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At least 199 records · Page 11Linked to original sources
PubMed1985

The use of the portal system for the transplantation of a neonate kidney graft in a child with Wilms' tumor.

A single an-encephalus neonate kidney graft was transplanted into the portal system of a 6-year-old recipient who had previously undergone removal of the right kidney and inferior vena cava because of Wilms tumor. The left kidney ceased to function shortly thereafter. The child was supported very poorly on hemodialysis, and showed repeated very high levels of cytotoxic antibodies in her serum. The first cross-negative kidney graft that was available harbored two main arteries and duplicate collecting system with two very thin ureters. These vascular anatomic and pathologic variations of both donor graft and recipient necessitated the use of the portal system for renal graft venous drainage and the aorta for the graft revascularization. The ureters that had pinpoint-like lumen were inserted together into the lumen of the native ureter stump and fixated. One year after the transplantation the serum creatinine level is 1.8 mg/dL.

Aorta↗
PubMed1988

Changes of portal systemic shunting after sclerotherapy and/or partial splenic embolization observed by Tl-201 per-rectal administration.

Tl-201 per-rectal scintigraphy was performed before and after injection sclerotherapy of esophageal varices and/or partial splenic embolization in patients with esophageal varices to observe the changes of portal systemic shunting by these treatments. The changes in the heart-to-liver uptake ratio of Tl-201 after injection sclerotherapy ranged widely from a decrease to an increase with the mean change rate (mean of the absolute value of change rate) +/- 1 SD of 19.0% +/- 19.9%. By partial splenic embolization the heart-to-live uptake ratio was decreased significantly with the mean change rate +/- 1 SD of 26.2% +/- 17.4% (P less than 0.05). This noninvasive and simple method seems to be useful in evaluating pathophysiological changes of portal systemic shunting observed from inferior mesenteric vein blood flow after treatments of portal circulation system.

Administration, Rectal↗
PubMed1992

Spastic paraparesis associated with portal-systemic venous shunting due to congenital hepatic fibrosis.

We report a case of progressive spastic paraparesis in a 45-year-old man with total portal-systemic shunting, which developed spontaneously due to congenital hepatic fibrosis. Cellular functions of the liver, except for an elevated blood ammonia level, were within normal limits, as is usual in congenital hepatic fibrosis. This case shows that spastic paraparesis following portal-systemic shunting may occur without liver failure.

Ammonia↗
PubMed1984

Reduction of portal vein pressure with the enlargement of portal-systemic shunts: observation made in one patient.

Whether portal vein pressure is reduced as spontaneous portal-systemic shunts are enlarged has long been disputed. We measured portal vein pressure directly by percutaneous transhepatic catheterization in one patient with cirrhosis at a 4-year interval, and demonstrated a significant reduction in portal vein pressure that had occurred along with enlargement of a collateral paraumbilical vein and splenorenal shunt during this period.

Catheterization↗
PubMed1980

Recognition of systemic portal shunts by lower extremity radionuclide venography.

Radionuclide venography was used to conduct 120 investigations of pelvic veins to find signs of systemic portal shunting. No signs of flow abnormalities were shown in the upper abdominal region in 80 patients with normal pelvic veins; 40 patients suffered from pelvic occlusions. Of these, 10 showed paraumbilical hot spots or liver demonstrations. These symptoms are assessed as signs of systemic portal shunts. The hemodynamic significance of this complication of pelvic vein thrombosis is discussed. It is supposed that a shunt from the systemic veins to the portal vein does not occur as infrequently as described in the literature. The radionuclide venography with 99mTc microspheres is a new and simple way to detect complication of pelvic vein occlusions.

Adult↗
PubMed1989

Portal system peculiarities may contribute to resistance against schistosomes in 129/J mice.

Using the technique of latex microsphere injection into a mesenteric vein, evidence has been obtained for a 'leaky' portal system in 129/J mice maintained in this institute (WEHI 129/J) and also in C57BL/6 mice. Thus, 20-microns beads injected into the portal venous system of BALB/c and (BALB/cx129/J)F1 mice are trapped efficiently in the liver whereas in many 129/J and C57BL/6 mice the bulk of the injected beads is found in the lungs. Peculiarities in the hepatic portal system may thus contribute to resistance of WEHI 129/J mice (and to a lesser extent C57BL/6 mice) to infection with Schistosoma mansoni and S. japonicum. The possibility is raised by the data that increased access to, or residency times in, the lungs increases opportunities for expression of anti-schistosome immune responses and, in particular, the effects of recently described T-cell-initiated inflammatory responses in this organ. The variability within groups of WEHI 129/J and C57BL/6 mice in susceptibility to schistosomes as well as hepatic trapping of injected microspheres suggests that an infection of unknown type, proposed by others, contributes to the several peculiarities that have been described in at least 129/J mice.

Animals↗
PubMed1983

The brain in experimental portal-systemic encephalopathy. I. Morphological changes in three animal models.

Morphological features of three models of portal-systemic encephalopathy in the rat were studied and compared with plasma ammonia levels and clinical observations. Carbon tetrachloride-induced cirrhosis with terminal coma produced a wide variety of structural changes in the brain whose severity was related to plasma ammonia levels at the time of death. These changes included diffuse gliosis, Alzheimer cells and focal neuronal necrosis but did not include spongiform changes in cerebral or cerebellar cortex. Porta-caval anastomosis (PCA) did not appear to produce any significant neurological symptoms. Rats with PCA of durations 1-30 weeks were studied and over this time the structural changes included astrocytic nuclear swelling, swelling of perivascular astrocytic foot-processes and spongiform change in the molecular layer of the cerebellum. No evidence of Alzheimer cells or gliosis was seen and plasma ammonia levels at no stage exceed twice the normal levels. Porta-caval anastomosis followed by gavage feeding with ammoniated cationic exchange resin produced severe neurological symptoms and marked hyperammonaemia. In these animals not only astrocytes but oligodendrocytes and neurons showed nuclear and cytoplasmic swelling and numerous Alzheimer type II cells were seen, together with a diffuse gliosis, but no evidence of spongiform change in the cerebral or cerebellar cortex was seen. It is concluded that ammonium ions are important in the genesis of morphological changes in the brain in rat models of portal-systemic encephalopathy, but the relevance of these changes to neurological dysfunction is uncertain.

Ammonia↗
PubMedDate not supplied

[Early detection of hepatobiliary involvement in children with mucoviscidosis using duplex sonography of the portal system].

To investigate early signs of hepatobiliary disease in CF, we measured portal, splenic, superior mesenteric vein and hepatic artery diameters, maximal flow velocity (Vmax) and time average velocity (TAV) in 25 males and 17 females with CF. Hepatic artery resistance, regional blood flow and liver perfusion were calculated. According to liver enzyme data (aminotransferases raised greater than 30 U/l) and sonographic findings (nodular changes), there were 17 CF-patients (mean age 11.4 yrs; range 0.75-31) with and 25 CF-patients (mean age 7.8 yrs; range 0.25-32) without liver involvement (L+/L-). No patient had clinical signs of portal hypertension. 61 healthy children were studied for control. Diameter of portal vein (PVD) and flow data for portal vein showed consistent abnormalities (mean +/- SD): CF-L+ CF-L- Control PVC (mm/m2) 10.7 +/- 3.9*** 10.5 +/- 3.4*** 7.2 +/- 1.3 Vmax (m/sec) 0.23 +/- 0.06*** 0.30 +/- 0.06*** 0.40 +/- 0.14 TAV (m/sec) 0.12 +/- 0.04*** 0.16 +/- 0.04* 0.18 +/- 0.05 Differences were statistically significant (* p less than 0.05, *** p less than 0.001) for CF-patients versus controls. Data for splenic and mesenteric veins and for hepatic artery were moderately alterated, with a significant reduction in TAV and Vmax of splenic vein for CF-L+ versus controls. Liver perfusion and portal vein flow showed no relevant differences in CF-patients versus controls. It is concluded that portal system abnormalities, especially a decrease in Vmax and TAV of portal vein shown by duplex sonography, may be earlier indicators of CF liver disease than biochemical and clinical signs.

Adolescent↗
PubMed1992

Is portal-systemic shunt worthwhile in Child's class C cirrhosis? Long-term results of emergency shunt in 94 patients with bleeding varices.

A prospective evaluation was conducted of 94 unselected patients ("all comers") with biopsy-proven Child's class C cirrhosis (93% alcoholic) and endoscopically proven acutely bleeding esophageal varices who underwent emergency portacaval shunt (EPCS) (85% side-to-side, 15% end-to-side) within 8 hours of initial contact (mean, 6.1 hours) during the past 12 years. Follow-up has been 100% and includes all patients for at least 1 year, and 61 patients (65%) for 5 to 12 years. Incidence of serious risk factors on initial contact was: ascites, 97%; jaundice, 86%; portal-systemic encephalopathy including past history, 71%; severe muscle wasting, 96%; alcohol ingestion within 7 days, 66%; delirium tremens, 16%; serum albumin, less than or equal to 2.5 g/dL 76%; indocyanine green dye retention greater than or equal to 50% in 45 minutes, 66%; serum glutamic-oxaloacetic transaminase greater than or equal to 100 units/L, 60%; hyperdynamic cardiac output greater than or equal to 6 L/minute, 98%. Mean Child's point score was 13.7 out of a maximum of 15. EPCS reduced mean corrected free portal pressure from 286 to 23 mm saline, and permanently controlled variceal bleeding in every patient. Of the 94 patients, 74 (80%) left the hospital alive and 68 (72%) survived 1 year. Five-year actuarial survival rate is 64%. Hepatic failure was the main cause of death during initial hospitalization as well as during follow-up, when it was related to continued alcoholism. Portal-systemic encephalopathy, which was present on initial contact in 55% of patients, occurred at some time during follow-up in 18.7%, but was recurrent and required dietary protein restriction in only 9%, all of whom had resumed alcoholism. The low incidence of portal-systemic encephalopathy was attributable to the lifelong program of follow-up with regular dietary counseling and continued emphasis on both protein restriction to 60 g/day and abstinence from alcohol. Abstinence was sustained in 69%, liver function improved in 82%, general health was judged excellent or good in 73%, and Child's risk class converted to class B in 73% and class A in 21%. Excluding retirees because of age, 42% were gainfully employed or engaged in full-time housekeeping. Long-term shunt patency was documented in 100% of survivors by yearly angiography or Doppler ultrasonography. It is concluded that EPCS within 8 hours of initial contact permanently controls variceal hemorrhage and results in prolonged survival and a life of acceptable quality in many alcoholic cirrhotic patients in Child's class C.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1998

Portal-systemic encephalopathy from a spontaneous gastrorenal shunt diagnosed by three-dimensional computed tomography and treated effectively by percutaneous vascular embolization.

A 67-year-old man with a portal-systemic shunt confirmed by three-dimensional computed tomography (3D-CT) was successfully treated by percutaneous vascular embolization. The patient had aggravated loss of memory, disorientation, and hyperammonemia. A gastrorenal shunt 16 mm in diameter was found by 3D-CT reconstructed by helical computed tomography (CT). Embolization was performed only in the shunt percutaneously through the inferior vena cava. One year after the embolization, no recurrence of portal-systemic encephalopathy and no portal hypertension have appeared, and the clinical course has been good.

Aged↗
PubMed1981

Measurement of portal-systemic shunting in the rat by using gamma-labeled microspheres.

A method for determining the extent of portal-systemic shunting (PSS) is described and evaluated in lightly anesthetized (ketamine) rats. This method relies on the intrasplenic injection of 15-micrometers gamma-labeled spheres and the subsequent measurement of liver and lung radioactivities. After the splenic injection of the microspheres, a fraction of microspheres shunting the hepatic sinusoidal bed will be entrapped in the lungs. Thus, the ratio, lung/(lung + liver) radioactivities, will indicate the degree of PSS. The percent of PSS was determined in normal (n = 13; 1.2 +/- 0.3%), in cirrhotic (n = 9; 15.0 +/- 4.5%; P less than 0.01), and in portal vein-ligated animals (n = 14; 95.0 +/- 0.9%; P less than 0.001 for normal and cirrhotic). In addition, PSS was sequentially quantitated (n = 3) before (3.0%) and after (89%) partial portal vein ligation. The variability of PSS found in cirrhotic rats (0.7-41.0%) is in agreement with the reported data for PSS in patients. This technique, which is simple, rapid, and reproducible, allows the quantitation of PSS in small laboratory animals.

Animals↗
PubMed1979

Effects of spontaneous portal-systemic shunting on insulin metabolism.

Insulin degradation was measured by the C-peptide/insulin ratio in 19 patients with portal vein block with extensive spontaneous portal-systemic shunting but minimal liver cell damage: 13 patients with biopsy-proved cirrhosis and 12 controls. Blood obtained fasting and for 3 hr after oral glucose was assayed for glucose, insulin, and C-peptide. Fasting C-peptide and insulin levels in patients with portal vein block and those in controls did not differ. Eight of 13 cirrhotic patients had fasting hyperinsulinemia with a significantly reduced C-peptide/insulin ratio. After glucose administration, the C-peptide/insulin ratio in portal vein block patients with normal aspartate transaminase levels did not differ from control values. In portal vein block patients with elevated asparatate transaminase levels, the C-peptide/insulin ratio was significantly reduced only from 60 min onwards. All the cirrhotic patients showed a significantly reduced C-peptide/insulin ratio after glucose administration. It is suggested that portal-systemic shunting of blood in the presence of a normal liver does not influence hepatic insulin metabolism and that the hyperinsulinemia of cirrhosis is a feature of parenchymal liver damage. In addition, insulin degradation was abnormal in all cirrhotic patients at high insulin secretion rates, even when fasting insulin levels were normal.

Adolescent↗
PubMed1977

[Change in portal system and liver hemodynamics under the influence of operations on the gastrointestinal tract organs and the basic principles of its correction].

A comprehensive study of hemodynamic indices of the portal system and liver (portal pressure, linear rate of portal blood flow in the liver, rheohepatography) as well as protein-formation function of the liver, its enzymatic activity, in the complex with histomorphology of hepatic tissue and comparison of the data, obtained by some functional tests of general hemodynamics (AP, VP, CVP, linear rate of total blood flow, the porto-caval gradient, TCB), rendered it possible to reveal significant disturbances in hepatic circulation and this organ functioning with satisfactory indices of general hemodynamics. Taking into account the data obtained, the complex therapy for the changes observed was elaborated by the authors; its main principles being as follows: the maintenance of general hemodynamics, restoration of TCB and its components deficiency, the provision of the organ (hepatic) blood flow, the correction of metabolic changes in the liver intra-and postoperatively. The entire complex of drugs was infused in the umbilical vein.

Blood Flow Velocity↗
PubMed2002

Pancreaticoportal fistula in association with antiphospholipid syndrome presenting as ascites and portal system thrombosis.

Fistulous communication between the pancreas and the portal venous system is extremely rare and is usually a complication of chronic pancreatitis or pancreatic pseudocysts. A patient who presented with abdominal pain and ascites secondary to a pancreaticoportal fistula and portal system thrombosis is described. The diagnosis was made by endoscopic retrograde cholangiopancreatography and confirmed by immediate postprocedure computed tomographic scanning. Laboratory studies identified concomitant antiphospholipid syndrome. The patient responded favourably to supportive medical therapy.

Abdominal Pain↗
PubMed2002

Surgical treatment of a descending aortic aneurysm in a patient with noncirrhotic portal hypertension and a portal systemic shunt.

A 63-year-old male with atrial fibrillation and mild mitral valve regurgitation was referred to hospital because of a descending aortic aneurysm. During the evaluation, he developed an encephalopathy because of hyperammoniaemia. Further examination revealed a portal systemic shunt, perhaps caused by the noncirrhotic portal hypertension. The patient underwent successful replacement of the aneurysm after controlling the blood ammonia level by eliminating protein from the diet and removal of nitrogen from the gastrointestinal tract. Cardiovascular surgery in a patient with noncirrhotic portal hypertension and a portal systemic shunt has not been previously reported. Meticulous management of the perioperative blood ammonia concentration is essential.

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

Comparative analysis of insulo-acinar portal system in rats, guinea pigs, and dogs.

The insulo-acinar portal system in the rat, guinea pig, and dog was comparatively analyzed using corrosion casting method in scanning electron microscopy and confocal laser scanning microscopy. In all animals examined, there were three types of arterioles according to their destination: 1) the arteriole which supplied the capillary glomerulus of the islet, 2) the arterioles which directly branched out into capillaries around the acini, and 3) the arterioles which supplied the duct system. In the rat, the afferent vessel usually ended in the cortical layer of the islet and its main branches ran along this layer before giving secondary capillary branches into the deeper regions, while in the dog and guinea pig, the region where the afferent arterioles branched out into secondary capillary branches varied among individual islets. There were three types of efferent vessels of the islet: 1) the insulo-acinar portal vessels that radiated from the islet to join the capillary network in the exocrine pancreas, 2) the emissary venules of the islet, leading directly into the systemic circulation, and 3) the insulo-ductal portal vessels which drained into the peri-ductal capillary network. In the rat and guinea pig, the intralobular islets possessed both the insulo-acinar portal vessels and the emissary venules, while the interlobular islets possessed emissary venules with occasionally occurring insulo-acinar portal vessels. In the dog, most of the islets were located within the lobule and possessed preferentially the insulo-acinar portal vessels. In this animal, the lobule was supplied by several microvascular units, in the center of which was located the capillary glomerulus of the islet. The peri-insular zone of the unit was mainly supplied by the insulo-acinar portal vessels, while the periphery, the tele-insular zone, was directly supplied by arterioles as well. The venules originated at the periphery of the unit. The islet in the dog had virtually no emissary venules. Confocal laser scanning microscopy of the rat islets showed that B cells occupied the core of all islets. The microvascular architecture within the rat islet appeared to be organized as to drain blood from the A and D cell area to the B cell area of the islet.

Animals↗