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51.
Treatment of Stomal Variceal Hemorrhage with TIPS: Case Report and Review of the Literature 总被引:4,自引:0,他引:4
Ryu RK Nemcek AA Chrisman HB Saker MB Blei A Omary RA Vogelzang RL 《Cardiovascular and interventional radiology》2000,23(4):301-303
We report a case in which recurrent hemorrhage from stomal varices was successfully treated by placement of a TIPS in a patient
with prior colectomy for inflammatory bowel disease. Although several treatment options have been reported for this entity
we believe that TIPS offers minimally invasive and definitive treatment. 相似文献
52.
Fulminant hepatic failure (FHF) remains a rare but devastating disease. Viruses and drug-induced hepatotoxicity are the most
common causes of the syndrome, but the relevance of each differs depending on the geographic area. In a large proportion of
patients no cause for FHF can be identified. Good intensive care is critical for patient survival. Orthotopic liver transplantation
(OLT) remains a definitive therapeutic option. Prognostic indices have helped to optimize patient selection and timing for
performance of OLT. However, the accuracy of these prognostic indices decreases when they are applied to different populations,
probably because of regional differences in etiology and peculiar native host factors. More accurate prognostic criteria and
new therapeutic alternatives to OLT are required. 相似文献
53.
Vaquero J Polson J Chung C Helenowski I Schiodt FV Reisch J Lee WM Blei AT 《Gastroenterology》2003,125(3):755-764
BACKGROUND & AIMS: Progression of hepatic encephalopathy (HE) is a major determinant of outcome in acute liver failure (ALF). Our aim was to identify predictive factors of worsening HE, including the relation of encephalopathy with the systemic inflammatory response (SIRS) and infection. METHODS: We included 227 consecutive patients with stage I-II HE prospectively enrolled in the U.S. Acute Liver Failure Study. Univariate and multivariate analysis of 27 variables at admission were performed separately for acetaminophen (n = 96) and nonacetaminophen (n = 131) etiologies. RESULTS: On multivariate analysis, acquisition of infection during stage I-II HE (P < 0.01), increased leukocyte levels at admission (P < 0.01), and decreased platelet count (P < 0.05) were predictive factors of worsening HE in the acetaminophen group. By contrast, only increased pulse rate (P < 0.05) and AST levels (P < 0.05) at admission were predictors in nonacetaminophen patients. In patients who progressed to deep HE, the first confirmed infection preceded progression in 15 of 19 acetaminophen patients compared with 12 of 23 nonacetaminophen patients. In patients who did not demonstrate positive microbiologic cultures, a higher number of components of SIRS at admission was associated with more frequent worsening of HE (25% vs. 35% vs. 50% for 0, 1, and >or=2 components of SIRS, P < 0.05). CONCLUSIONA: This prospective evaluation points to infection and/or the resulting systemic inflammatory response as important factors contributing to worsening HE in ALF, mainly in patients with acetaminophen- induced ALF. The use of prophylactic antibiotics in these patients and the mechanisms by which infection triggers hepatic encephalopathy require further investigation. 相似文献
54.
Protein C deficiency in splanchnic venous thrombosis 总被引:1,自引:0,他引:1
Deficiencies of protein C activity and antigen were observed in eight consecutive patients with splanchnic venous thrombosis. There was a significant reduction in the ratio of protein C to factor X. Six of the eight patients had a decrease in antithrombin III, but free protein S antigen was within normal limits in all but two subjects. It is proposed that a thrombogenic stimulus such as stasis, altered hormonal milieu, or failure of hepatic clearance of activated coagulants results in consumption of protein C and antithrombin III, predisposing to splanchnic venous occlusion. This further impairs hepatic function, prevents restitution of protein C and antithrombin levels, and promotes continuing venous thrombosis. Thus, a vicious cycle of thrombosis and hepatic damage is perpetuated. 相似文献
55.
Cerebral edema and intracranial hypertension in acute liver failure: distinct aspects of the same problem 总被引:2,自引:0,他引:2
A T Blei 《Hepatology (Baltimore, Md.)》1991,13(2):376-379
56.
Michelle Levi Shirah Schwartz Francine Blei Emily Ceisler Mark Steele Louis Furlan Arthur Millman Sylvia R Kodsi 《Journal of AAPOS》2007,11(3):230-234
BACKGROUND: Capillary hemangiomas of the eyelids and orbit can cause refractive and occlusive amblyopia. Although oral and intralesional steroid injections are the most common treatment modalities, sometimes they are not successful. There is a paucity of information in the literature on the success of eliminating amblyogenic factors by treating these lesions with surgical resection. METHODS: Retrospective chart review of 10 patients in two pediatric ophthalmology practices who underwent surgical excision of a capillary hemangioma that was causing amblyopia and that had failed to regress with other treatment. RESULTS: Two patients had surgery secondary to pupillary occlusion, which was successful in relieving occlusion. Eight patients had surgery secondary to significant astigmatism. The average preoperative astigmatic difference between the affected and unaffected eye in five of these patients undergoing surgery before the age of 21 months was 2.15 D. The average postoperative astigmatic difference was 0.1 D. The average preoperative astigmatic difference between the affected and unaffected eye in three patients undergoing surgery after 21 months of age was 1.6 D. Surgery completely failed to reduce the astigmatism in two of these patients. The third patient had a decrease of 0.75 D of cylinder but still had a difference of 1.75 D between the two eyes postoperatively. Postoperative complications in this study included wound infection in one patient. CONCLUSIONS: Surgical excision of capillary hemangiomas that were resistant to other modes of treatment was useful in relieving pupillary occlusion and in decreasing the amount of astigmatism if performed before the age of 21 months in our series of patients. Our cases as well as the literature suggest that surgery should be performed at 13 months or earlier to reduce the amount of astigmatism. 相似文献
57.
Lipoblastomas are rare benign tumors of infancy that usually affect children younger than 3 years. Most lipoblastomas (70%) occur on the extremities. Lipoblastomas may mimic other infantile tumors, including hemangiomas, hibernomas, lipomas, and liposarcomas, and correct diagnosis is necessary to ensure appropriate treatment. Lipoblastomas fall under 2 discrete subtypes: well-circumscribed lipoblastomas and diffuse lipoblastomatosis. Both types present with firm, nontender masses of lobulated, well-circumscribed soft tissue. Histologically they can be highly vascularized with plexiform capillaries, often with an individual feeder artery to each lobule. Complete surgical removal is the recommended treatment. Only 2 cases of lipoblastomas of the cheek have been reported in the English-language literature. We present the case of a young child with a cheek lipoblastoma, emphasizing the importance of correct diagnosis and highlighting techniques used to provide suitable treatment. 相似文献
58.
59.
60.
Thirteen patients with suspected extrathyroidal neck masses were investigated with the combination of fluorescent scanning and echography. Iodine content, the solid or cystic consistency of the lesion, and the position of the lesion with respect to the thyroid were determined preoperatively to estimate thyroidal origin and benignity or malignancy of the lesions. Pathologic diagnoses correlated well with these totally noninvasive studies of extrathyroidal neck masses. 相似文献