1/19. Acute coagulopathy following infusion of prothrombin complex concentrate.An acute coagulopathy developed in a 49 year old woman with severe liver disease after she received an infusion of prothrombin complex concentrate. The concentrate used in the infusion was subsequently studied by observing the effect of the concentrate on the partial thromboplastin times of various plasmas. The evidence suggests that activated coagulation factors, including activated factor X, were present in the concentrate, and probably played a role in initiating the acute change in the patient's coagulation status. Mechanisms whereby liver disease predisposes toward the development of such a coagulopathy are discussed. It would appear that prothrombin complex concentrates should be used in patients with liver disease only with utmost caution.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/19. An unusual case, in italy, of hepatocarcinoma characterized by portal hypertension and absence of cirrhosis.We report a case of a 40-year-old man of Bantu origin, affected by both HBV infection and primitive hepatocarcinoma in the absence of cirrhosis. The fine-needle aspiration specimen reported a rare variant of liver cancer resembling an adenocarcinoma. The neoplasm was certainly a hepatic primitive carcinoma, because chest X-ray, cranial computed tomography, colonoscopy, and abdominal computed tomography did not detect neoplastic lesions and alpha-fetoprotein was > 1000 ng/mL. The present neoplasm, characterized by severe portal hypertension and absence of cirrhosis, is rare in italy, but largely diffused in Bantu people in africa.- - - - - - - - - - ranking = 1.2258650961955keywords = neoplasm (Clic here for more details about this article) |
3/19. Neuroendocrine pancreatic carcinoma causing sinistral portal hypertension.BACKGROUND: Non-functioning neuroendocrine pancreatic tumors are usually connected with non-specific syndromes. CASE REPORT: This case history presents the diagnosis and treatment of a non-functioning neuroendocrine pancreatic tumor causing sinistral portal hypertension and gastrointestinal bleeding in a 36-year-old man. RESULTS: A peripheral resection of the pancreas with splenectomy was performed. Intraoperative examination of the specimen revealed a malignant neoplasm, probably neuroendocrinal carcinoma. CONCLUSIONS: Peripheral resection of the pancreas with splenectomy treats not only the symptoms of segmental portal hypertension caused by pathology of this organ, but also allows the etiology of the disease to be determined.- - - - - - - - - - ranking = 0.61293254809775keywords = neoplasm (Clic here for more details about this article) |
4/19. Recurrent portal hypertension after composite liver/small bowel transplantation.Late technical complications of composite liver/small bowel transplantation procedures are often complex and have not been well defined. Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis. Both patients presented with portal hypertension late after composite liver/small bowel transplantation. One patient presented with recurrent bouts of upper gastrointestinal hemorrhage and was ultimately found to have a stenosis of her native portacaval shunt. After unsuccessful balloon dilatation of the anastomosis, a successful side-to-side distal splenorenal shunt was performed. The second patient presented with severe thrombocytopenia, the etiology of which was determined to be a short segment occlusion of the inferior vena cava between the native portacaval shunt and the piggyback outflow anastomosis of the liver graft. Total caval occlusion prevented balloon dilatation; the patient was relisted for transplantation but died of chronic rejection four months later. Recurrent portal hypertension is challenging in patients who have had combined liver/small bowel transplantation. Surgeons performing intestinal transplantation need to be increasingly aware of these possible late complications.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
5/19. Polymeric hydrogel compounds and their application in restorative surgery in cases of portal hypertension.This paper deals with aspects of developing the biologically-compatible polymeric material for filling cavities or deposition of the physiologically-active preparations. Determined is the possibility of using the composite material in one of the complex fields of restorative surgery, i.e. the syndrome of portal hypertension.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
6/19. Pulmonary hypertension with coexisting portal hypertension.A 10-year-old boy who had portal hypertension secondary to portal fibrosis/intrahepatic biliary atresia developed syncopal episodes related to strenuous activity. A work-up excluded a metabolic or neurologic etiology and cardiac catheterization demonstrated significant pulmonary hypertension. Six months later he died and an autopsy revealed pulmonary plexogenic arteriopathy without microemboli. Previous reported cases of this symptom complex are reviewed. In addition, he had a history of nonspecific colitis, ulcerative stomatitis, and conjunctivitis responsive to steroid therapy. The possible relationship of these manifestations to the portal pulmonary pathology is discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
7/19. pancreaticoduodenectomy in portal hypertension: use of the Ligasure.BACKGROUND/PURPOSE: The Ligasure Vessel Sealing System (LVSS) is a new bipolar device, put on the market in 1999, which provides safe and quick hemostasis, sealing blood vessels up to 7 mm in diameter or tissue bundles without dissection or isolation. We tested this instrument in a patient with portal hypertension who had to be submitted to a complex abdominal procedure. methods: A male patient (aged 57 years) with well-compensated cirrhosis of the liver, related to hepatitis c virus (HCV) (child A) was diagnosed with a neoplasm of the pancreatic head. We performed a Whipple pancreaticoduodenectomy and hemostasis was almost entirely performed with the LVSS. All the blood vessels up to 7 mm in diameter were sealed in this way. Larger vessels were suture ligated primarily. RESULTS: No post-application bleeding was seen. No postoperative hemorrhagic complications occurred. A significant reduction in blood loss and in surgical time was noted. CONCLUSIONS; We believe that the LVSS could be extremely useful in all the fields of hepatopancreatobiliary surgery, especially in patients with portal hypertension with large intestinal and omental varices. The LVSS guarantees excellent hemostasis, reducing the risk of serious blood loss and shortening the time of surgery, so improving the prognosis.- - - - - - - - - - ranking = 0.77959921476442keywords = neoplasm, complex (Clic here for more details about this article) |
8/19. Surgery is inadvisable: massive varicocele due to portal hypertension.The pathophysiology of idiopathic varicoceles as a dilatation of the pampiniform venous plexus has been traced to anatomical and embryological development, but is still unclear. Right or non-decompressible lesions are worrisome for retroperitoneal pathology, such as renal cell carcinoma, hydronephrosis, abdominal neoplasm or fibrosis. As a very rare finding we describe a patient who presented with an exorbitant left sided varicocele due to portal hypertension. We were well advised to avoid surgery.- - - - - - - - - - ranking = 0.61293254809775keywords = neoplasm (Clic here for more details about this article) |
9/19. Sinistral portal hypertension. A case report.Sinistral portal hypertension is a clinical syndrome of gastric variceal hemorrhage in the setting of splenic vein thrombosis due to a primary pancreatic pathology. The distinguishing features from other forms of portal hypertension are preserved liver function and a patent extrahepatic portal vein. The important causes include acute and chronic pancreatitis, pancreatic pseudocysts and pancreatic carcinomas. Benign pancreatic neoplasms only rarely cause sinistral portal hypertension. splenic vein thrombosis complicates 7-20% of patients having pancreatitis or a pancreatic pseudocyst; however, bleeding occurs in only approximately 5% of patients. The diagnosis of sinistral portal hypertension is achieved by a combination of gastroscopy, liver function tests, ultrasound examination (with Doppler) and/or contrast-enhanced CT scan of the abdomen. A mere demonstration of sinistral portal hypertension does not warrant intervention. An expectant management is justifiable in asymptomatic patients with pancreatitis. However, concomitant splenectomy may be considered in patients undergoing operative treatment of symptomatic chronic pancreatitis if sinistral portal hypertension and gastroesophageal varices are present. In patients presenting with gastric variceal hemorrhage, splenectomy (with treatment for the primary pancreatic pathology, e.g. distal pancreatectomy) is curative with excellent long term results.- - - - - - - - - - ranking = 0.61293254809775keywords = neoplasm (Clic here for more details about this article) |
10/19. Acinar cell carcinoma of the pancreas: a rare cause of left-sided portal hypertension.Isolated splenic vein obstruction with left-sided portal hypertension is a rare clinical condition. Owing to the close relationship of the splenic vein and the pancreas, this rare phenomenon is usually secondary to pancreatic inflammation or neoplasm. Acinar cell carcinoma has long been recognized as a distinctive, rare type of pancreatic carcinoma. A case of isolated splenic vein obstruction with left-sided portal hypertension secondary to acinar cell carcinoma of the pancreas, which we are reporting here, is thought to the first documented in the literature.- - - - - - - - - - ranking = 0.61293254809775keywords = neoplasm (Clic here for more details about this article) |
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