1,102 results match your criteria Portal-Systemic Encephalopathy


Early TIPS failure in association with left mesenterico-gonadal spontaneous portosystemic venous shunt; a case report.

Clin Imaging 2019 Jan - Feb;53:200-203. Epub 2018 Oct 27.

Department of Radiology, University of Kentucky Chandler Medical Center, Lexington, KY, United States of America. Electronic address:

Transjugular intrahepatic portosystemic shunt (TIPS) periprocedural thrombosis rates have fallen significantly since the introduction of polytetrafluoroethylene-covered stent grafts. We present a case of a cirrhotic patient with portal hypertension presenting with early TIPS thrombosis in association with an underlying competing spontaneous left mesenterico-gonadal venous shunt, an uncommon variant of spontaneous portal systemic shunt (SPSS). The patient presented with bleeding distal duodenal varices refractory to endovascular therapy, and although a successful TIPS procedure was performed for this indication, early thrombosis was determined by follow-up abdominopelvic computed tomographic angiography (CTA) scan. Read More

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October 2018
3 Reads

NADPH oxidase 1/4 inhibition attenuates the portal hypertensive syndrome via modulation of mesenteric angiogenesis and arterial hyporeactivity in rats.

Clin Res Hepatol Gastroenterol 2018 Nov 6. Epub 2018 Nov 6.

Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, PR China. Electronic address:

Aim: NADPH oxidase (NOX)-derived reactive oxygen species (ROS) plays key roles in the development of portal hypertension (PHT) and represents a potential therapeutic method. The objective of this study was to investigate whether pharmacological inhibition of NADPH oxidase activity could ameliorate PHT in rats.

Method: PHT model was established by partial portal vein ligation (PPVL). Read More

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November 2018
7 Reads

Pulmonary Arterial Pressure Management Based on Oral Medicine for Pediatric Living Donor Liver Transplant With Portopulmonary Hypertension.

Transplant Proc 2018 Nov 15;50(9):2614-2618. Epub 2018 Mar 15.

Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.

Pediatric living donor liver transplantation (LDLT) in patients with advanced portopulmonary hypertension (PoPH) is associated with poor prognoses. Recently, novel oral medications, including endothelin receptor antagonists (ERAs), phosphodiesterase 5 (PDE5) inhibitors, and oral prostacyclin (PGI2) have been used to treat PoPH. Pediatric patients with PoPH who underwent LDLT from 2006 to 2016 were enrolled. Read More

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November 2018
2 Reads

Method for Calculating the Bending Angle of Puncture Needle in Preoperative Planning for Transjugular Intrahepatic Portal Systemic Shunt (TIPS).

Comput Math Methods Med 2018 30;2018:4534579. Epub 2018 May 30.

Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China.

Transjugular Intrahepatic Portal Systemic Shunt is a comprehensive interventional therapy for portal hypertension. During this intervention, puncturing from hepatic vein into portal vein is a difficult step. Selecting puncture needle with a proper bending angle is vital to accurate puncture. Read More

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November 2018
9 Reads

Refractory Hepatic Hydrothorax: A Rare Complication of Systemic Sclerosis and Presinusoidal Portal Hypertension.

Case Reports Hepatol 2018 30;2018:2704949. Epub 2018 Apr 30.

Department of Pathology, Greenville Health System, University of South Carolina School of Medicine Greenville, Greenville, SC, USA.

We report on a rare case of refractory hepatic hydrothorax in an individual with Scleroderma/CREST syndrome and noncirrhotic portal hypertension. Portal pressure measurements revealed a normal transjugular hepatic venous portal pressure gradient, mild pulmonary hypertension, and an unremarkable liver biopsy except for mild sinusoidal dilation. Pulmonary hypertension, cardiac diastolic dysfunction, and chronic kidney disease were determined to be the causes of his refractory pleural effusions and ascites. Read More

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April 2018
3 Reads

Management of Hepatic Encephalopathy Not Responsive to First-Line Treatments.

Curr Treat Options Gastroenterol 2018 Jun;16(2):253-259

Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.

Purpose Of Review: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that occurs in up to 30% of patients with cirrhosis. HE may be a consequence of pure liver failure, as in patients with fulminant hepatitis, or of the combination of liver failure and portal-systemic shunting, as in patients with liver cirrhosis. Episodes of HE are usually related to precipitating events, such as infections or gastrointestinal bleeding; a minority of cirrhotic patients experienced a chronic HE, refractory to standard medical treatment. Read More

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June 2018
2 Reads

Hepatic encephalopathy: Diagnosis and management.

Authors:
Piero Amodio

Liver Int 2018 Jun 24;38(6):966-975. Epub 2018 Apr 24.

Department of Medicine -DIMED- and CIRMANMEC, University of Padova, Padova, Italy.

Hepatic encephalopathy (HE) is a peculiar kind of brain dysfunction caused by liver insufficiency and/or portal-systemic shunting. It is related to gut-derived substances. It is a relevant cause of morbidity and hospitalisation for patients with cirrhosis. Read More

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June 2018
2 Reads

Portal-systemic Encephalopathy due to Complicated Spleno-renal Shunt Successfully Treated with Balloon-occluded Retrograde Transvenous Obliteration Using a Double Coaxial Balloon Catheter System and Shape-memory Coils.

Intern Med 2018 Jul 28;57(13):1861-1866. Epub 2018 Feb 28.

Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Japan.

A 70-year-old woman with hepatitis C cirrhosis underwent balloon-occluded retrograde transvenous obliteration for hepatic encephalopathy due to spleno-renal shunt. Because the shunt was thick, long, and winding, we used a coaxial and double interruption system, which enables the effective occlusion of the drainage route, and shape-memory coils, which are more physically stable than conventional metallic coils because they form three-dimensional loops. The patient was successfully treated with the combined usage of these devices, resulting in a normal serum ammonia level. Read More

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July 2018
2 Reads

[Application of degree of portal systemic shunting in assessing upper gastrointestinal bleeding in patients with schistosomiasis cirrhosis].

Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2017 Mar;29(3):286-289

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, China.

Objective: To discuss the application of the degree of portal systemic shunting in assessing the upper gastrointestinal bleeding in patients with hepatic schistosomiasis.

Methods: Thirty-three patients with upper gastrointestinal bleeding caused by hepatic schistosomiasis (a bleeding group) and 29 schistosomiasis cirrhosis patients without bleeding (a non-bleeding group) were enrolled as investigation subjects in Jinshan Hospital. The subjects were scanned by the 128 abdominal slice spiral CT. Read More

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March 2017
4 Reads

Effect of sirolimus on liver cirrhosis and hepatic encephalopathy of common bile duct-ligated rats.

Eur J Pharmacol 2018 Apr 11;824:133-139. Epub 2018 Feb 11.

Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.

Cirrhosis is often associated with portal hypertension and portal-systemic collateral vessels formation attributed to angiogenesis, which leads to severe complications as hepatic encephalopathy. Sirolimus has anti-fibrosis and anti-angiogenesis effects, but whether it influences the severity of portal-systemic collaterals and hepatic encephalopathy is unknown. This study was thus designed to address this issue in rats with common bile duct ligation-induced liver cirrhosis. Read More

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April 2018
1 Read
2.530 Impact Factor

[Non-cirrhotic Portal-systemic Encephalopathy with Total Aphasia and Right Hemiplegia Following Transient Right Hemiparesis: A Case Report].

Brain Nerve 2018 Feb;70(2):155-159

Department of Neurology, Imari Arita Kyoritsu Hospital.

A 77-year-old right-handed woman without any liver diseases was admitted to our hospital because of transient right hemiparesis. She developed total aphasia with right hemiplegia on the third hospital day. We suspected that she had a cerebral infarction following a transient ischemic attack. Read More

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February 2018

Spontaneous Intrahepatic Portal Systemic Venous Shunt: It Can Happen!

Clin Gastroenterol Hepatol 2018 Nov 21;16(11):e113. Epub 2018 Mar 21.

Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas.

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November 2018
3 Reads
7.900 Impact Factor

Disabling portosystemic encephalopathy in a non-cirrhotic patient: Successful endovascular treatment of a giant inferior mesenteric-caval shunt the left internal iliac vein.

World J Gastroenterol 2017 Dec;23(47):8426-8431

Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy.

Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. Read More

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December 2017
11 Reads

Lactulose: A Simple Sugar in a Complex Encephalopathy.

Neurocrit Care 2018 Apr;28(2):154-156

Division of Critical Care Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

Hepatic encephalopathy is a common encephalopathy and one of the very few that are treatable. Lactulose has remained a standard pharmaceutical intervention and is listed as one of the World Health Organization's Essential Medicines. The discovery of lactulose, the acid dialysis proof of concept, and the role of Bircher are not well known. Read More

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April 2018
4 Reads

Efficacy and safety of rifaximin in Japanese patients with hepatic encephalopathy: A phase II/III, multicenter, randomized, evaluator-blinded, active-controlled trial and a phase III, multicenter, open trial.

Hepatol Res 2018 May 19;48(6):411-423. Epub 2018 Jan 19.

Shunan Memorial Hospital/Yamaguchi University, Yamaguchi, Japan.

Aim: The efficacy and safety of rifaximin in the treatment of hepatic encephalopathy (HE) are widely known, but they have not been confirmed in Japanese patients with HE. Thus, two prospective, randomized studies (a phase II/III study and a phase III study) were carried out.

Methods: Subjects with grade I or II HE and hyperammonemia were enrolled. Read More

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May 2018
20 Reads

[Portal-systemic encephalopathy with bilateral thalamic and internal capsule lesions using diffusion-weighted MRI in a super-aged patient].

Rinsho Shinkeigaku 2017 Dec 28;57(12):759-763. Epub 2017 Nov 28.

Department of Neurology, Nanpuh Hospital.

We describe the case of a 90-year-old woman who was hospitalized in July 2016 and subsequently experienced a sudden decline in consciousness level resulting in a state of deep coma. Involuntary movements were not observed, and bilateral Babinski signs were inconclusive. Diffusion-weighted MRI (DWI) of the brain showed bilateral hyperintensity in the thalamus and internal capsule, laboratory testing detected high levels of plasma ammonia, and an electroencephalogram showed delta waves and triphasic waves predominantly in the frontal lobe. Read More

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December 2017
5 Reads

'All that glitters is not gold': when hyperammonaemia is not from hepatic aetiology.

BMJ Case Rep 2017 May 22;2017. Epub 2017 May 22.

Internal Medicine, Wayne State University, Detroit, Michigan, USA.

Hyperammonaemia is often caused by decompensated liver disease. However, non-hepatic causes can sometimes result in hyperammonaemia, severe enough to cause symptoms.We report a case of a 65-year-old man with a history of hypertension and bilateral peripelvic renal cyst who presented with acute confusion. Read More

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May 2017
18 Reads

Branched-chain amino acids for people with hepatic encephalopathy.

Cochrane Database Syst Rev 2017 05 18;5:CD001939. Epub 2017 May 18.

Department of Hepatology and Gastroenterology, Aarhus Kommunehospital, Nørrebrogade 44, Aarhus C, Denmark, DK-8000.

Background: Hepatic encephalopathy is a brain dysfunction with neurological and psychiatric changes associated with liver insufficiency or portal-systemic shunting. The severity ranges from minor symptoms to coma. A Cochrane systematic review including 11 randomised clinical trials on branched-chain amino acids (BCAA) versus control interventions has evaluated if BCAA may benefit people with hepatic encephalopathy. Read More

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May 2017
12 Reads

Hemodiafiltration for hepatic encephalopathy induced by Budd-Chiari syndrome in a patient with end-stage kidney disease.

CEN Case Rep 2016 Nov 11;5(2):125-130. Epub 2015 Dec 11.

Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan.

A 36-year-old woman who was undergoing dialysis for end-stage kidney disease (ESKD) was admitted to our hospital with consciousness disorder. She was diagnosed with Budd-Chiari syndrome due to antiphospholipid syndrome at the age of 28 years. Her kidney function and leg edema gradually deteriorated. Read More

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November 2016
22 Reads

Recommendation of Repeated Ammonia Tests for Intrahepatic Portal-Systemic Shunt Without Cirrhosis in Elderly Patients With Psychiatric Symptoms.

Jpn Clin Med 2017 16;8:1179066017693597. Epub 2017 Mar 16.

Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.

We report an elderly male patient with hyperammonemia induced by intrahepatic portal-systemic shunt without cirrhosis (IPSSwoC). The occasional emergence of his erratic behaviors was misdiagnosed as a psychiatric disorder. Regardless of his uneven symptoms, IPSSwoC was suspected due to his hyperammonemia. Read More

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March 2017
7 Reads

Is a liver biopsy necessary to diagnose hemodialysis-related portal-systemic encephalopathy (HRPSE)? A proposal of the concise diagnostic criteria for HRPSE.

Clin Exp Nephrol 2018 02 8;22(1):203-205. Epub 2017 Apr 8.

Division of Nephrology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan.

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February 2018
4 Reads

Effects of raloxifene on portal hypertension and hepatic encephalopathy in cirrhotic rats.

Eur J Pharmacol 2017 May 24;802:36-43. Epub 2017 Feb 24.

Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Cheng-Hsin General Hospital, Taipei, Taiwan.

Raloxifene, a selective estrogen receptor modulator, has been used extensively for osteoporosis. In addition to the effect of osteoporosis treatment, emerging evidences show that raloxifene affects the vascular function in different tissues. Cirrhosis is characterized with portal hypertension and complicated with hepatic encephalopathy. Read More

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May 2017
30 Reads

Reduction of manganese intake improves neuropsychological manifestations in rats with minimal hepatic encephalopathy.

Neuroscience 2017 04 11;347:148-155. Epub 2017 Feb 11.

Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, China.

Brain manganese deposition is led by liver dysfunction and/or portal-systemic shunting in minimal hepatic encephalopathy (MHE). Manganese is toxic and can cause cognitive disorders and extrapyramidal symptoms. Thus, reduction of manganese intake might be considered as a potential treatment strategy for MHE. Read More

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April 2017
5 Reads

Portal systemic shunt between the hepatic portal vein and right renal vein in a patient with multifocal hepatocellular carcinoma: Case report.

J Clin Ultrasound 2017 Oct 2;45(8):524-527. Epub 2017 Feb 2.

Division of Clinical Immunology, Pulmonology, and Rheumatology, Department of Internal Medicine, "Sestre milosrdnice" University Hospital Center, Medical and Dental Faculty, University of Zagreb, Zagreb 10000, Vinogradska 29, Croatia.

Portal hypertension is a clinical syndrome characterized by the development of collateral circulation and portosystemic shunts, as well as ascites and hepatic encephalopathy. We present the case of a large portosystemic shunt between the hepatic portal vein and aneurysmal right renal vein in a cirrhotic 64-year-old man with thrombosis of the portal vein and hepatocellular carcinoma. This is a very rare clinical manifestation which, to our knowledge, has been described only once previously in the literature. Read More

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October 2017
7 Reads

[A Case of Advanced Gastric Cancer with Portosystemic Shunt Successfully Treated with Percutaneous Transvenous Coil Embolization].

Gan To Kagaku Ryoho 2016 Nov;43(12):1917-1919

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences.

A 57-year-old man with advanced gastric cancer and multiple liver metastases was referred to our hospital. He underwent a palliative gastrectomy to treat hemorrhage, and S-1 and cisplatin therapy was administered. After 7 courses of chemotherapy, a new liver metastatic lesion and a tumor thrombus in the right portal vein appeared. Read More

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November 2016
5 Reads

Roux-en-Y gastric bypass increases systemic but not portal bile acid concentrations by decreasing hepatic bile acid uptake in minipigs.

Int J Obes (Lond) 2017 04 17;41(4):664-668. Epub 2017 Jan 17.

CHU Lille, Lille, France.

Roux-en-Y gastric bypass (RYGB) surgery is widely used in the management of morbid obesity. RYGB improves metabolism independently of weight loss by still unknown mechanisms. Bile acids (BAs) are good candidates to explain this benefit, since they regulate metabolic homeostasis and their systemic concentrations increase upon RYGB. Read More

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Magnetic Resonance Spectroscopy for Evaluating Portal-Systemic Encephalopathy in Patients with Chronic Hepatic Schistosomiasis Japonicum.

PLoS Negl Trop Dis 2016 12 15;10(12):e0005232. Epub 2016 Dec 15.

Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China.

Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Owing to lack of detectable evidence of intrinsic liver disease, chronic HSJ patients with PSE are frequently clinically undetected or misdiagnosed, especially chronic HSJ patients with covert PSE (subclinical encephalopathy). Read More

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December 2016
5 Reads

Homocysteine deteriorates intrahepatic derangement and portal-systemic collaterals in cirrhotic rats.

Clin Sci (Lond) 2017 01 1;131(1):69-86. Epub 2016 Nov 1.

Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.

In liver cirrhosis, the altered levels of vasoactive substances, especially endothelin-1 (ET-1) and nitric oxide (NO) lead to elevated intrahepatic resistance, increased portal-systemic collaterals and abnormal intra- and extra-hepatic vascular responsiveness. These derangements aggravate portal hypertension-related complications such as gastro-oesophageal variceal bleeding. Homocysteine, a substance implicated in cardiovascular diseases, has been found with influences on vasoresponsiveness and angiogenesis. Read More

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January 2017
11 Reads

Intracranial hemorrhage induced uncontrolled seizure in a deceased donor liver transplant patient: a case report.

Korean J Anesthesiol 2016 Oct 25;69(5):527-531. Epub 2016 Jul 25.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

Seizure is the second most common neurologic complication after liver transplantation and may be caused by metabolic abnormalities, electrolyte imbalance, infection, and immunosuppressant toxicity. A 61-year-old male patient underwent liver transplantation due to hepatitis B virus-related liver cirrhosis with portal systemic encephalopathy. The immediate postoperative course of the patient was uncomplicated. Read More

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October 2016
7 Reads

[A Case of Hyperammonemia Caused by Urinary Tract Infection Due to Urease-Producing Bacteria].

Hinyokika Kiyo 2016 Aug;62(8):421-5

The Department of Urology, Nishi-Kobe Medical Center.

We present here a rare case of hyperammonemia without liver dysfunction or portal-systemic shunting. The patient was an 80-year-old woman with a history of neurogenic bladder. She was admitted to a nearby hospital for vomiting, diarrhea and consciousness disturbance. Read More

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August 2016
20 Reads

Hepatic encephalopathy in patients with non-cirrhotic portal hypertension: Description, prevalence and risk factors.

Dig Liver Dis 2016 Sep 30;48(9):1072-7. Epub 2016 Jun 30.

Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy. Electronic address:

Background: Hepatic encephalopathy (HE) is a common complication of cirrhosis but it is less studied in patients with non-cirrhotic portal hypertension (NCPH).

Aims: To describe the prevalence of cognitive impairment (overt and covert HE) in NCPH patients and to identify the risk factors for its development.

Methods: 51 patients with NCPH, 35 with chronic portal vein thrombosis (PVT) and 16 with idiopathic non-cirrhotic portal hypertension (INCPH), were evaluated for the presence of previous or present overt HE (OHE). Read More

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September 2016
13 Reads

Sildenafil Treatment Eliminates Pruritogenesis and Thermal Hyperalgesia in Rats with Portacaval Shunts.

Neurochem Res 2017 Mar 20;42(3):788-794. Epub 2016 Jun 20.

Laboratory of Neurobiology, Centro de Investigación Príncipe Felipe, Eduardo Primo Yufera, 3, 46012, Valencia, Spain.

Pruritus is a common symptom in chronic liver diseases, which may also alter thermal sensitivity. The underlying mechanisms remain unclear and treatments are not satisfactory. Portal-systemic shunting has been proposed to alter thermal sensitivity in cirrhotics. Read More

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March 2017
3 Reads

Re: Fetal umbilical-portal-systemic venous shunt: in-utero classification and clinical significance. R. Achiron and Z. Kivilevitch. Ultrasound Obstet Gynecol 2016; 47: 739-747.

Authors:
C Berg B Strizek

Ultrasound Obstet Gynecol 2016 06;47(6):672-3

Division of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.

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Angiogenesis and portal-systemic collaterals in portal hypertension.

Ann Hepatol 2016 May-Jun;15(3):303-13

Division of Gastroenterology, Hepatology & Nutrition, Department of Paediatrics, University of Toronto, and The Hospital for Sick Children, Toronto, Canada.

In patients with advanced liver disease with portal hypertension, portal-systemic collaterals contribute to circulatory disturbance, gastrointestinal hemorrhage, hepatic encephalopathy, ascites, hepatopulmonary syndrome and portopulmonary hypertension. Angiogenesis has a pivotal role in the formation of portal-systemic shunts. Recent research has defined many of the mediators and mechanisms involved in this angiogenic process, linking the central roles of hepatic stellate cells and endothelial cells. Read More

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January 2017
3 Reads

Hepatocellular Carcinoma within Milan Criteria: No-Touch Multibipolar Radiofrequency Ablation for Treatment-Long-term Results.

Radiology 2016 08 24;280(2):611-21. Epub 2016 Mar 24.

From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.).

Purpose To assess the long-term outcome in 108 consecutive patients treated with no-touch multibipolar radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) that met the Milan criteria. Materials and Methods This retrospective study was approved by the ethical review board, and the need to obtain informed consent was waived. Between November 1, 2006, and December 31, 2011, 132 HCC tumors (diameter, 10-45 mm; 39 tumors ≥ 30 mm) in 108 consecutive patients (106 with cirrhosis) that met Milan criteria were treated with no-touch multibipolar RFA, which consisted of activating, in bipolar mode, three or four electrodes inserted just beyond the tumor margins. Read More

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August 2016
24 Reads
6.870 Impact Factor

2'-Hydroxyflavanone ameliorates mesenteric angiogenesis and portal-systemic collaterals in rats with liver fibrosis.

J Gastroenterol Hepatol 2016 May;31(5):1045-51

Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.

Background And Aim: Portal-systemic collaterals lead to dreadful consequences in patients with cirrhosis. Angiogenesis participates in the development of liver fibrosis, hyperdynamic circulation, and portal-systemic collaterals. 2'-Hydroxyflavanone (2'-HF), one of the citrus fruits flavonoids, is known to have antiangiogenesis effect without adverse response. Read More

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May 2016
2 Reads

Qualifying and quantifying minimal hepatic encephalopathy.

Metab Brain Dis 2016 12 28;31(6):1217-1229. Epub 2015 Sep 28.

Department of Neurology, Hannover Medical School, 30623, Hannover, Germany.

Minimal hepatic encephalopathy is the term applied to the neuropsychiatric status of patients with cirrhosis who are unimpaired on clinical examination but show alterations in neuropsychological tests exploring psychomotor speed/executive function and/or in neurophysiological variables. There is no gold standard for the diagnosis of this syndrome. As these patients have, by definition, no recognizable clinical features of brain dysfunction, the primary prerequisite for the diagnosis is careful exclusion of clinical symptoms and signs. Read More

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December 2016
1 Read

Branched-chain amino acids for people with hepatic encephalopathy.

Cochrane Database Syst Rev 2015 Sep 17(9):CD001939. Epub 2015 Sep 17.

Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Kettegaards Alle, Hvidovre, Denmark, 2650.

Background: Hepatic encephalopathy is a brain dysfunction with neurological and psychiatric changes associated with liver insufficiency or portal-systemic shunting. The severity ranges from minor symptoms to coma. A Cochrane systematic review including 11 randomised clinical trials on branched-chain amino acids (BCAA) versus control interventions has evaluated if BCAA may benefit people with hepatic encephalopathy. Read More

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September 2015
1 Read

Contrast enhanced computed tomography and reconstruction of hepatic vascular system for transjugular intrahepatic portal systemic shunt puncture path planning.

World J Gastroenterol 2015 Aug;21(32):9623-9

Jian-Ping Qin, Shan-Hong Tang, Ming-De Jiang, Hong-Bin Chen, Xin Yao, Wei-Zheng Zeng, Department of Digestion, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.

Aim: To describe a method for the transjugular intrahepatic portal systemic shunt (TIPS) placement performed with the aid of contrast-enhanced computed tomography (CECT) and three-dimensional reconstructed vascular images (3D RVIs), and to assess its safety and effectiveness.

Methods: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein (PV) prior to the operation. Read More

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August 2015
13 Reads

Establishment of a hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol.

World J Gastroenterol 2015 Aug;21(32):9544-53

Lei Wang, Fu-Liang He, Fu-Quan Liu, Zhen-Dong Yue, Hong-Wei Zhao, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.

Aim: To determine the feasibility and safety of establishing a porcine hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol.

Methods: Twenty-one healthy Guizhou miniature pigs were randomly divided into three experimental groups and three control groups. The pigs in the three experimental groups were subjected to hepatic arterial perfusion with 7, 12 and 17 mL of 80% alcohol, respectively, while those in the three control groups underwent hepatic arterial perfusion with 7, 12 and 17 mL of saline, respectively. Read More

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August 2015
1 Read

The Impact of Spironolactone on the Severity of Portal-Systemic Collaterals and Hepatic Encephalopathy in Cirrhotic Rats.

J Pharmacol Exp Ther 2015 Oct 10;355(1):117-24. Epub 2015 Aug 10.

Faculty of Medicine (S.-J.H., S.-S.W., F.-Y.L., H.-C.H., C.-C.C., I-F.H., H.-C.L., S.-D.L.) and Institute of Pharmacology (S.-J.H., T.-I.H., I-F.H., H.-L.H.), School of Medicine, National Yang-Ming University; Division of Gastroenterology (S.-J.H., T.-I.H., F.-Y.L., H.-C.H., H.-L.H., H.-C.L.) and General Medicine, Department of Medicine (C.-C.C.), Endoscopy Center for Diagnosis and Treatment (I-F.H.), and Department of Medical Affairs and Planning (S.-S.W.), Taipei Veterans General Hospital; and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital (S.-D.L.), Taipei, Taiwan.

Liver cirrhosis and portal hypertension are accompanied by portal-systemic collaterals formation and lethal complications. Angiogenesis participates in the development of collaterals. Spironolactone is an aldosterone receptor antagonist used to control fluid overload in cirrhotic patients although recent studies suggest that it also inhibits angiogenesis. Read More

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October 2015
11 Reads

Pathophysiology and a Rational Basis of Therapy.

Dig Dis 2015 6;33(4):508-14. Epub 2015 Jul 6.

Barcelona Hepatic Hemodynamic Laboratory, IDIBAPS, Hospital Clinic de Barcelona, CIBEREHD, Barcelona, Spain.

Portal hypertension is a common complication of chronic liver disease. Its relevance comes from the fact that it determines most complications leading to death or liver transplantation in patients with cirrhosis of the liver: bleeding from esophageal or gastric varices, ascites and renal dysfunction, sepsis and hepatic encephalopathy. Portal hypertension results from increased resistance to portal blood flow through the cirrhotic liver. Read More

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April 2016
6 Reads

Clinical neurophysiology of hepatic encephalopathy.

J Clin Exp Hepatol 2015 Mar 3;5(Suppl 1):S60-8. Epub 2014 Aug 3.

Department of Medicine, DIMED, University of Padova, Italy.

Background/objectives: Hepatic encephalopathy (HE) has relevant impact on the quality of life of patients and their caregivers and causes relevant costs because of hospitalizations and work days lost. Its quantification is important to perform adequate clinical trials on this relevant complication of cirrhosis and portal-systemic shunting. Clinical neurophysiology, which detects functional alterations of the nervous system, has been applied to the study of HE for over 60 years. Read More

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March 2015
1 Read

Hepatic encephalopathy: historical remarks.

Authors:
Piero Amodio

J Clin Exp Hepatol 2015 Mar 16;5(Suppl 1):S4-6. Epub 2014 Dec 16.

Department of Medicine, DIMED, University of Padua, Italy.

The history of hepatic encephalopathy (HE) is briefly reviewed since the beginning of western medicine by Hippocrates. For about 2000 years the main evidence was the mere association between jaundice, fever and delirium. A clear link between delirium and cirrhosis was proven in the 17th century by Morgagni. Read More

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March 2015
1 Read

Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review.

Intern Med 2015 1;54(11):1375-80. Epub 2015 Jun 1.

Department of Nephrology, Tokyo Medical and Dental University, Japan.

The onset of hyperammonemia due to the flow of ammonia-rich portal vein blood through a portal-systemic shunt causes a type of encephalopathy known as chronic portal-systemic shunt encephalopathy (CPSE). We herein report two cases of CPSE that presented with opposite changes in the blood ammonia concentrations during hemodialysis. It is curious that the encephalopathy was ameliorated by hemodialysis in case 1, but not case 2. Read More

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January 2016
3 Reads

Fetal umbilical-portal-systemic venous shunt: in-utero classification and clinical significance.

Ultrasound Obstet Gynecol 2016 Jun;47(6):739-47

Maccabi Health Services, Ultrasound Unit, Negev Medical Center, Be'er Sheva, Israel.

Objectives: To review our experience with fetal umbilical-portal-systemic venous shunts (UPSVS), to devise an in-utero classification system, and to analyze their clinical and prognostic characteristics.

Methods: This was a retrospective review of cases of UPSVS examined at an academic tertiary referral center over the 14-year period from 2001 to 2014 inclusive. The anatomical origin and drainage of the fetal umbilical, portal, ductus venosus and hepatic venous systems, and the integrity of the intrahepatic portal venous system (IHPVS), were assessed using two- and three-dimensional color Doppler sonography. Read More

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Current concepts in minimal hepatic encephalopathy.

Rev Med Chir Soc Med Nat Iasi 2015 Jan-Mar;119(1):9-17

Minimal hepatic encephalopathy (MHE) defines the presence of neurocognitive impairments in patients with cirrhosis or portal-systemic shunting that show a normal neurologic and psychiatric status on clinical examination. Although ammonia has the central role in MHE pathogenesis, factors such as infection, oxidative stress, manganese or intestinal bacterial overgrowth contribute to the development of the neurocognitive deficits associated with this disease. Many methods have proven useful in identifying MHE but because of the major drawbacks (standardization requirements, high price, sophisticated equipment, and limited access) a gold-standard test is still missing. Read More

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June 2015
1 Read

Randomized trials of endoscopic therapy and transjugular intrahepatic portosystemic shunt versus portacaval shunt for emergency and elective treatment of bleeding gastric varices in cirrhosis.

Surgery 2015 Jun;157(6):1028-45

Department of Surgery, University of California, San Diego Medical Center, San Diego, CA.

Importance: Bleeding esophageal varices has been studied extensively, but bleeding gastric varices (BGV) has received much less investigation. However, BGV has been reported in ≤ 30% of patients with acute variceal bleeding. In our studies of 1,836 bleeding cirrhotics, 12. Read More

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June 2015
14 Reads

Hemodialysis-related portal-systemic encephalopathy.

Intern Med 2015 1;54(9):1113-7. Epub 2015 May 1.

Department of Neurology, Nagoya University Graduate School of Medicine, Japan.

Hemodialysis-related portal-systemic encephalopathy (HRPSE) is characterized by the presence of portosystemic encephalopathy without liver dysfunction, usually caused by changes in the systemic venous flow related to hemodialysis. We herein describe the case of a 75-year-old woman who developed hepatic encephalopathy five years after the initiation of hemodialysis. Abdominal contrast-enhanced computed tomography (CT) and three-dimensional CT angiography revealed a portosystemic venous shunt, and the patient was diagnosed with portosystemic encephalopathy. Read More

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December 2015
3 Reads