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PubMed1978

[The transjugular approach to the hepatic region for the differential diagnosis of jaundice and exploration of the portal system (author's transl)].

The results obtained in a series of 200 patients, using the transjugular approach to the common bile duct for the differential diagnosis of cholestasis, are presented and discussed. 1. The advantages of the method are: --the simplicity of the technique and the rapidity with which it can be mastered, the negligeable investment required; --the safety in use if the only contra-indication is respected: recent acute infection of the biliary tract; --the possibility of obtaining a cholangiography and a liver needle-biopsy at the same time, even in cases with disorders of the blood. 2. The limitation of the method is the failure to visualize the CBD, which is seen in 30% of cases when the latter is not dilated by an obstruction. 3. The respective indications for either transjugular cholangiography or retrograde catheterization of the papilla can be defined. 4. A preliminary series of 37 explorations of the portal system by the transjugular approach with embolization of bleeding oesophageal varices is reported.

Adult↗
PubMed1990

[Segmentation of the liver and anatomical variants of the portal system].

The authors, who studied 605 human livers according to various techniques, present their own anatomo-surgical conception of human liver segmentation, based on the distribution of the whole intrahepatic Glisson's system, and by dividing the liver into two hemi-livers, right and left (the term "lobe" being reserved, according to Tôn-Thât-Tùng, for the classical anatomical lobes): the right hemi-liver is subdivided into two segments: anterior and posterior; the left hemi-liver is subdivided into three segments: medial (IV), lateral-anterior (III) and lateral-posterior (II); the dorsal segment (I) or the classical Spigel's lobe tends to overlap both half livers (more on the left than on the right). The authors then describe, indicating the percentages, the typical patterns and anatomical variants of intersegmental fissures and the portal system. During the discussion, the authors say that, according to their experience, the right hemi-liver segments can be divided into some smaller units: the posterior segment into two subsegments (VI and VII) and the anterior ones into three subsegments (V, VIIIi and VIIIe); and they justify the segmental division of the left hemi-liver. The authors conclude that statistical and analytical study can define a typical anatomical pattern but that, owing to many anatomical variants, it is easier to perform the transparenchymal approach to the vasculo-biliary structures, enveloped in the same Glisson's capsule, rather than to make long and dangerous dissections at the porta hepatis.

Humans↗
PubMed2001

Portal-systemic myelopathy after transjugular intrahepatic portosystemic shunt creation: report of four cases.

The authors attempted to describe the clinical manifestations of portal-systemic myelopathy (PSM) after transjugular intrahepatic portosystemic shunt (TIPS) creation. PSM was developed in four of 212 (1.89%) patients who underwent TIPS procedures in our hospital. Three men and one woman, ranging in age from 41 to 56 years, with a history of posthepatitis cirrhosis and recurrent bleeding from gastroesophageal varices had intrahepatic shunts created with 10-mm-diameter Wallstents. Shunt patency was confirmed by color Doppler ultrasonography (US) in each patient after TIPS creation. Progressive spastic paraparesis involving the lower extremities occurred between 5 weeks and 5 months after TIPS creation in the four patients. Neurologic examination showed evidence of spasticity in all cases, with ankle clonus, extensor plantar responses, and lower extremity hyperreflexia. All sensory modalities remained intact. Cytologic examination of cerebrospinal fluid from each patient was normal. There was no evidence of spinal cord compression on the imaging studies. PSM is a rare syndrome that includes spastic paraparesis with intact sensation. Initially noted in patients who have undergone surgical placement of a portacaval shunt, it also may occur after TIPS creation.

Adult↗
PubMed1998

L-ornithine-L-aspartate in experimental portal-systemic encephalopathy: therapeutic efficacy and mechanism of action.

Strategies aimed at the lowering of blood ammonia remain the treatment of choice in portal-systemic encephalopathy (PSE). L-ornithine-L-aspartate (OA) has recently been shown to be effective in the prevention of ammonia-precipitated coma in humans with PSE. These findings prompted the study of mechanisms of the protective effect of OA in portacaval-shunted rats in which reversible coma was precipitated by ammonium acetate administration (3.85 mmol/kg i.p.). OA infusions (300 mg/kg/h, i.v) offered complete protection in 12/12 animals compared to 0/12 saline-infused controls. This protective effect was accompanied by significant reductions of blood ammonia, concomitant increases of urea production and significant increases in blood and cerebrospinal fluid (CSF) glutamate and glutamine. Increased CSF concentrations of leucine and alanine also accompanied the protective effect of OA. These findings demonstrate the therapeutic efficacy of OA in the prevention of ammonia-precipitated coma in portacaval-shunted rats and suggest that this protective effect is both peripherally-mediated (increased urea and glutamine synthesis) and centrally-mediated (increased glutamine synthesis).

Ammonia↗
PubMed1998

Proton magnetic resonance spectroscopy in portal-systemic encephalopathy.

Localized proton magnetic resonance spectroscopy (MRS) with short echo times provides unique information of human cerebral metabolism. Studies on patients with portal-systemic encephalopathy (PSE) have been performed to clarify the pathogenesis of this disease and to find a method which allows an objective diagnosis. Spectra of patients with PSE show typical abnormalities. Regional variations of these spectral changes are observed. The metabolic changes correlate with the grade of encephalopathy but the dependence on the Child-Pugh score is controversial. No causal dependence between MRS findings and abnormalities in magnetic resonance imaging is evident. Differences in magnetic resonance spectra in patients compared to controls vanish after liver transplantation, but increase after TIPS. The results of proton magnetic resonance spectroscopy are important for an understanding of the pathogenesis of PSE, but do not aid in the diagnosis of subclinical hepatic encephalopathy.

Brain↗