Splenoportal System Research Articles

Role of Doppler ultrasonography of the splenoportal system in diagnosing early hepatic dysfunction in non-alcoholic fatty liver disease patients

Role of Doppler ultrasonography of the splenoportal system in diagnosing early hepatic dysfunction in non-alcoholic fatty liver disease patients

Doppler Surrogate Endoscopy for Screening Esophageal Varices in Patients With Cirrhosis

Background:Portal hypertension is a common consequence of hepatic cirrhosis, which causes esophageal varices. Bleeding from varices has a high mortality rate. The present gold standard for diagnosing varices is endoscopy. Considering endoscopy side effects and patients' low acceptance, there have been always efforts for finding alternative diagnostic methods including Doppler ultrasonography (US).Objectives:The aim of the present study was to evaluate changes of Doppler indices in cirrhotic patients with and without esophageal varices.Patients and Methods:Sixty six patients with known cirrhosis entered this cross-sectional study. Gastroscopy was performed for patients, and the first questionnaire was filled based on the Japanese Portal Hypertension Society guidelines. Then patients were referred for Doppler US of splenoportal system, and information was documented in the second questionnaire.Results:Forty-four patients were male and 22 female. Forty six patients had esophageal varices, and 20 did not. There were no significant associations between splenoportal indices found by Doppler US, and presence of esophageal varices in patients. However, we found a negative association between platelet ratio to spleen diameter, and to splenic vein diameter.Conclusions:Neither of studied variables was perfect to differentiate cirrhotic patients with and without EVs. Endoscopy is still the gold standard diagnostic method for diagnosing esophageal varices in patients with cirrhosis. It seems that some of the splenoportal Doppler indices are promising, but more research and evaluation is necessary.

Short‐ and long‐term risks of splenectomy for benign haematological disorders: should we revisit the indications?

Splenectomy has represented a key treatment option in the treatment of many benign haematological diseases, including immune thrombocytopenia (ITP) and disorders associated with ongoing haemolysis (thalassaemia major and intermedia, sickle cell disease, and hereditary or acquired haemolytic anaemias). Improvements in surgical techniques have reduced perioperative complications and mortality. Preventive measures (new protein conjugate vaccines, antibiotic prophylaxis, and increased vigilance) are thought to greatly reduce the risk of overwhelming post-splenectomy infection (OPSI), although their implementation is inconsistent. Nevertheless, there is increasing documentation of the short- and long-term risks of splenectomy, which vary according to the underlying indication. Splenectomized patients are at increased risk of venous thromboembolism, particularly within the splenoportal system. The long-term thromboembolic risk is higher in haematological disorders associated with ongoing haemolysis, particularly in thalassaemia intermedia, which has led to a more conservative approach. In comparison, patients with ITP appear to be at lower risk of adverse effects of splenectomy, which maintains its place as the potentially most curative and safe second-line treatment. However, a splenectomy-sparing approach is also emerging for ITP, and recent guidelines recommend that this procedure is deferred until ≥ 12 months from ITP diagnosis, to allow sufficient time for possible remission.

Randomized controlled trial to investigate the impact of anticoagulation on the incidence of splenic or portal vein thrombosis after laparoscopic splenectomy

Splenic and portal vein thrombosis (SPVT) is a potentially life-threatening complication of splenectomy. There is a paucity of studies examining the role of prophylactic pre- and postoperative anticoagulation in the prevention of this complication. We designed a prospective randomized controlled trial (RCT) to more rigorously address the impact of prophylactic anticoagulation on the incidence of asymptomatic or symptomatic SPVT, detected on Doppler ultrasound, after laparoscopic splenectomy. This 2-centre, phase II, prospective, open-label, parallel-assignment RCT compared no postoperative anticoagulation to a regimen of 40 mg of enoxaparin subcutaneously once daily for 21 days. All patients underwent Doppler ultrasonography of the splenoportal system preoperatively and again 14-28 days after surgery to screen for nonocclusive or occlusive thrombosis. From November 2006 to November 2008, 35 patients were enrolled in the RCT. Four patients withdrew, 1 required conversion to an open procedure and 1 died at 3 months (the cause of death was not related to the study). Of the 29 patients remaining, 15 were randomly assigned to the anticoagulation group and 14 to the nonanticoagulation group. One (3.4%) patient in the treatment group experienced portal thrombosis. Rates of postoperative bleeding were similar in both groups. This RCT of anticoagulation found a low overall risk of SPVT after laparoscopic splenectomy; however, this is an underpowered study, and further multicentred clinical trials are needed.

Infant Death Due to Air Embolism from Peripheral Venous Infusion

An otherwise healthy male infant was brought to the hospital because the mother suspected superficial infection at the operative site 5 days after an inguinal hernia repair. He was admitted to the pediatric unit overnight to be evaluated by his surgeon the next morning. When a venous infusion of maintenance fluids was started, the patient immediately went into cardio-respiratory arrest and was pronounced dead after resuscitation efforts failed. Subsequently, air collections were found in both venous and arterial circulations, including the splenoportal system. Detailed review of the clinical presentation and course, laboratory results, radiological, and pathological findings, along with a review of pertinent literature provides an explanation for the death by air embolism. Apparent inconsistent findings both radiographically and at autopsy are resolved. The mechanism of distribution of air to both systemic and splenoportal circulation is discussed. We believe this to be only the eighth case reported in English-language literature of infantile death from peripheral venous infusion. In all age groups, we find only six other cases in the English-language literature of gas found concomitantly in both the systemic and portal venous systems.

First clinical results of ultrafast, contrast-enhanced 2-phase 3D-angiography of the abdomen

To assess the utility of breath-hold abdominal ultrafast three-dimensional (3D) gadolinium-enhanced dual-phase magnetic resonance angiography (MRA). 125 patients with various abdominal pathologies were imaged using a breath-hold ultrafast gadolinium-enhanced dual-phase 3D-MRA technique. 119 (95%) of 125 MRA's were of good or excellent quality. The sensitivity in the detection of renal artery stenoses as well as stenoses of the celiac trunk and the superior mesenteric artery was 100%. Accessory renal arteries (n = 9) and replaced hepatic arteries (n = 4) were reliably detected by MRA. In 24 (71%) of 34 cases MR-angiographic delineation of the spleno-portal system and hepatic veins was superior compared to conventional angiography. Breath-hold gadolinium-enhanced dual-phase 3D-MRA has the potential to replace conventional angiography in the abdomen.

Do Umbilical Vein Catheterization and Sepsis Lead to Portal Vein Thrombosis? A Prospective, Clinical, and Sonographic Evaluation

SummaryExtrahepatic portal vein obstruction (EHPVO) affects 20–30% of all patients with portal hypertension in India. The etiopathogenesis of this disease is unknown. In retrospective studies, umbilical vein cannulation and sepsis have been alleged to cause portal thrombosis. This prospective study was undertaken to detect clinically and by serial sonography whether thrombosis and consequent obstruction of the splenoportal venous system develops after umbilical vein catheterization and sepsis. Forty‐seven children who had undergone exchange transfusion for hyperbilirubinemia, belonging to two different age groups, were studied. Twenty‐two new‐borns (Group A) were studied within 4 weeks of birth and later at 3‐month intervals until the age of 12 months and subsequently at 24 months. Another group of 25 children (Group B), 1− to 5‐year‐olds who had earlier undergone exchange transfusion and 15 healthy newborns (Group C) were also screened. In Group A, seven (29%) neonates had septicemia, and in five, the splenic vein could not be initially visualized. The splenic vein was not seen in five of the 15 newborns in Group A who had no umbilical sepsis. Twenty‐one of the 22 neonates in Group A were folio wed‐up, and the splenic vein was well visualized and found patent on subsequent ultrasound in all of them. In Group B, four (16%) children had umbilical sepsis. None of these or the other Group B children showed any thrombosis or obstruction of the splenoportal system. The portal vein and its branches and the splenic vein were visualized in all healthy (Group C) neonates. In conclusion, our results demonstrate that umbilical vein catheterization and sepsis do not lead to development of portal vein thrombosis, at least, in the hospital.

Do Umbilical Vein Catheterization and Sepsis Lead to Portal Vein Thrombosis? A Prospective, Clinical, and Sonographic Evaluation

Extrahepatic portal vein obstruction (EHPVO) affects 20-30% of all patients with portal hypertension in India. The etiopathogenesis of this disease is unknown. In retrospective studies, umbilical vein cannulation and sepsis have been alleged to cause portal thrombosis. This prospective study was undertaken to detect clinically and by serial sonography whether thrombosis and consequent obstruction of the splenoportal venous system develops after umbilical vein catheterization and sepsis. Forty-seven children who had undergone exchange transfusion for hyperbilirubinemia, belonging to two different age groups, were studied. Twenty-two new-borns (Group A) were studied within 4 weeks of birth and later at 3-month intervals until the age of 12 months and subsequently at 24 months. Another group of 25 children (Group B), 1- to 5-year-olds who had earlier undergone exchange transfusion and 15 healthy newborns (Group C) were also screened. In Group A, seven (29%) neonates had septicemia, and in five, the splenic vein could not be initially visualized. The splenic vein was not seen in five of the 15 newborns in Group A who had no umbilical sepsis. Twenty-one of the 22 neonates in Group A were followed-up, and the splenic vein was well visualized and found patent on subsequent ultrasound in all of them. In Group B, four (16%) children had umbilical sepsis. None of these or the other Group B children showed any thrombosis or obstruction of the splenoportal system. The portal vein and its branches and the splenic vein were visualized in all healthy (Group C) neonates.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental injection of oily contrast into the splenoportal system in a case of tuberculosis of the spleen.

The clinical value of fistulography and sinography is well documented (Gage and Williams, 1943; Pendergrass and Ward, 1947; Dell, 1949; Goldfarb, Monafo and McAlister, 1964). It is common practice to introduce the contrast material under fluoroscopy. Where the fistulous openings are such that even the best instruments fail to prevent regurgitation of the contrast during injection, the “overcouch” method is a satisfactory alternative. Saxton and Strickland (1964) advocate its use particularly in the investigation of sinuses which are suspected to originate from bone infection, a situation in which films with sharp definition are required. An inherent drawback of this technique is the inability to make full use of fluoroscopic control during contrast injection. A rare case of primary splenic tuberculosis is presented here to record an unusual complication which might have been avoided if fluoroscopy had been used. S.Y.P., a male Chinese patient aged 63 years, presented in June, 1968 with a chronic discharging sinus in the left hypochondrium of ten months’ duration. He had been a known diabetic for the past ten years and between 1963 and 1965 was treated for pulmonary tuberculosis. Towards the middle of 1967 he developed a tender, hard, left hypochondrial swelling. This was incised and drained, but the wound did not heal. During the same period a similar swelling appeared in his left loin. It was drained and the wound healed spontaneously.

Detection of Hepatic Shunts by the Use of 131I-Macroaggregated Albumin

Summary By scintiscanning the lung and liver following the injection of 131 I-macroaggre-gated albumin ( 131 I-MAA) into the spleen, the presence and degree of extra- and intrahepatic shunts were studied. On this basis, 13 patients among 15 cirrhotics and 1 patient with liver fibrosis had collateral circulation in the splenoportal system. Three patients with hemolytic anemias, 4 with hepatitis, and 2 with cirrhosis had no shunts. Shunt indices calculated from liver and lung counts in scintigrams ranged from 18 to 90 in patients with cirrhosis of the liver with shunts and below 6 in patients without shunts.The radioactivity accumulation curves were recorded over the liver and lung following MAA injection to detect the presence of intrahepatic shunts. An initial hump of the liver MAA accumulation curve was observed in 7 cirrhotics, suggesting the presence of intrahepatic shunts.The MAA transit time from spleen to liver was almost the same whether or not cirrhosis was present. Spleen to lung time through collateral veins ranged widely.The application of 131 I-MAA was considered to be an easy and useful method for the detection and semiquantitation of intra- and extrahepatic shunts in cirrhosis of the liver.

New twelve by twelve-inch roll film magazine for rapid serial roentgenography.

In 1949, a roll film magazine for angiocardiography and cerebral angiography was described (1). This device, a modification of the Fairchild aerial photography camera, brought about a great advance in serial radiography, but because of the relatively small size of the individual films 9 ½ ×; 9 ½ inches, it was of limited usefulness for adults with large hearts. It proved satisfactory, however, for contrast cardiac roentgenography of children and adults with small hearts (2). The development of a newly designed 12 ×; 12-inch roll film magazine for rapid serial roentgenography has made possible the contrast roentgen examination of enlarged hearts, most of the pulmonary circulation, the abdominal aorta, the spleno-portal system, and other examinations for which a larger film area is required. Description Of The Magazine The magazine consists of two main parts: (a) a removable light-proof box which contains the roll film, screens, and grid, and (b) a metal frame housing which supports the magazine and contain...