal varices, including 5 patients with bleeding, no rebleeding occurred during a 6-17 month follow-up. Hypersplenism was not corrected in 2 of 3 patients whose infarcted splenic parenchyma was less than 50%. No splenic abscesses or other severe complications were observed. Of the 30 patients treated, 19 are still alive after 1 year. CONCLUSIONS: THAE combined with PSE is a safe and effective measure for patients with HCC.

Adult↗

PubMedDate not supplied

beta-Adrenoceptors in endothelium of rabbit coronary artery and alteration in atherosclerosis.

The existence of beta-adrenoceptor (beta-AR) in endothelium of rabbit coronary artery and its alteration in atherosclerosis (AS) were determined by relaxation experiments in isolated preparations and in situ hybridization with a digoxigenin-labelled beta 2-AR cDNA probe. The concentration-relaxing response curves for isoproterenol (ISO) and norepinephrine (NE) in the presence of phentolamine were shifted to the right, and the maximal relaxations were reduced by removing the endothelium. Nitric oxide synthase inhibitor L-NG-nitro-arginine reduced the maximal relaxation induced by ISO, while the cyclooxygenase inhibitor indomethacin showed no effect on relaxation. In situ hybridization showed that mRNA for beta-AR was detected not only in smooth muscles, but also in endothelial cells. Coronary artery AS was created by high cholesterol feeding and was confirmed histologically under light microscopy. The relaxation response to acetylcholine (ACh) was abolished or significantly diminished in AS preparations. The relaxation responses to ISO or NE, however, were potentiated in AS arteries, especially in those which showed diminished (but not abolished) ACh response. The relaxation induced by sodium nitroprusside was reduced significantly in the AS arteries. Those results suggest that beta-AR are present in endothelium of rabbit coronary artery, and that endothelium beta-AR-mediated vasorelaxation is potentiated in AS.

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