[Splenoportography as a diagnostic method in blockage of the portal system].
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Angiography↗
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The effect of portal-systemic shunting on hepatic sex hormone receptors in male rats.
Signs of feminization are seen in men with cirrhosis of alcoholic but also of nonalcoholic origin even in the absence of markedly increased plasma estrogen levels. Recently identified alterations of hepatic sex hormone receptor levels have provided a hypothetical mechanism for the pathogenesis of the feminization seen in cirrhotic men. The aim of the present study was to determine the effect of experimental portal-systemic shunting in adult male rats on hepatic sex hormone receptor levels, plasma sex hormones, and two markers for sex hormone action in the liver. The following alterations were found in male rats with surgically created portacaval shunts compared with sham-operated controls: the hepatic content of cytosolic estrogen receptors was reduced by 35% and the cytosolic androgen receptors content by 59%; plasma levels of estradiol increased 6.7-fold while those of testosterone were reduced by 71%; the estrogen-responsive ceruloplasmin levels were decreased by 31% and the androgen-responsive male-specific estrogen binder by 72%. Based on these data, it can be concluded that portal-systemic shunting reduces the hepatic cytoplasmic content of several sex hormone related proteins. These changes are paralleled by a decreased estrogen responsiveness of the liver, as evidenced by the plasma ceruloplasmin level.
Animals↗
Blood flow distribution in the renal portal system of the intact hen. A study of venous system using microspheres.
The blood flow in the renal portal system of intact hens was characterized by determining the fractional distribution of 15 microns and 50 microns microspheres in this system after injection into a leg vein. Validation tests showed that only 50 microns spheres gave reliable estimation of this distribution. The blood flow in the coccy-geomesenteric vein was directed towards the liver in nearly all cases. On the average 44, 47 and 8% of the portal blood from the external iliac vein perfused the ipsilateral kidney, the liver and the lungs, respectively. However, the distribution of portal blood to these organs varied considerably between individuals and changed appreciably within 35 min in half the animals studied. The reason for these variations is not clear. The portal blood from the right and left external iliac veins was asymmetrically distributed in most animals illustrating the importance of local factors in its regulation. Variation was great in the regional distribution of portal blood within the kidney possibly due to local vasoconstriction of portal vessels. Further information e.g. on the regulation of renal portal blood flow is needed to explain its physiological significance. Microspheres provide a convenient method for such studies. A combination of microsphere and Sperber techniques allows us to determine the renal excretion efficiency of a given substance.
Animals↗
Effects of keto analogues of essential amino acids in portal-systemic encephalopathy.
Keto analogues of five essential amino acids (valine, leucine, isoleucine, methionine, and phenylalanine) were given either parenterally or orally in varying proportions to 11 patients with portal-systemic encephalopathy and hyperammonemia. Plasma concentrations of amino acids corresponding to the infused analogues, including alloisoleucine, increased significantly after infusions. Plasma tyrosine and glycine, which were abnormally elevated in control samples, fell after the infusions. After one to five daily infusions, the ratio of essential to nonessential amino acids in fasting plasma was increased toward normal, suggesting improved protein nutrition. Arterial blood ammonia and glutamate did not change immediately after infusions, but a pronounced decrease in glutamine (42%) was observed. Eight nitrogen balance studies performed in 5 patients during 3 to 12 days of oral or intravenous keto acid therapy failed to show consistent improvement in balance as compared with control periods. After five courses of oral therapy there was again significant improvement in the ratio of essential to nonessential amino acids. No toxicity from keto analogue administration was found, and clinical improvement, as assessed by mental status and psychological testing occurred in 8 of 11 patients. These studies suggest keto analogues of essential amino acids are converted to the corresponding amino acids in patients with portal-systemic encephalopathy, and that such therapy may be of benefit.
Administration, Oral↗
[Factors in long-term survival after total portal systemic shunting: a multiple regression analysis].
163 patients with portal hypertension underwent portal systemic shunting at PUMC hospital during the time of 1970's. There were 98 cases had central spleno-renal shunts. 38 had portacaval shunts and 27 had meso-caval shunts. The live function in this group are A-40%, B-55% and C-5%. The totaled operative mortality was 11.0%, and the totaled 5 years survival was 59.5%. The analysis reveals that: (1) The long-term survival and the patient's life quality were significant influenced by liver function and the type of shunting; (2) The mortality of emergency operation was significant higher than elective shunting surgery (30.0% vs 4.6%); (3) The cephalopathy and rebleeding rate were correlated with the type of shunting, liver function and the diameter of shunt; (4) The patient with A or B liver function could accept either elective or emergency operation, but emergency surgery should be carefully chosen for. The mortality was higher than 80% in emergency shunting for the patient with liver function C.
Adolescent↗
[The portal system and the hepatic artery in children with extrahepatic bile duct atresia. 2: Further duplex sonography parameters and flowmetry].
Since 1 1/2 year we performed duplex-sonographic examinations including flowmetry of the portal system and hepatic artery in children with biliary atresia. In children with hepatofugal collaterals we found a significant decreased Time Average Velocity (TAV) with 0.09 m/s against the control group with TAV of 0.18 m/s. The TAV in the splenic vein was also decreased. In the hepatic artery we found no change of the TAV. In most of the children a portal hypertension with hepatofugal collaterals was to be found in the first year of life. In 14 children the collaterals were visible. In these 14 children and 7 other children calculated parameters indicated the very high probability of collateral vessels. In children with hepatofugal collaterals we found a decreased portal vein flow. In 16 of 21 cases the flow in the hepatic artery was increased.
Biliary Atresia↗
Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy. A controlled, double-blind clinical trial.
In a double-blind, randomized study the efficacy of lactulose was compared with neomycin-sorbitol in 45 episodes of acute nitrogenous portal-systemic encephalopathy (PSE) induced by dietary protein, azotemia, or gastrointestinal hemorrhage. All patients had underlying cirrhosis, and at the time of randomization had encephalopathy of at least grade 2 severity and arterial ammonia concentrations greater than 150 microgram/100 ml. Two thirds of the patients in each group returned to normal mental status and more than 80% in each group showed at least one grade improvement in mental state. In addition, there was equivalent improvement in asterixis, in the performance of the Number Connection Test, in the electroencephalographic pattern, and in arterial ammonia concentration. The principal difference between the two groups was a greater reduction in stool pH after lactulose therapy than after neomycin-sorbitol therapy. One patient randomized to neomycin-sorbitol had to be withdrawn from the study because of persistent vomiting related to the administration of the medication. Otherwise there were no complications attributable to therapy in either group. These data suggest that neomycin-sorbitol and lactulose are equally effective in the treatment of acute nitrogenous portal-systemic encephalopathy.
Clinical Trials as Topic↗
Case report: portal-systemic encephalopathy due to a congenital extrahepatic portosystemic shunt.
We present a case of portal-systemic encephalopathy due to a congenital splenorenal shunt. A 69 year old woman was admitted to hospital because of recurrent episodes of disturbed consciousness. The present episode had begun 3 months prior to admission. Although the patient demonstrated mildly slurred speech, the remainder of her neurological examination was unremarkable. She showed no clinical signs of portal hypertension and her liver function, except for a serum hepaplastin test of 58% and an ICG retention rate of 28% at 15 min, was normal. Her serum ammonium level was 210 micrograms/dL. The venous phase of a superior mesenteric arteriogram revealed a splenorenal shunt and narrowing of the portal vein, which was 4 mm in diameter. The histological findings, demonstrated by a needle liver biopsy specimen, were consistent with mild fibrosis and lymphocytic infiltration. Following the diagnosis of a splenorenal shunt in the absence of liver cirrhosis, ligature of the shunt was performed with a splenectomy. The portal vein pressure after ligature of the shunt rose from 12.5 to 18.8 mmHg. This shunt was thought to be of congenital origin. The high preoperative serum ammonia concentration decreased to the normal range postoperatively and the serum hepaplastin test and ICG retention rate similarly improved postoperatively. A follow-up superior mesenteric arteriogram was performed during the venous phase, demonstrating resolution of the shunt and decreased portal vein narrowing. The patient has suffered no further episodes of disturbed consciousness postoperatively.
Aged↗
Lactose enemas plus placebo tablets vs. neomycin tablets plus starch enemas in acute portal systemic encephalopathy. A double-blind randomized controlled study.
A randomized, double-blind comparison of lactose enemas plus placebo tablets vs. starch enemas plus neomycin tablets was performed on 18 patients with acute portal systemic encephalopathy. Ten patients received starch enemas (10%; 1000 ml t.i.d.) plus neomycin tablets and 8 patients received lactose enemas (20%; 1000 ml t.i.d.) plus placebo tablets. A significant mental state improvement was demonstrated in the group of patients treated with starch enemas-neomycin tablets (p less than 0.05) and in the group of patients treated with lactose enemas-placebo tablets (p less than 0.025). Both treatments significantly improved the frequency of asterixis, ammonia blood levels, and electroencephalograms. In addition, patients treated with lactose enemas showed significant improvement in number-connection test times (p less than 0.02), and their stools showed a more acid pH (p less than 0.05). No side effects were evident with either treatment. Lactose enemas are a safe and effective treatment for acute portal systemic encephalopathy.
Acute Disease↗
Portal-systemic encephalopathy due to a congenital extrahepatic portosystemic shunt: three cases and literature review.
Extrahepatic portal-systemic encephalopathy due to congenital extrahepatic portosystemic shunt has so far been rarely reported in the literature. We herein report 3 such cases without liver cirrhosis or portal hypertension which were presented with the chief complaint being disturbance of consciousness and abnormal behavior. In all cases the brain computed tomography scan revealed no pathological findings, while electroencephalogram showed a diffuse slow activity with triphasic waves. The laboratory data revealed a high serum ammonia level. Percutaneous transhepatic portography demonstrated portosystemic shunts. After these shunts were surgically occluded, the serum ammonia level reached a normal range and encephalopathy disappeared. A liver biopsy also revealed neither fibrosis nor cirrhosis in any of the cases. The 23 previously reported cases are also discussed.
Aged↗
Patent ductus venosus with a hypoplastic intrahepatic portal system presenting intrapulmonary shunt: a case treated with banding of the ductus venosus.
A case of patent ductus venosus (PDV) presenting intrapulmonary shunting is described. Although retrograde venography of ductus venosus showed few intrahepatic branches, banding of PDV resulted in increased intrahepatic portal branches and disappearance of symptoms 10 months after the operation. Banding of the ductus venosus may be effective in PDV even with hypoplastic intrahepatic portal system.
Child↗
Infusion of 2-deoxy-D-glucose into the hepatic-portal system causes eating: evidence for peripheral glucoreceptors.
Injections of 2-deoxyglucose into the hepatic-portal system of normal rabbits increased eating to a greater extent and with shorter latency than comparable injections of 2-deoxyglucose into the jugular vein or into the hepaticportal circulation of the vagotomized rabbit. These differences suggest the existence of vagally mediated peripheral glucoreceptors important in the initiation of food intake.
Animals↗
The concentration in brain of octopamine and tyramine after portal-systemic bypass in rats: neuroamine concentrations determined simultaneously by methane chemical ionization gas chromatography mass spectrometry.
The concentration in brain of both octopamine (OCT) and tyramine (TYR) was significantly increased in rats 8 weeks after portal-systemic bypass. This suggests that the increase in OCT is secondary to increased decarboxylation of tyrosine to TYR. However, the role these neuroamines, particularly OCT, play in the development of hepatic encephalopathy remains controversial.
2-Hydroxyphenethylamine↗
Opacification of the portal system during ERCP: demonstration of an anomalous pancreatico-portal connection in a patient with pancreatic carcinoma.
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Aged↗
The anatomy and perfusion of the renal portal system in the red-eared slider (Trachemys scripta elegans).
The anatomy of the renal portal system of the red-eared slider (Trachemys scripta elegans) is described, based on dissection of six double latex-injected specimens (three males, three females). The anatomy of these vessels, which had not previously been described in this species, was found not to differ significantly from the fundamental chelonian pattern. Fluoroscopic radioangiography revealed that venous blood returning from the hindlimbs flowed predominantly to the liver and bypassed the kidneys. Blood from the tail either flowed to the kidneys or bypassed them and flowed directly to the liver. A putative valve is described that governs venous blood flow from the caudal body to or around the kidneys.
Animals↗
[Endoscopic decompression of carpal tunnel syndrome with the "Agee one-portal system"].
The aim of the present study was to present the results after endoscopic carpal tunnel release in the first 30 hands operated in our department. Over a five month period we used the Agee one-portal system for endoscopic carpal tunnel release in all patients operated with a carpal tunnel release in our department. All patients were operated by one surgeon, who recorded all data and results prospectively. The patients were evaluated preoperatively and after two and eight weeks. A total of 30 hands in 25 patients were operated. There were 19 females and six males with a mean age of 50.1 years (23-80). There were no haematomas, injuries to the arcade vessels, nerve lesions or infections. All patients but one stated a good clinical result of the operation, and all patients had regained normal movement of all fingers at the two-week postoperative check-up. All patients, who were working preoperatively, were able to return to work after two to three weeks except for three patients. In conclusion, we have not experienced any complications in our series, and all patients but one had a good clinical results. We feel that the Agee one-portal system ensures carpal tunnel release with a minimum of discomfort, and we find the preliminary results in our department so promising, that we now use this technique as a routine in uncomplicated cases of carpal tunnel syndrome.
Adult↗
THROMBOSIS AND INTIMAL THICKENING IN THE PORTAL SYSTEM IN CIRRHOSIS OF THE LIVER.
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Adolescent↗
Treatment of chronic portal-systemic encephalopathy with lactose in lactase-deficient patients.
A controlled cross-over clinical comparison of lactose (50 g twice a day) versus neomycin (3 g/day) plus milk of magnesia, was carried out in ten cirrhotic patients with chronic portal-systemic encephalopathy and documented lactase deficiency. Serial semiquantitative assessments were done including: mental state, asterixis, number connection test, electroencephalogram, and blood ammonia levels. No patient developed deep coma while ingesting either lactose or neomycin plus milk of magnesia. However, a significant improvement of mental state, asterixis, number connection tests, and electroencephalograms was evident during lactose therapy. apart from mild diarrhea and bloating, no severe side effects were noticeable during lactose treatment. Based on these results, we propose lactose as a valuable alternate treatment of portal-systemic encephalopathy in lactase-deficient populations.
Chronic Disease↗