[Transjugular intrahepatic portosystemic shunt in patients with portal vein thrombosis]

PURPOSE

To evaluate the feasibility of TIPS for portal vein thrombosis (PVT) with/without portal vein occlusion/cavernomatous transformation and with/without underlying cirrhosis.

MATERIALS AND METHODS

13 patients with PVT and refractory ascites (n=7) and variceal bleeding (n = 6) received TIPS placement. The function of the TIPS was controlled with Doppler US at 1 day, 1 week, 4 weeks and 4 months after TIPS placement and subsequently every 3 months. The rates of technical success, revision and mortality after TIPS were evaluated.

RESULTS

The TIPS was successfully placed in 85% (11/13) of the cases. TIPS placement was successful in 87.5% (7/8) of patients with occlusion of the right portal vein and in 100% (5/5) of patients with non-occlusive right portal vein (p > 0.05), in 80% (8/10) of cirrhotic (x/10) and in 100% (3/3) of non-cirrhotic patients (p > 0,05), as well as in one patient with a fresh PVT and in 1 of 2 patients with cavernous transformation. 30 and 14.3% of patients needed a TIPS revision in the first and second year, respectively. No patient with occlusion of the right portal vein required a revision. 54.5% (6/11) of patients died within 6 months. Under exclusion of 4 patients with advanced malignant diseases, the mortality rate was 28.6%.

CONCLUSION

TIPS should be considered for selected patients with symptomatic occlusive PVT with/without cavernous transformation and with/without underlying cirrhosis. The frequency of TIPS revision is not greater, and the mortality rate 6 months after PVT recanalization seems to be comparable with that of patients without PVT.

Spontaneous internal drainage of a pancreatic pseudocyst: a case report

A 72 year old patient was admitted to our department with progressive abdominal symptoms caused by chronic pancreatitis. Physical examination and laboratory data were unremarkable, ultrasound showed a cystic lesion beneath the pancreatic head. Initial endoscopic examination demonstrated a duodenal stenosis; in the second examination the stenosis had resolved by spontaneous perforation of the pseudocyst into the duodenal bulb. Pancreatic and peri-pancreatic pseudocysts are common in acute and chronic pancreatitis; the frequency of their diagnosis increased following the advent of ultrasonography and computed tomography as diagnostic tools and more intensive clinical monitoring. Our knowledge about the incidental course of the disease is still limited. When the diagnosis is established, a lot of questions referring to the choice of therapeutic regime-conservative treatment, percutaneous intervention, endoscopic or surgical procedures arise. Therapeutic possibilities and their advantages are discussed.

Influence of anti-inflammatory drugs and free radical scavengers on intestinal ischemia induced oxidative tissue damage

The influence of oxygen free radical scavengers and anti-inflammatory drugs on postischemic lipid peroxidation and myeloperoxidase activity was shown. The best results were obtained from vitamin E and the antiinflammatory treatment with CP and SUL, whereas an iron elimination only showed slight effects on myeloperoxidase activity above all. In experiments without therapy a linear increase of lipid peroxides dependent on reperfusion durance was found, whereas myeloperoxidase already showed a remarkable increase during ischemia and early reperfusion. This difference can be interpreted by scavenging mechanisms, which are overcharged after an appointed durance of reperfusion.

Influence of free radical scavengers on myeloperoxidase activity and lipid peroxidation in acute skin grafts

Activated neutrophil granulocytes are an important source of oxygen free radicals in acute skin grafts. Lipid peroxidation and immigration of PMNs, indicating inflammatory mechanisms, affect each other to a variable extent. The effect of the scavengers allopurinol and alpha-D-tocopherol on both lipid peroxidation and neutrophilic infiltration was investigated. A possible mechanism for the superior effect of allopurinol compared to vitamin E was discussed.

Combination of treatment with perfluorochemicals and free radical scavengers

P-cyclohexylmorpholine, given as oxygen carrier of second generation, was tested in two experimental models: the ischemic intestine and the lung under hyperbaric oxygen condition. In both instances in separated groups either alpha-tocopherol or allopurinol was additionally given as oxygen free radical scavenger. The thiobarbituric acid reaction (TBAR) was used as screening test for the occurrence of lipid peroxidation in organ probes; further the content of glutathione in reduced (GSH) and oxidized form (GSSG) was determined. Whereas only slight increases of TBAR substances and GSSG could be found compared to controls, the effect of the administrated scavenging drugs was very impressive: they could suppress nearly totally the effect of an enhanced oxidative stress.

Magnetometric studies on the reticulo-endothelial system of the liver after administration of different lipid emulsions

A comparison of the burdening effects on the reticulo-endothelial system (RES) by soybean oil emulsions with two different emulsifiers [soybean lecithin (SOB) and egg lecithin (EGG)] or by a perfluorochemical emulsion (Fluosol-DAR, PFC) was performed using a magnetometric method. This method is based on measuring the relaxation of injected iron oxide (gamma-Fe2O3) above the liver after magnetization in a strong external magnetic field. Three different methods of evaluation of the data were chosen. First, according to the conventional monoexponential function, second, according to a monoexponential function with a constant, and third, using the ratio of the initial dynamic to total magnetic field strength. In contrast to SOB and EGG, the PFC emulsion which was used depressed the RES-capacity to less than 31% of the control values (p less than 0.001). Following the administration of SOB the phagosomal motion was significantly lowered after 6 h (p less than 0.01) and 1-2 days (p less than 0.05); thereafter no significant difference of the relaxation constants remained as compared to the control group. The fatty emulsion with egg lecithin showed no significant lowering of the RES-capacity during the entire observation period (p greater than 0.05). Our results indicate that the RES-capacity is diminished not only by a PFC emulsion, but also temporarily by a soybean lecithin emulsion, though not by an egg lecithin emulsion, when given in the same dosages.