共查询到20条相似文献,搜索用时 15 毫秒
1.
Chronic portosystemic encephalopathy (CPSE) is uncommon, and its management has yet to be determined. We have been able to
control five cases of CPSE using transjugular retrograde obliteration (TJO), and we report our clinical results with this
technique. All of the five patients were suffering from cirrhosis and had gastric varices and large gastrorenal shunts. According
to Sherlock's classification, the grade of encephalopathy was II in two patients, III in two, and IV in one. According to
Child's classification, one had class B and four had class C cirrhosis. TJO was performed using a 6-F angiographic catheter
with an occlusive balloon 20 mm in diameter. Absolute ethanol and 5% ethanolamine oleate with iopamidol were used to obliterate
the gastrorenal shunt. The gastrorenal shunt was successfully obliterated, and the encephalopathy improved to grade 0 after
TJO in all cases. The portal flow volume increased significantly from 542 ± 189 to 992 ± 139 mL/min (p < 0.01). The plasma ammonia levels before and after TJO were 189 ± 40 and 51 ± 23 μg/dL, and the indocyanine green retention rates
at 15 min were 44 ± 13% and 27 ± 12%, with both changes being significant (p < 0.01). Minor complications observed were fever of over 38°C and tarry stools due to hemorrhagic gastritis in one patient, which
was being controlled conservatively. One patient died of hepatocellular carcinoma 27 months after TJO. The other four patients
survived without recurrence of CPSE 17–74 months (44 ± 24 months) after TJO. We conclude that TJO can be adopted as a safe
and effective treatment for CPSE. RID=" ID=" <E5>Correspondence to:</E5> F. Chikamori
Received: 27 January 2000/Accepted: 23 February 2000 相似文献
2.
We describe a case of bleeding gastric fundal varices associated with a gastrorenal shunt that were successfully treated with
balloon-occluded retrograde transvenous obliteration. Blood flow in the varices disappeared after treatment. Because of its
safety and simplicity, balloon-occluded retrograde transvenous obliteration appears to be a feasible alternative to transjugular
intrahepatic portosystemic shunt for the treatment of gastric fundal varices.
Received: 18 November 2000/Accepted: 13 December 2000 相似文献
3.
Gastric varices are a major complication of portal hypertension in patients with liver cirrhosis and are associated with more massive bleeding events and higher mortality rate. Transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) have been well documented as effective therapies for portal hypertensive gastric variceal bleeding. In China, TIPS are well accepted but BRTO is not well recieved due to the increase risk of complications associated with traditional BRTO. However, modified-BRTO, known as coil-assisted and plug-assisted retrograde transvenous obliteration (CARTO and PARTO, respectively), is receiving increased attention due to devoid of BRTO’s shortcomings. No CARTO case from China has been reported in literature thus far. Here, we present a Chinese case of CARTO to treat gastric varices bleeding. 相似文献
4.
Purpose: The purpose of this study was to evaluate changes in thrombosis in gastric varices. Material and methods: Fourteen patients were studied who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices with a gastrorenal shunt. The B-RTO catheter was retained overnight in all patients. Balloon-occluded retrograde venography (B-RTV) was performed to evaluate the degree of thrombus formation. This evaluation was done twice during the overnight B-RTO procedure: A few hours after the procedure and on the following day. Investigated were the degree of thrombus formation observed by the first and second B-RTV, change in the degree of thrombus between the first and second B-RTV, and whether and how much sclerosing agent was administered on the second day. Results: The first B-RTV showed entire or partial enhancement of the gastric varix in seven (50%) cases and complete or almost complete lack of enhancement in the remaining seven cases. In four of the former seven cases, the second B-RTV showed entire or partial enhancement of the gastric varix, and the sclerosing agent was added. However, in the remaining ten cases, enhancement was almost or completely lacking. Conclusion: When complete thrombosis is shown on B-RTV obtained a few hours after B-RTO, the addition of a sclerotic agent would be unnecessary. 相似文献
5.
We here present a case involving a complicated type of gastric fundal varices treated by balloon-occluded retrograde transvenous obliteration. A newly developed 1.8-Fr tip coaxial microballoon catheter was successfully advanced into narrow and tortuous varices, and a sclerosant could be infused in a reasonable manner, avoiding reflux into collaterals. Divided injections of sclerosant were performed over two days, via a microballoon catheter that remained inserted overnight with balloon inflation, and the sclerosant could be infused sufficiently in the entirety of the varices. The varices were completely thrombosed and prominently reduced. 相似文献
6.
The type, incidence, and severity of complications of balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices should be precisely estimated. Complications were evaluated in 38 patients who had fundic gastric varices and 43 B-RTO procedures during injection of ethanolamine oleate (phase 1), within 4 h after injection (phase 2), 24 h after injection (phase 3), and from 24 h to 10 days after injection (phase 4). Endoscopic evaluation at 8 weeks showed resolution of gastric varices in 35 of 38 patients (92%) and smaller varices in the remaining three (8%). B-RTO caused transient hypertension in 35% of patients, hemoglobinuria in 49%, and fever in 33% during phases 1, 2, and 3, respectively. Pleural effusion, pulmonary infarction, ascites, gastric ulcers with unique appearance, localized mosaic-like change of gastric mucosa, and hemorrhagic portal hypertensive gastropathy were noted in phase 4. There were no fatalities. Lactate dehydrogenase, aspartate aminotransferase, and bilirubin increased on day 1. Each datum was retrieved within 7 days. The severity of lactate dehydrogenase elevation correlated significantly with the volume of infused ethanolamine oleate. Thus, B-RTO is a safe and effective management of fundic varices. However, short-term hemodynamic change after B-RTO may cause gastric mucosal damage. Pulmonary infarction and pleural effusion are potential complications. 相似文献
7.
正门静脉高压患者中约20%出现胃底静脉曲张(gastricfundal varices,GFV)~([1])。尽管与食管静脉曲张相比,GFV出血发生率较低,但由于其曲张静脉粗大、位置特殊和高血流量,较难通过内镜成功治疗~([2])。此外,GFV具有更高的再出血风险和死亡率~([3])。球囊导管逆行性静脉栓塞术(balloonoccluded retrograde transvenous obliteration, 相似文献
8.
Background: We evaluated the differences in sample adequacy and safety between a transseptal needle and Quick-core biopsy needle for
transjugular liver biopsy.
Methods: Eighteen consecutive patients who had a bleeding diatheses and/or ascites underwent transjugular liver biopsy using a transseptal
needle (11 patients) and Quick-core biopsy needle (seven patients). The length of the specimens was measured before fixation.
A pathologist reviewed histologic slides for sample adequacy and pathologic diagnoses. Clinical records were reviewed for
complication.
Results: In all patients, liver biopsy was successful. A total of 45 specimens were obtained, with an average of 2.5 passes per patient.
The length of specimen was significantly longer with the Quick-core biopsy needle than with the transseptal needle ( p < 0.05). Biopsied tissue was fragmented in 17 of 25 specimens with the transseptal needle but not fragmented in any specimen
with the Quick-core biopsy needle. All specimens were determined to be adequate except one with the transseptal needle. There
was no early or delayed complication in any patient.
Conclusion: Transjugular liver biopsy is a safe and effective procedure without any significant difference in complication and adequacy
when using a transseptal needle or Quick-core biopsy needle. Larger specimens can be obtained without tissue fragmentation
with the Quick-core biopsy needle.
Received: 30 August 1999/Revision accepted: 26 January 2000 相似文献
9.
A 64-year-old man was admitted to our hospital with hematemesis and melena. Six years ago, he had undergone total gastrectomy with Roux-en-Y esophagojejunostomy for gastric cancer. Endoscopic examination revealed varicose veins at the anastomotic sites with cherry-red spots and hemorrhage. Abdominal computed tomography showed that the varices were supplied by a dilated jejunal vein. Transjugular intrahepatic portosystemic shunt (TIPS) and variceal embolization were performed. There were no major complications or episodes of bleeding during the three-month follow-up. We conclude that TIPS in combination with varices obliteration is an effective alternative method for treatment of ruptured esophagojejunal varices after total gastrectomy. 相似文献
10.
The gray-scale ultrasonographic appearances of dilated intrarenal vascular structures may mimic peripelvic cysts or hydronephrosis.
We report a patient with portal hypertension in whom color Doppler ultrasound was found to be a very practical imaging technique
in demonstrating varices of the renal segmental veins.
Received: 14 November 1995/Accepted: 22 December 1995 相似文献
11.
Aims: We evaluated the feasibility, efficacy and safety of a novel technique of balloon-occluded retrograde transvenous obliteration (BRTO) assisted endoscopic Histoacryl (N-buthyl-2-cyanoacrylate) injection. Material and methods: A total with 11 patients were enrolled and analyzed in this single center, open-label, prospective study. Patients with high-risk gastric varices (defined as fundal varices, large GV (>5?mm), presence of a red spot, and Child-Pugh score C) and concurrent gastrorenal shunt underwent endoscopic Histoacryl injection while the gastrorenal shunt was temporarily occluded with an occlusion balloon. Feasibility, hemostatic effect, intra- and postoperative complications, and varices recurrence were evaluated. Results: All procedures were successfully done per protocol. Except for one patient who underwent rescue Histoacryl injection due to residual varices, single therapy was sufficient to eliminate gastric varices in ten patients. Intra-operative hemorrhage occurred in one case and was stopped after additional Histoacryl injection. One patient was confirmed to have treatment-related fungemia. No death or major complications occurred, including ectopic embolism, worsening of hepatic and renal function, etc. No recurrence of the varices was found during a median follow-up time (mean?±?SD) of 228?±?153 days. Conclusions: BRTO assisted endoscopic Histoacryl injection is effective and safe for patients with high-risk gastric varices and concurrent gastrorenal shunt. 相似文献
12.
Background: This study was performed to determine the echo layer structures of the normal gastric wall and early gastric cancer when
visualized with a 30-MHz ultrasonic miniprobe.
Methods: Twelve surgically resected gastric specimens were used for an ex vivo study. Eighteen normal sites and 12 early gastric cancer
sites were scanned with an Olympus (XUM-S30-25R) probe with a frequency of 30-MHz. Endoscopic ultrasound images were compared
with corresponding histopathologic sections stained with hematoxylin and eosin.
Results: The normal mucosa was visualized as at least four alternating echo layers; the muscularis mucosa was delineated at all normal
sites. Lymphoid aggregates within the mucosa could be seen. The submucosa was clearly visualized in most cases, but the muscularis
propria and subserosa were seldom depicted due to attenuation of ultrasound waves. At the sites of gastric cancer, the layered
architecture of the mucosa was disturbed by an irregular hypoechoic lesion. Minimal submucosal infiltration (400 and 750 μm)
was clearly depicted in two cases, without ulceration at or around the tumor site. However, attenuation at the site of a deep
ulcer scar prevented adequate visualization of the tumor extent in two other cases with ulceration.
Conclusion: A 30-MHz ultrasonic miniprobe may provide additional imaging information of the gastric wall and could play a role in the
assessment of early cancer lesions.
Received: 29 January 2002/Accepted: 27 February 2002 相似文献
13.
Transjugular intrahepatic portosystemic shunt (TIPS) placement has been used as a bridge to transplantation in patients with Budd-Chiari syndrome. Stent occlusion is a fairly common but seldom described complication after TIPS placement for Budd-Chiari syndrome. I present a case of a patient with Budd-Chiari who developed vascular channels paralleling an occluded stent. These channels were demonstrated only by power Doppler ultrasound and resulted in an unusual transient hepatic attenuation difference around the stent on computed tomography. 相似文献
14.
Management of isolated gastric varices with a gastropericardiac shunt (GPS) has not yet been established. We were able to
control a case of isolated gastric varices with a GPS by percutaneous transhepatic obliteration (PTO) using a microcatheter.
In this case, the main blood drainage route was not a gastrorenal shunt, so transvenous retrograde obliteration could not
be performed and PTO using the microcatheter was applied. Percutaneous transhepatic splenic venography revealed that the gastric
varices came from the posterior gastric vein and the main drainage route was a GPS. Gastric varices and their blood supply
were superselectively embolized using platinum microcoils and absolute ethanol. Portal venous pressure did not change after
PTO because the route from the left gastric vein to the azygos venous system was preserved. Computed tomography 7 days after
PTO revealed that the gastric varices were completely obliterated by the thrombi. Plasma ammonia level, arterial ketone body
ratio, and indocyanine green retention rate at 15 min were improved. We conclude that PTO using a microcatheter is a rational,
effective, and safe therapy for isolated gastric varices with a GPS. 相似文献
15.
Background: To determine the accuracy of CT in the postchemotherapy assessment of resectability of gastric cancer.
Methods: Thirty patients deemed to have unresectable gastric cancer on CT were studied. This was verified at laparotomy in 10 of these
patients. Following initial assessment, all received three to eight cycles of chemotherapy aiming for disease control and
potential resection. Serial CT examinations, endoscopy, and biopsy were performed after the fourth, sixth, and eighth cycle
of treatment. The primary tumor and lymph nodes seen on CT were compared with operative findings.
Results: After completion of chemotherapy, CT findings were correct in 23 patients. Fourteen of them had operable tumors and nine
were inoperable. However, the CT findings were either equivocal or incorrect in the remaining seven patients.
Conclusion: Chemotherapy is now able to downstage a previously inoperable gastric cancer, and CT is an accurate method in identifying
those patients who can proceed to resection.
Received: 24 October 1994/Accepted after revision: 6 April 1995 相似文献
16.
Extrahepatic portosystemic shunt usually occurs secondary to severe portal hypertension, and it is rare to encounter it in
patients without portal hypertension. We report herein a large extrahepatic portosystemic shunt between the left gastric vein
and left renal vein without portal hypertension in which color Doppler sonography was useful not only for detection but evaluation
of the effect of embolization.
Received: 11 April 1995/Accepted: 26 July 1995 相似文献
17.
Purpose: To evaluate normal retrograde cholangiograms to determine a normal range of ductal calibers and identify its variation with
age.
Materials and methods: The retrograde cholangiograms of 136 patients (age range: 17–84 years; mean age 49.8 years ± 17.3 [standard deviation]) with
clinical follow-up and subsequent studies suggesting normal biliary trees were evaluated. Patients with previous cholecystectomy,
choledocholithiasis, or pancreatitis were excluded. Common bile duct (CBD) and common hepatic duct (CHD) sizes were measured.
Results: Measurements uncorrected for radiographic magnification of CBD revealed a mean of 8.5 mm ± 2.7 mm [standard deviation] and
CHD had a mean of 8.1 mm ± 2.6 mm. There was an increase in CBD caliber by 0.5 mm per decade of increasing age ( p < 0.001) and an increase in CHD caliber by 0.35 mm per decade of age ( p < 0.01).
Conclusion: The range of normal cholangiographic bile duct caliber is wide and a CBD caliber of 13.9 mm occurs at the top of this range
(mean plus two standard deviations). There is a small but statistically significant trend of ductal dilatation with advancing
age.
Received: 13 December 1995/Accepted after revision: 24 April 1996 相似文献
18.
Two cases of small bowel (S-B) varices associated with portal hypertension, one with liver cirrhosis and one with portal
thrombus, are reported. Detection of S-B varices has been a challenging task and several invasive diagnostic techniques have
been used for this purpose. However, in our cases, color Doppler sonography revealed the S-B varices supplied by the superior
mesenteric vein and draining to the iliac (one case) or ovarian vein (other case), which helped to establish an early appropriate
diagnostic and treatment plan.
Received: 19 March 1997/Accepted: 14 May 1997 相似文献
19.
Background: To evaluate clinical usefulness of oral contrast agents (gadopentetate dimeglumine and water) and to assess proper magnetic
resonance (MR) imaging in evaluating advanced gastric cancer (AGC) by comparing different MR imaging techniques.
Methods: Fifteen patients with AGC were imaged with a 1.0-T MR imager and body-array coil. All patients underwent surgery or laparascopic
biopsy. Fast low-angle shot (FLASH), half-Fourier single-shot turbo spin-echo (HASTE), and true fast imaging with steady-state
precession time (FISP) images were obtained after ingestion of 900 mL tap water in each patient, followed by postcontrast
FLASH images after additional ingestion of gadopentetate dimeglumine (Gd-DTPA). Qualitative analysis including T-staging of
AGC and scoring of imaging quality and quantitative analysis were performed prospectively.
Results: In image quality and diagnostic accuracy of T-staging, FLASH imaging showed results slightly superior to those of other imaging
modalities, and there was no great difference between using water and Gd-DTPA as an oral contrast agent. As for cancer-to-gastric
lumen contrast-to-noise ratio (CNR), HASTE and true FISP imaging were superior to FLASH imaging with Gd-DTPA ( p < 0.0001). In cancer-to-pancreas CNR, FLASH imaging without Gd-DTPA showed the best result.
Conclusions: The use of Gd-DTPA as a positive contrast agent may not be imperative, and T1-weighted FLASH imaging in combination with
true FISP imaging with ingestion of tap water can be very useful in evaluating AGC with MR imaging.
Received: 29 October 1998/Revision accepted: 27 January 1999 相似文献
20.
Background: To compare the diagnostic accuracy of magnetic resonance (MR) images obtained with three different pulse sequences for lymph-node
metastases in patients with gastric cancer.
Methods: T1-weighted spin-echo (SE), breath-hold T2-weighted fast SE, and triphasic gadolinium-enhanced dynamic gradient-recall-echo
(GRE) MR images obtained in 16 patients with gastric carcinoma were retrospectively reviewed. Regional lymph nodes were assigned
to four different groups, and image review was conducted on a lymph-node group-by-group basis; 64 lymph-node groups were reviewed
by two radiologists. Relative sensitivity, specificity, and accuracy were determined based on the findings with definitive
surgery and follow-up imaging. Diagnostic accuracy was determined by means of receiver-operating-characteristic (ROC) analysis.
Results: Relative sensitivities for lymph-node metastases with T1-weighted SE, breath-hold T2-weighted fast SE, and dynamic GRE images
were 61%, 94%, and 59%, respectively. Relative sensitivity with breath-hold T2-weighted fast SE images was significantly greater
than that with T1-weighted SE (p < 0.05) and dynamic GRE (p < 0.05) images. Diagnostic accuracy determined by ROC analysis was marginally higher with breath-hold T2-weighted fast SE (area under
ROC curve [Az]= 0.87) than with T1-weighted SE (Az = 0.78, p= 0.08 ) and dynamic GRE (Az = 0.79, p= 0.12 ) images.
Conclusion: Breath-hold T2-weighted fast SE sequence is useful in the detection of regional lymph-node metastases in patients with gastric
carcinoma.
Received: 11 November 1998/Revision accepted: 7 April 1999 相似文献
|