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Heung Bae Kim James J Pomposelli Craig W Lillehei Roger L Jenkins Maureen M Jonas Laura E Krawczuk Steven J Fishman 《Liver transplantation》2005,11(11):1389-1394
Extrahepatic portal vein thrombosis (EHPVT) may occur in children or adults and usually comes to clinical attention due to complications of portal hypertension such as variceal hemorrhage. A variety of standard surgical techniques exist to manage these patients, but when these fail surgical options are limited. We describe two novel portosystemic shunts that utilize the gonadal vein as an autologous conduit. Four patients were evaluated for EHPVT with variceal bleeding. None of the patients were candidates for a standard splenorenal shunt due to prior surgical procedures. The first patient underwent a left mesogonadal shunt and the remaining 3 patients underwent a right mesogonadal shunt. Postoperative ultrasound or computed tomography (CT) scan confirmed early patency of the shunt in each patient. There have been no further episodes of variceal hemorrhage with follow-up of 3.5 years in the child who underwent the left mesogonadal shunt, and 17, 19, and 20 months in the patients who underwent the right mesogonadal shunt. Three of the 4 shunts remain patent. One shunt thrombosis occurred in a patient homozygous for the Factor V Leiden mutation despite anticoagulation with coumadin. This is the first report of the successful use of the gonadal vein as an in situ conduit for constructing a portosystemic shunt. In conclusion, the right and left mesogonadal shunts may be useful as salvage operations for patients with EHPVT who have failed standard surgical shunt procedures. 相似文献
6.
Can carotid endarterectomy be justified? No 总被引:1,自引:0,他引:1
S Jonas 《Archives of neurology》1987,44(6):652-654
7.
Kamil Torres Anna Torres Grzegorz J. Staśkiewicz Andrzej Chrościcki Tadeusz Łoś Ryszard Maciejewski 《Surgical endoscopy》2009,23(9):2117-2123
Background Surgical procedures enhance production of pro- and anti-inflammatory cytokines and angiogenic factors that play a pivotal
role in the immunological response to surgical trauma and take part in the pathogenesis of tumor growth and adhesions formation.
The purpose of the study was to access the influence of low-pressure CO2 pneumoperitoneum on the inflammatory and angiogenic responses during the postoperative period after laparoscopy.
Methods The study group consisted of 40 patients, operated on due to cholelithiasis using standard-pressure (n = 20) and low-pressure (n = 20) CO2 pneumoperitoneum. Serum concentration of interleukin (IL)-6, IL-8, IL-10, vascular endothelial growth factor (VEGF)-A, and
endostatin were measured before and at 6, 24, and 48 h after surgery with commercially available enzyme-linked immunosorbent
assay (ELISA).
Results Concentrations of IL-6 increased significantly after the operations in both groups. No differences were observed between the
groups in regards to IL-6, IL-8, and IL-10 levels. Concentrations of VEGF-A measured at 6 and 48 h were significantly lower
in patients who underwent laparoscopies performed with low-pressure pneumoperitoneum. No significant variations were observed
in endostatin serum concentration. Concentrations of the studied parameters were not influenced by duration of surgery or
by age, gender, or body mass index (BMI) of the patients.
Conclusions The results obtained in our study do not show any significant differences between studied operative procedures with regards
to systemic inflammatory response. Changes in the concentrations of VEGF-A and endostatin observed in the studied population
may suggest this technique is more favorable with regards to angiogenesis process intensity, along with all its consequences
and implications. 相似文献
8.
Michael Hermansson Anders Ekedahl Jonas Ranstam Thomas Zilling 《BMC gastroenterology》2009,9(1):25-13
Background
Despite a decreasing incidence of peptic ulcer disease, most previous studies report a stabile incidence of ulcer complications. We wanted to investigate the incidence of peptic ulcer complications in Sweden before and after the introduction of the proton pump inhibitors (PPI) in 1988 and compare these data to the sales of non-steroid anti-inflammatory drugs (NSAID) and acetylsalicylic acid (ASA). 相似文献9.
10.
Stereological evaluation of liver volume in living donor liver transplantation using MDCT via the Cavalieri method. 总被引:4,自引:0,他引:4
Cihan Duran Bulent Aydinli Yaman Tokat Yildiray Yuzer Mecit Kantarci Metin Akgun Kamil Yalcin Polat Bünyami Unal Refik Killi S Selcuk Atamanalp 《Liver transplantation》2007,13(5):693-698
In living donor liver transplantation (LDLT), obtaining the precise volume of the graft is very important to decrease volume-related postoperative complications, especially in cases with suspected small-for size grafts. We used stereology based on the Cavalieri method (CM), a new method to measure liver graft volume, and compared the results with those obtained through intraoperative measurement (IOM) and through multidetector computed tomography (MDCT) measurement. Liver volumes estimated using the 3 methods were well-correlated with each other (r(2) = 0.94 and P < 0.001 for IOM and CM; r(2) = 0.91 and P < 0.001 for IOM and MDCT, and r(2) = 0.95 and P < 0.001 for CM and MDCT); however, they were different from each other (in descending order, 908 +/- 124 cm(2), 861 +/- 121 cm(2), and 777 +/- 168 cm(2) for MDCT, CM, and IOM, respectively). Although MDCT and CM overestimated the volumes, the results of CM were almost similar to those obtained via IOM. In conclusion, our results suggest that CM measured the liver graft volume more reliably. Thus, its use, particularly in cases with suspected small-for-size graft, may prove useful. 相似文献