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Portal hypertension

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https://www.readbyqxmd.com/read/28730648/calcineurin-inhibitor-withdrawal-or-tapering-for-kidney-transplant-recipients
#1
REVIEW
Krishna M Karpe, Girish S Talaulikar, Giles D Walters
BACKGROUND: Calcineurin inhibitors (CNI) can reduce acute transplant rejection and immediate graft loss but are associated with significant adverse effects such as hypertension and nephrotoxicity which may contribute to chronic rejection. CNI toxicity has led to numerous studies investigating CNI withdrawal and tapering strategies. Despite this, uncertainty remains about minimisation or withdrawal of CNI. OBJECTIVES: This review aimed to look at the benefits and harms of CNI tapering or withdrawal in terms of graft function and loss, incidence of acute rejection episodes, treatment-related side effects (hypertension, hyperlipidaemia) and death...
July 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28729141/effects-of-transjugular-intrahepatic-portosystemic-shunt-tips-on-blood-volume-distribution-in-patients-with-cirrhosis
#2
Troels M Busk, Flemming Bendtsen, Jens H Henriksen, Stefan Fuglsang, Jens O Clemmesen, Fin S Larsen, Søren Møller
BACKGROUND: Cirrhosis is accompanied by portal hypertension with splanchnic and systemic arterial vasodilation, and central hypovolaemia. A transjugular intrahepatic portosystemic shunt (TIPS) alleviates portal hypertension, but also causes major haemodynamic changes. AIMS: To investigate effects of TIPS on regional blood volume distribution, and systemic haemodynamics. METHODS: Thirteen cirrhotic patients had their regional blood volume distribution determined with gamma-camera technique before and after TIPS...
June 27, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28723777/short-outcome-comparison-of-elderly-patients-versus-nonelderly-patients-treated-with-transjugular-intrahepatic-portosystemic-stent-shunt-a-propensity-score-matched-cohort-study
#3
Yang Li, Fengyan Wang, Xiaomei Chen, Bin Li, Wei Meng, Chengyong Qin
A transjugular intrahepatic portosystemic stent shunt (TIPSS) has been widely used to treat portal hypertension and its complications. However, no established guidelines mentioned whether age was a risk factor for the treatment of TIPSS.The aim is to determine whether age is a risk factor for poor outcomes following TIPSS.The retrospective cohort study included 134 patients who received TIPSS treatment from 2003 to 2016. The adverse events after the TIPSS treatment were compared after propensity score matching to reduce the effect of selection bias...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28721347/peliosis-hepatis-complicating-pregnancy-a-rare-entity
#4
Muhammad Osama Butt, Nasir Hassan Luck, Syed Mujahid Hassan, Zaigham Abbas, Muhammed Mubarak
Peliosis hepatis (PH) is a rare, benign condition of the liver characterized by the presence of blood-filled lacunar spaces in the parenchyma. It usually has a chronic presentation and is a rare cause of portal hypertension reported in adult patients. Its etiology is diverse and ranges from infectious agents to tumors to toxic substances and anabolic steroids; however, the cause remains unclear in 25-50% of patients. Similarly, the symptomatology and imaging findings are diverse. Biopsy is the definitive test to diagnose the condition...
June 2017: Journal of Translational Internal Medicine
https://www.readbyqxmd.com/read/28717870/laparoscopic-liver-resections-for-hepatocellular-carcinoma-can-we-extend-the-surgical-indication-in-cirrhotic-patients
#5
Federica Cipriani, Corrado Fantini, Francesca Ratti, Roberto Lauro, Hadrien Tranchart, Mark Halls, Vincenzo Scuderi, Leonid Barkhatov, Bjorn Edwin, Roberto I Troisi, Ibrahim Dagher, Paolo Reggiani, Giulio Belli, Luca Aldrighetti, Mohammad Abu Hilal
BACKGROUND: Evidence on the value of laparoscopic liver resections (LLR) for hepatocellular carcinoma (HCC) and severe cirrhosis is still lacking. The aim of this study is to assess surgical and oncological outcomes of LLR in cirrhotic HCC patients. METHODS: The analysis included 403 LLR for HCC from seven European centres. 333 cirrhotic and 70 non-cirrhotic patients were compared. A matched comparison was performed between 100 Child-Pugh A and 25 Child-Pugh B patients...
July 17, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28715896/use-of-abdominal-ultrasound-in-the-diagnosis-of-hepatic-sinusoidal-obstruction-syndrome-sos-in-a-patient-receiving-a-hematopoietic-cell-transplant
#6
Marta Abadía Barnó, Eva Marín Serrano, Gloria Ruiz Fernández
The sinusoidal obstruction syndrome (SOS) is an uncommon form of portal hypertension that occurs in hematopoietic-cell transplant recipients who receive intense conditioning treatments. The diagnosis is clinical and it is usually delayed, because in these patients there are many causes that can damage the liver and can delay its detection. We present the case of a 47-year-old man, whose diagnosis was made with clinical and analytical data supported by ultrasound signs that showed hepatic congestion. After treatment with defibrotide the patient improved clinically and analytically...
July 18, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28712920/amelioration-of-cirrhotic-portal-hypertension-by-targeted-cyclooxygenase-1-sirna-delivery-to-liver-sinusoidal-endothelium-with-polyethylenimine-grafted-hyaluronic-acid
#7
Liteng Lin, Mingyue Cai, Shaohui Deng, Wensou Huang, Jingjun Huang, Xinghua Huang, Mingsheng Huang, Yong Wang, Xintao Shuai, Kangshun Zhu
Portal hypertension (PH), a leading cause of mortality in cirrhosis, lacks effective clinical therapeutic strategies. The increased thromboxane A2 (TXA2), derived primarily from the upregulation of cyclooxygenase-1 (COX-1) in cirrhotic liver sinusoidal endothelial cells (LSECs), is responsible for hepatic endothelial dysfunction and PH. Thus, blocking the COX-1 pathway in cirrhotic LSECs may benefit the treatment of PH. In this study, hyaluronate-graft-polyethylenimine (HA-PEI) was synthesized for the targeted delivery of COX-1 siRNA to LSECs...
July 13, 2017: Nanomedicine: Nanotechnology, Biology, and Medicine
https://www.readbyqxmd.com/read/28712738/a-technology-supported-collaboration-between-a-health-plan-and-a-community-pharmacy-to-improve-blood-pressure-control
#8
Caitlin K Frail, Susan Cooper, Tim Gallagher, Josh Sarkis, Laura Topor, Richard J Bruzek
OBJECTIVES: To assess the impact of a health plan and community pharmacy partnership to improve blood pressure control. SETTING: A midwestern health plan and a regional community pharmacy chain. PRACTICE INNOVATION: Health plan members with a hypertension diagnosis and attributed to the pharmacy chain based on prescription claims were invited to participate. Interested patients enrolled in the program at their pharmacies and were assigned a "smart card" for use with a blood pressure kiosk in the pharmacy...
July 14, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28711320/liver-stiffness-measurement-by-transient-elastography-predicts-late-posthepatectomy-outcomes-in-patients-undergoing-resection-for-hepatocellular-carcinoma
#9
Muthukumarassamy Rajakannu, Daniel Cherqui, Oriana Ciacio, Nicolas Golse, Gabriella Pittau, Marc Antoine Allard, Teresa Maria Antonini, Audrey Coilly, Antonio Sa Cunha, Denis Castaing, Didier Samuel, Catherine Guettier, René Adam, Eric Vibert
BACKGROUND: Postoperative hepatic decompensation is a serious complication of liver resection in patients undergoing hepatectomy for hepatocellular carcinoma. Liver fibrosis and clinical significant portal hypertension are well-known risk factors for hepatic decompensation. Liver stiffness measurement is a noninvasive method of evaluating hepatic venous pressure gradient and functional hepatic reserve by estimating hepatic fibrosis. Effectiveness of liver stiffness measurement in predicting persistent postoperative hepatic decompensation has not been investigated...
July 12, 2017: Surgery
https://www.readbyqxmd.com/read/28704189/chronic-hepatitis-due-to-gluten-enteropathy-a-case-report
#10
Irina I Ivanova, Denitsa Y Dukova, Pavlina G Boikova, Lili S Grudeva, Ivan B Shalev, Iskren A Kotzev
BACKGROUND: Celiac disease is an immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals. CASE DESCRIPTION: A 45-year-old Caucasian woman presented with severe iron-deficient anemia and mild elevation of liver enzymes. Upper endoscopy was done in the context of evaluation of anemia, which revealed reduced duodenal folds and mosaic pattern of the mucosa, but also grade II esophageal varices and portal hypertensive gastropathy...
June 1, 2017: Folia Medica
https://www.readbyqxmd.com/read/28702738/impact-of-etiological-treatment-on-prognosis
#11
REVIEW
Chien-Wei Su, Ying-Ying Yang, Han-Chieh Lin
Portal hypertension (PHT) is a frequent and severe complication of cirrhosis. PHT may lead to the development of various complications with high mortality. Liver transplantation is the gold standard as a surgical curative treatment for end-stage liver disease. Theoretically, etiological treatment focusing on the pathophysiology of the underlying disease should be the objective of the nonsurgical management of cirrhotic PHT. Chronic viral hepatitis is the major etiology of cirrhosis and PHT. In cirrhotic patients with chronic hepatitis B virus infection, antiviral therapies can suppress viral replication, ameliorate hepatic inflammation, regress fibrosis, and restore liver functional reserve...
July 12, 2017: Hepatology International
https://www.readbyqxmd.com/read/28698986/novelties-in-the-pathophysiology-and-management-of-portal-hypertension-new-treatments-on-the-horizon
#12
REVIEW
Seong Hee Kang, Moon Young Kim, Soon Koo Baik
Portal hypertension (PH) is responsible for the most severe complications of cirrhosis and leading cause of death and liver transplantation. The standard pharmacological treatment available for PH currently consists of the use of a non-selective beta-blocker. However, a significant proportion of patients do not respond to pharmacological treatment. This has led to the development of identifiable targets for the discovery of new horizons in PH treatment. Recently, there has been significant progress in understanding the mechanism behind PH, which is a product of increased hepatic vascular resistance including structural changes and functional change due to endothelial dysfunction...
July 11, 2017: Hepatology International
https://www.readbyqxmd.com/read/28698881/assessment-of-haemodynamic-response-to-nonselective-beta-blockers-in-portal-hypertension-by-phase-contrast-magnetic-resonance-angiography
#13
Natasha McDonald, David M L Lilburn, Neil J Lachlan, Gillian Macnaught, Dilip Patel, Arjun N A Jayaswal, Peter C Hayes, Scott I Semple, Jonathan A Fallowfield
A significant unmet need exists for accurate, reproducible, noninvasive diagnostic tools to assess and monitor portal hypertension (PHT). We report the first use of quantitative MRI markers for the haemodynamic assessment of nonselective beta-blockers (NSBB) in PHT. In a randomized parallel feasibility study in 22 adult patients with PHT and a clinical indication for NSBB, we acquired haemodynamic data at baseline and after 4 weeks of NSBB (propranolol or carvedilol) using phase-contrast MR angiography (PC-MRA) in selected intra-abdominal vessels...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28698169/effectiveness-of-digital-medicines-to-improve-clinical-outcomes-in-patients-with-uncontrolled-hypertension-and-type-2-diabetes-prospective-open-label-cluster-randomized-pilot-clinical-trial
#14
Juan Frias, Naunihal Virdi, Praveen Raja, Yoona Kim, George Savage, Lars Osterberg
BACKGROUND: Hypertension and type 2 diabetes mellitus are major modifiable risk factors for cardiac, cerebrovascular, and kidney diseases. Reasons for poor disease control include nonadherence, lack of patient engagement, and therapeutic inertia. OBJECTIVE: The aim of this study was to assess the impact on clinic-measured blood pressure (BP) and glycated hemoglobin (HbA1c) using a digital medicine offering (DMO) that measures medication ingestion adherence, physical activity, and rest using digital medicines (medication taken with ingestible sensor), wearable sensor patches, and a mobile device app...
July 11, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28694570/extrahepatic-portal-vein-obstruction-in-children-role-of-preoperative-imaging
#15
Shashidhar Achar, Hemonta Kumar Dutta, Rudra Kanta Gogoi
AIM: Extrahepatic portal vein obstruction (EHPVO) is characterized by features of recent thrombosis or portal hypertension with portal cavernoma as a sequel of portal vein obstruction. Imaging of spleno-portal axis is the mainstay for the diagnosis of EHPVO. The aim of this study is to analyze the role of imaging in the preoperative assessment of the portal venous system in children with EHPVO. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted on twenty children with EHPVO aged between 1 and 18 years over a period of 1 year...
July 2017: Journal of Indian Association of Pediatric Surgeons
https://www.readbyqxmd.com/read/28691048/feasibility-of-transnasal-endoscopy-in-screening-for-esophageal-and-gastric-varices-in-patients-with-chronic-liver-disease
#16
Anderson Antônio de Faria, Carlos Alberto Freitas Dias, Luciana Dias Moetzsohn, Silas de Castro Carvalho, Tereza Abreu Ferrari, Vitor Nunes Arantes
BACKGROUND AND STUDY AIMS:  Screening for esophageal and gastric varices is indicated for patients with portal hypertension or cirrhosis. Typically, conventional endoscopy is used; however, the need for sedation increases the costs and risks, especially in cirrhotic patients. Use of transnasal endoscopy with an ultrathin endoscope enables study of the upper gastrointestinal tract without the need for sedation. The objective of this study is to evaluate the feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease...
July 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28690995/pediatric-vascular-surgery-review-with-a-30-year-experience-in-a-tertiary-referral-center
#17
REVIEW
Seung-Kee Min, Sungsin Cho, Hyun-Young Kim, Sang Joon Kim
Pediatric vascular disease is rare, and remains a big challenge to vascular surgeons. In contrast to adults, surgery for pediatric vascular disease is complicated by issues related to small size, future growth, and availability of suitable vascular conduit. During the last 30 years, 131 major vascular operations were performed in a tertiary referral center, Seoul National University Hospital, including aortoiliac aneurysm, acute or chronic arterial occlusion, renovascular hypertension, portal venous hypertension, trauma, tumor invasion to major abdominal vessels, and others...
June 2017: Vascular Specialist International
https://www.readbyqxmd.com/read/28689488/modified-laparoscopic-pyloroplasty-during-laparoscopic-splenectomy-and-azygoportal-disconnection-for-the-prevention-of-postoperative-gastroparesis
#18
Guoqing Jiang, Dousheng Bai, Jianjun Qian, Ping Chen, Shengjie Jin
BACKGROUND: Gastroparesis is a common complication after splenectomy and azygoportal disconnection, remaining a chronic debilitating disorder with considerable treatment challenges. To minimize postoperative gastroparesis, we have developed a new modified laparoscopic pyloroplasty (LP) technique for use during laparoscopic splenectomy and azygoportal disconnection (LSD). METHODS: We retrospectively evaluated the outcomes of 31 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent synchronous LSD with modified LP (n = 14) or LSD without modified LP (n = 17) between January 2015 and August 2015...
August 2017: Surgical Innovation
https://www.readbyqxmd.com/read/28685316/-liver-biopsy-in-children-and-adolescents-preliminary-morphological-examinations-in-diffuse-liver-disease
#19
REVIEW
C Lackner, A S Knisely
BACKGROUND: Frequencies of types of liver disease differ between adults and nonadults (NA). OBJECTIVES: The particular problems encountered in interpreting liver-biopsy findings in NA often require referral in consultation.  To permit this efficiently, we recommend specific approaches to light microscopy, with special stains and immunohistochemistry, as well as to ultrastructural study. METHODS: Prosection and the choice of special stains are described, and are discussed in relation to clinical questions...
July 2017: Der Pathologe
https://www.readbyqxmd.com/read/28685257/budd-chiari-syndrome-hepatic-venous-outflow-tract-obstruction
#20
REVIEW
Dominique-Charles Valla
BACKGROUND: Budd-Chiari syndrome (BCS) is a rare disease characterized by hepatic venous outflow tract obstruction (HVOTO). METHODS: Recent literature has been analyzed for this narrative review. RESULTS: Primary BCS/HVOTO is a result of thrombosis. The same patient often has multiple risk factors for venous thrombosis and most have at least one. Presentation and etiology may differ between Western and certain Eastern countries. Myeloproliferative neoplasms are present in 40% of patients and are usually associated with the V617F-JAK2 mutation in myeloid cells, in particular peripheral blood granulocytes...
July 6, 2017: Hepatology International
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