Circulatory actions of vasopressin in anaesthetized rats with portal hypertension subjected to haemorrhage

To assess the influence of vasopressin on splanchnic and renal circulatory changes induced by haemorrhage in portal hypertension, we studied 4 groups of 7 rats with chronic portal vein stenosis. Two groups received saline (C and H) and two groups vasopressin, 0.01 IU/kg/min (VP and VP-H). Ten minutes after starting drug infusion, group H and VP-H animals were allowed to bleed from the superior mesenteric vein. Both haemorrhage and vasopressin alone, decreased portal venous tributary blood flow and pressure but their association was not additive (as reflected by comparable bleeding rate in groups H and VP-H). By contrast, vasopressin increased renal perfusion in bleeding and non-bleeding animals whereas haemorrhage alone decreased renal perfusion. These results indicate that the effects of vasopressin on the splanchnic circulation in bleeding anaesthetized animals differ from the effects observed when blood volume is normal. Therefore, in patients with cirrhosis the effects of vasopressin during bleeding might also differ from those observed in patients in stable condition.     

Gastric pneumatosis and portal venous gas in superior mesenteric artery syndrome.

Superior mesenteric artery (SMA) syndrome is a condition where compression of the duodenum between the root of the SMA and the aorta results in intermittent obstruction of the third part of duodenum. Portal venous gas associated with nonischemic bowel is uncommon. We report an 81-year-old man who developed gastric pneumatosis and hepatoportal venous gas due to SMA syndrome, which healed without any sequelae.     

经TIPSS途径门静脉及肠系膜上静脉血栓溶栓治疗

目的 评价经TIPSS途径门静脉及肠系膜上静脉血栓溶栓治疗的安全性和效果。方法 对6例诊断为PV和SMV广泛血栓形成患者进行了经颈静脉途径经肝穿刺门静脉(简称TIPSS途径)介入溶栓治疗。患者主要症状有腹痛、腹胀、厌食等。腹部体检有压痛，均无明确腹肌紧张和反跳痛。B超、增强CT检查和直接PV-SMV造影确诊为本病。溶栓方法：穿刺PV分支成功后插入导管做PV-SMV造影，确定诊断及了解栓塞范围，抽吸及捣碎血栓，间断将尿激酶经多侧孔导管注入PV和SMV清除大部分血栓后，保留多侧孔导管至SMV内持续溶栓3天-13天。术后药物抗凝治疗6个月左右，此间，密切监测出凝血时间及影象学血变化。结果 介入治疗后，大部分血栓被清除，PV和SMV有血流通过，腹痛、腹胀和腹泻症状逐步缓解。经留置于SMV的导管造影显示PV和SMV主干及主要分支血流通畅，3例门静脉肝内少数分支有残留血栓，但无明显症状。随访4个月至3年，除1例死于外科手术并发症外，其余5例健在、无血栓复发证据及上消化道出血发生。结论 经TIPSS途径介入技术溶栓治疗，是治疗急性PV和SMV血栓形成的安全、具有良好的近期及中远期疗效的方法。     

门脉高压症导致的异位静脉曲张

静脉曲张发生在食管胃结合部以外，称之为异位或迷走静脉曲张，其发生率约30％。这些异位静脉曲张主要位于消化道，在腹膜后、腹壁、胆道、阴道及膀胱处也有报道，发生率较低。异位曲张静脉破裂导致的出血占门脉高压性出血的5％左右，是引起消化道出血的少见原因，报道的多为个案病例，目前经验有限。     

儿童肝外型门脉高压症

儿童门脉高压症较为少见 ,由于其病因复杂 ,临床表现特殊 ,容易误诊漏诊。肝外门静脉阻塞是儿童门脉高压症的重要原因 ,现将本院近 10年来所见 4例报告如下。临床资料本组 4例中男 3例 ,女 1例 ,平均年龄 3岁 ,病程自 1个月～ 6年。主要临床表现为反复发作的呕血和 (或 )黑便 ,轻～中度脾肿大。外周血象呈全血细胞减少 ,肝功能试验正常 ,乙型、丙型肝炎病毒标志物均阴性。血清铜蓝蛋白及角膜Ｋ -Ｆ环阴性。Ｘ线钡餐和 (或 )胃镜检查均见食管静脉曲张。Ｂ超显示肝外门静脉增粗 ,其内可见不规则回声光团。本组 4例均诊断为肝外型门脉高压症 ,…     

Effects on growth after portal hypertension induced in young rats

BACKGROUND: Physical growth retardation in children with hypertension portal was observed regardless of schistosomiasis. It has been suggested that the shunt of portal blood through portosystemic collateral vessels would result in metabolic consequences that would lead to the physical growth deficit observed. AIM: Study the effects of hypertension portal in the growth of young rats. METHODS: The growth of 20 young rats, divided in the groups hypertension portal, n = 10, 103 +/- 3.7 g and sham operation n = 10, 102.6 +/- 3.4 g was evaluated throughout 5 weeks and the following parameters were under observation: quality of diet offered, diet ingestion, weight increase and urinary creatinine within 24 hours. At the end of the experiment, blood was taken for biochemical tests, prothrombin time and hematocrit and hypertension portal was measured. RESULTS/CONCLUSIONS: Rats with hypertension portal induced at early stages of their lives present growth delay in the first week after surgery recovering their growth rhythm in the next weeks, catching up with the sham animals. Differences related to urinary creatinine excretion, biochemical tests and hematocrit were not observed. Such results are evidence against the hypothesis that the hypertension portal induced in early stages of rats lives would cause delay in their growth.     

Posterior mediastinal venous masses in patients with portal hypertension.

Of 304 consecutive splenic venograms performed for suspected portal hypertension, oesophageal collateral veins were filled in 145. In seven patients massively dilated paraoesophageal collaterals were visible on the plain chest radiograph as a retrocardiac posterior mediastinal mass. Erect and supine radiographs have been compared in four patients, and the Valsalva and Mueller manoeuvres performed in one patient. The size of the masses was unchanged by these procedures, which were therefore of no value in differential diagnosis. The mass was still present immediately after portocaval anastomosis in one patient, but in another is no longer seen on radiographs taken seven years postoperatively. All seven patients also had submucosal oesophageal varices and therefore the barium swallow remains the most useful study to clarify the nature of a retrocardiac mass. Correct identification of pseudotumoural venous collaterals may avoid unnecessary further investigation.     

丹参、心得安对门静脉高压症大鼠门静脉压力和胃肠激素的影响

目的:观察丹参、心得安对门脉高压症大鼠门静脉压力、胃肠激素的影响.方法:采用CCl4加酒精饮料制作大鼠门脉高压模型,造模4周后分别给大鼠服用丹参、心得安,造模结束后用Medlab-Ug4Cs生物信号采集处理系统检测正常组、模型组、丹参治疗组、心得安治疗组大鼠门静脉压力.处死大鼠后颈动脉取血,用放免法检测4组大鼠血浆胃肠激素(胃动素、胃泌素、胰高血糖素)的含量.结果:模型组大鼠门静脉压力较正常组明显升高(P＜0.01),丹参治疗组、心得安治疗组大鼠门脉压力较模型组明显下降(P＜0.01),丹参治疗组大鼠门脉压力与心得安治疗组比较差异无显著性意义(P＞0.05).心得安组大鼠与模型组比较胃动素含量无明显改善(P＞0.05),而胃泌素、胰高血糖素明显下降(P＜0.05).丹参治疗组大鼠胃泌素、胃动素、胰高血糖素含量与模型组比较明显下降(P＜0.01或P＜0.05),与心得安治疗组比较,胃动素、胰高血糖素指标下降明显(P＜0.05).结论:丹参能有效降低门脉高压症大鼠门静脉压力,调节胃肠激素,疗效优于心得安治疗组.其作用机制可能与其良好的抗肝纤维化、阻止肝硬化形成、调节胃肠激素水平、改善肝功能等作用有关.     

Impaired mesenteric leukocyte recruitment in experimental portal hypertension in the rat.

Increased incidence of septic complications in human and experimental portal hypertension has been documented. Because development of an inflammatory response is essential in defense against infectious agents, the aim of this study was to assess leukocyte-endothelial cell interactions in an experimental model of portal hypertension. Intravital microscopy studies showed that under baseline conditions, leukocyte rolling, adhesion, and emigration in mesenteric venules were similar in control, sham operated (SO), and partial portal vein ligated (PPVL) rats. Compared with either control or SO rats, PPVL animals exhibited a markedly reduced recruitment of rolling, adherent, and emigrated leukocytes in response to leukotriene B(4) (LTB(4)) stimulation. Similarly, platelet-activating factor (PAF) superfusion, which induced a large increment in leukocyte rolling and adherence in control and SO rats, was without any effect in PPVL animals. Endothelial P-selectin expression in control rats, as measured by the double radio-labeled monoclonal antibody (mAb) technique, was not modified by LTB(4), but significantly increased in response to PAF. PPVL rats had a significantly lower expression of P-selectin after stimulation with PAF. Neutrophils isolated from PPVL rats exhibited increased L-selectin shedding and CD11b up-regulation in response to PAF and LTB(4), compared with neutrophils isolated from SO rats. These observations indicate that portal hypertension is associated with a defective inflammatory response, which is manifested as a decreased recruitment of rolling leukocytes, and subsequently reduced adhesion/emigration. This defect appears to result from a reduced endothelial P-selectin up-regulation and increased L-selectin shedding.     

Splenic venous hemodynamics in portal hypertension]

The percentage of splenic blood in portal venous flow (SV%) was measured in 96 patients by using scintiphotosplenoportography and angiography. The patients were divided into two groups: Group 1, without collateral pathways from the splenic vein; Group 2, with collateral pathways from the splenic vein. SV% was significantly lower in patients without liver diseases or in patients of Group 1 with liver cirrhosis (LC). SV% was significantly higher in patients with idiopathic portal hypertension (IPH). A significant correlation was observed between SV% and splenic volume or ICGR15. No significant correlation of SV% was found with etiology of LC in patients of Group 1, esophagogastric varices, Child's criteria, portal venous pressure, cholinesterase, hepaplastin test or prothrombin time. Hence, the local hyperdynamic state of the splenic region was detected in patients with CH, LC and IPH.     

Extrahepatic aneurysm of the portal venous system and portal hypertension

Portal venous aneurysm (PVA) is a rare condition characterized by dilatation of the portal venous system. PVA manifestation of symptoms is varied and depends on the aneurysm size, location and related-complications, such as thrombosis. While the majority of reported cases of PVA are attributed to portal hypertension, very little is known about the condition’s pathophysiology and clinical management remains a challenge. Here, we describe a 67-year-old woman who presented with complaint of dyspepsia and without a significant medical history, for whom PVA was incidentally diagnosed. The initial upper abdominal ultrasound revealed marked dilatation of the main portal vein, and subsequent contrast-enhanced computed tomography with angiography revealed a large aneurysm arising from the extrahepatic troncus portion of the portal vein, as well as gastroesophageal varices. A conservative approach using beta-blocker therapy was chosen. The patient was followed-up for 60 mo, during which time the asymptomatic status was unaltered and the PVA remained stable.