role of surgery in portal hypertension is promising. Devascularization is one of the procedure of choice in unshuntable portal vein. Though LT is treatment of choice
Management of renal cell carcinoma - presented at Asian Oncology Summit 2013Siewhong Ho
Dr Ho lectured at the Asian Oncology Summit 2013 in Bangkok on the surgical opinion on management of renal cell carcinoma. He presented to a varied audience of medical oncologist, radiation oncologist, urologists, researchers, para clinical staff and nurses. The most interesting aspect of the lecture was on the role of urologists in management of Stage 4 kidney cancer in the era of 'targeted therapy'. The role of cytoreductive nephrectomy was reviewed potential future developments in this area was discussed
pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
esophageal cancer surgery types and complicationsved sah
Background-Anatomy & Staging
Surgical Candicate
Contraindication of sx
Assessment of patients for surgery
Approaches of esophagectomies
Esophageal reconstruction
Complications of esophagectomy
Management of renal cell carcinoma - presented at Asian Oncology Summit 2013Siewhong Ho
Dr Ho lectured at the Asian Oncology Summit 2013 in Bangkok on the surgical opinion on management of renal cell carcinoma. He presented to a varied audience of medical oncologist, radiation oncologist, urologists, researchers, para clinical staff and nurses. The most interesting aspect of the lecture was on the role of urologists in management of Stage 4 kidney cancer in the era of 'targeted therapy'. The role of cytoreductive nephrectomy was reviewed potential future developments in this area was discussed
pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
esophageal cancer surgery types and complicationsved sah
Background-Anatomy & Staging
Surgical Candicate
Contraindication of sx
Assessment of patients for surgery
Approaches of esophagectomies
Esophageal reconstruction
Complications of esophagectomy
Extra Hepatic Portal Vein Obstruction (EHPVO) with Extensive Mesenteric Venou...Apollo Hospitals
Extra hepatic portal vein obstruction (EHPVO) is the commonest cause of portal hypertension in children. EHPVO along with thrombosis of splenic vein (SV) and superior mesenteric vein (SMV) is an uncommon condition causing extensive varices formation in the oesophagus, stomach and in other parts of gastrointestinal tract including rectal varix as well as splenomegaly and associated hypersplenism. Most commonly the child presents with hematmesis and due to extensive varices it is difficult to obliterate the varices using endoscopic therapy. Due to thrombosed SMV and SV shunt surgery is not possible. We describe here a case of EHPVO with SMV and SV thrombosis with bleeding gastric varix that underwent gastro- oesophageal devascularisation with splenectomy and oesophageal transection to prevent recurrent bleed from gastric varices.
Simple and Algorthymic approach ,covering all aspects of gastrointestinal hemorrhage.
A concise discussion of the diagnostic approach to obscure
bleeding.
Fundamental principles of initial evaluation and management followed with a welldefined and logical approach to the patient with GI hemorrhage
is outlined.
Similar to Devascularization in portal hypertension.dr quiyum (20)
Primary sclerosing cholangitis (PSC) is a chronic, idiopathic, cholestatic liver disease characterized histologically by peribiliary inflammation and fibrosis.
It can lead to end stage cirrhosis and is a recognized risk factor for hepatobiliary cancers
A fibroscan is a test used to help measure the amount of scarring (fibrotic tissue) in the liver. It’s essentially a specialized ultrasound specifically for the liver
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Devascularization in portal hypertension.dr quiyum
1. Role of devascularization in
management of portal
hypertension
Presented by
Dr Quiyum
Phase B
Hepatobiliary,pancreatic and liver Transplant surgery
2. Introduction
Gastroesophageal varices are major source of morbidity and mortality among
patients with portal hypertension.
The reported 6-week mortality following each episode of variceal bleeding
remains in the range of 15-20%.
3.
4. Devascularization being a variceal-directed ablative surgery
aims at obliteration of varices or disconnection of the esophagogastric veins from
the hypertensive portal tributaries.
The goal of the esophagogastric devascularization is to disconnect the esophagus
esophagus and stomach from this collateral system while maintaining a
portosystemic shunt in place via the adventitial plexus surrounding the esophagus
5. Relevant anatomy
portal hypertension develops<<diversion of portal venous blood away << join the low-
pressure systemic circulation via collateral pathways— natural portosystemic shunts
(esophagogastric region is the main site of shunting.)
The coronary vein and gastric veins are connected with the superior vena cava by
collateral channels in the submucosa of the esophagus(mainly)
between the two muscular layers,
and in the periesophageal area (adventitial plexus).
increased blood flow and resistance in the muscularis layer << increase in venous
pressure<<formation of dilated and tortuous varices.
in the esophageal wall ,
The intrinsic veins include the submucosal, subepithelial,
and the intraepithelial veins
the extrinsic vein - Periesophageal veins
.
6. In portal hypertension, the increased venous pressure can produce
varices throughout the length of the esophagus and down into the
upper stomach; however, the bleeding from esophageal varices usually
occurs in the lowest 5 cm of the esophagus.
In the stomach, although varices are seen more often on the lesser
curve, it is the less common fundal varices that are more dangerous
and likely to lead to exsanguinating hemorrhage (Mathur et al, 1990).
Therefore a technique targeting this vulnerable area would help in
controlling or preventing bleeding from esophageal varices.
An ideal technique would be the permanent obliteration or
interruption of varices in the lower periesophageal vessels and
intraepithelial dilated vessels
7. Indication
patients with underlying chronic liver disease
1. Acute VH when other method have failed
2.not candidates for transplantation and need varices-directed surgery or have symptomatic
hypersplenism needing splenectomy,
3. bridge to liver transplantation when TIPPS unavailable.
4. a shunt is indicated but unshuntable vein in patients with
extensive mesenteric venous thrombosis, including portal, splenic, and superior
mesenteric vein thrombosis or
an inadequate vein size to permit a shunt
Not recommended if LT available,
Not recommended in chronic or prophylactic setting
8. patients with healthy liver,
extrahepatic portal vein obstruction (EHPVO) and noncirrhotic portal fibrosis
(NCPF
portal biliopathy in the absence of a shuntable vein (Varma et al, 2014)
and chronic pancreatitis with portal hypertension
#good results in children with massive splenomegaly with hypersplenism secondary to EHPVO (Rao et al, 2004; Subhasis et al, 2007).
Goyal and coworkers (2007
##isolated splenectomy as a means of secondary prophylaxis for variceal bleeding has a 30% to 50% failure rate and hence is not
advocated (Coelho et al, 2014; Raia et al, 1984), except in the instance of left-sided portal hypertension.
10. Type of devascularization procedure
HASSAB DEVASCULARIZATION PROCEDURE (1960-
1970)
SUGIURA AND FUTAGAWA DEVASCULARIZATION
PROCEDURE(1970-1980)
MODIFIED SUGIURA DEVASCULARIZATION PROCEDURE
(later)
Other modification
Laparoscopic devascularization
11. Hassab’s procedure 1957
Dr. Mohammed Aboul-Fotouh Hassab, a professor of surgery at Alexandria University in Egypt.
abdominal incision.
Splenic artery ligation followed by splenectomy is performed.
ligation of short gastric veins is followed by ligation of the vessels
ascending through the hiatus and the diaphragm.
The gastrohepatic ligament is incised, the left gastric vessel is
divided between ligatures.
abdominal esophagus is circumferentially dissected and looped
with umbilical tape,ligation of vessels around the abdominal
esophagus; this includes devascularization of 3 to 4 inches (7 to 10
cm) of lower esophagus and proximal stomach
with sacrificing of vagus nerve and ligation of left gastric vessels
The abdomen is closed after placement of a drain in the region.
An important aspect of the Hassab procedure is the
absence of esophageal transection and pyloroplasty
12. Result
In Hassab’s series (1967),
174 patients operated during or after a bleed, with 39 patients operated under emergency
conditions at the time of bleeding, and in 151 patients, devascularization was performed
prophylactically (total 364 pt)
an in-hospital mortality of 9% for elective cases, an emergency setting, the mortality was 38.4%
there was only one late rebleeding event during follow-up.
varices disappeared completely or improved in 91% of patients.
But the intramural connections, combination with sclerotherapy is necessary further.
13. literature
modified gastroesophageal decongestion and splenectomy GEDS (Hassab) was performed on
patients who need immediate surgical intervention for variceal bleeding.
safe, simple and less time-consuming No esophageal transection was performed in this
procedure; therefore no esophageal fistula,
The rebleeding rate was 23%
14. Sugiura and fataura procedure
transthoracic and an abdominal procedure
performed through two separate incisions.(lt
lateral thoracotomy and upper midline)
The thoracic procedure involves extensive
paraesophageal devascularization (30-50)up to the
inferior pulmonary vein and esophageal
transection.
The abdominal procedure includes splenectomy,
devascularization of the abdominal esophagus
and cardia, and selective vagotomy and
pyloroplasty
15. Sugiura and Futagawa (1973) reported
the disappearance of varices (97%).
The overall operative mortality was 4.6%, and postoperative hemorrhage occurred in two patients.,
patients who underwent the procedure, 203 (30%) had prophylactic, 363 (54%) had elective, and 105
(16%) had an emergency procedure.
Portal hypertension etiology was cirrhotic in 495 cases, EHPVO in 39 cases, and from other causes in
remainder.
Operative mortality was 4.9% overall, with 13.3% mortality in emergency cases and 3% in elective
In patients with cirrhosis, ChildPugh status–based mortality was 0% for 244 Child-Pugh class A patients,
2% for 251 class B patients, and 16% for 176 class C patients.
Late deaths were due to hepatic failure and hepatocellular carcinoma and not due to variceal bleeding.
the Sugiura procedure was believed to be technically complex and time consuming and
was largely ignored or abandoned.
16. Modified Sugiura procedure
Only abdominal approach
with variations being
inclusion or exclusion of esophageal transection
splenectomy,
vagal preservation,
and anti reflux surgery
The main vagal trunk is preserved; highly selective
vagotomy is performed, and therefore no drainage
procedure is necessary. Fundoplication is not
performed. Esophageal transaction is performed by
using an EEA stapler
17. When the esophagus is inflamed
because of multiple sessions of
sclerotherapy, especially in the acute
setting, the stapling is done just below
the gastroesophageal junction
(Chaudhary & Aranya, 1991).
Occasionally, fundic resection is needed
for bleeding from large fundic varices
the Sengstaken-Blakemore tube is
used for temporary control of bleeding,
we first perform the esophagogastric
devascularization and splenic artery
ligation without deflating the tube and
later proceed to splenectomy
Placement of a feeding jejunostomy
in patients with esophageal
transection or stapling permits early
institution of enteral nutrition
postoperatively. A gastrograffin
swallow is done around the seventh
postoperative day, after which oral
alimentation is resumed.
20. the Hassab operation devascularizes only the extramural vessels; intramural vessels are not
treated.
Only one study in the Chinese literature compared the Hassab and Sugiura procedures and found
the Sugiura procedure to be more effective in terms of reduction of rebleeding and eradication of
varices, with comparable operating time and morbidity (Wen et al, 2008
Studies comparing devascularization alone with devascularization with esophageal
transection have shown comparable rebleeding rates. The esophageal transection group has a
higher incidence of esophageal stricturing (Johnson et al, 2006; Zhang et al, 2014)
comparing splenectomy with no splenectomy groups, both were comparable in rebleeding,
operative time, and morbidity. The preservation of the spleen was associated with decreased
perioperative blood transfusion requirement and the portal vein thrombosis rate.
another modification included splenic artery ligation instead of performing a splenectomy.
21. Efficacy
ability to control bleeding without the attendant liver dysfunction, as occurs with a shunt procedure.
Overall, devascularization procedures have a rebleeding rate of 5% to 16% and mortality rate of 1%
to 7%, without risk of encephalopathy
Immediate control of bleeding is achieved in almost all cases: 95% to 100%
The 5 year survival rate with the Hassab operation ranges from 73% to 85%, seemingly better than other devascularization
procedures.
The 5 year survival rate of the Sugiura and modified Sugiura operations is approximately 70% and dramatically decreases
to approximately 30% in the emergency setting.
Outcomes are much better in noncirrhotic portal hypertension. Approximately 10% to 15% of patients with EHPVO have
no shuntable vein or a thrombosed splenoportal and mesentericoportal axis.
22. Shunt or devascularization ???
RCT showed ,
devascularization was found to have superior survival and less incidence of encephalopathy rate
Rebleeding was less with shunting in another RCT
A meta-analysis (2013(1716 patients, of which 770 underwent devascularization, and in 946, a shunt ).
Although there was no significant difference in the mortality rate and overall survival,
the recurrent bleeding rate was significantly higher in the devascularization group than shunt group;
the rate of encephalopathy was lower in the devascularization group.
Ascites control was better in the shunt group.
25. Summery :
16 cases were undertaken the splenectomy and esophagogastric devascularization.
During the follow-up of 6-72 months, no esophageal and gastric varices were found.
26. The surgical treatment of 18 patients with PVCT was studied retrospectively. Eight
patients underwent mesocaval shunt with artificial grafts, two patients had splenectomy
and disconnection, three patients had a central splenorenal shunt, and six patients had a
distal splenorenal shunt.
There were no deaths or hepatic encephalopathy after operation.
Bleeding recurred in two patients (disconnection in one, mesocaval shunt in one).
The individualized choice of shunt is ideal for treating PVCT, and the combined procedures
of shunt and disconnection are useful. The Rex shunt will be the focus of PVCT surgery in
the future.
27. Surgical procedure selection was based on overall consideration of several factors, according to
the severity of vascular dilation, the PC location, and the extent of liver dysfunction.
Splenectomy was performed for 21 cases with apparent splenomegaly, but without obvious
lumpy, tortuous dilation of the lower esophagus and gastric fundus veins.
Surgical vascular disconnection in the gastric fundus and lower esophagus in combination with
splenectomy was performed in 36 cases with severe tortuous dilation in the lower esophagus
and gastric fundic mucosa.
Among them, surgical thrombus removal and end-to-end anastomosis of the PV were
performed in 8 cases with the main PV trunk occlusion
In three children tortuous dilation of the intrahepatic portal vein, with severe damaged liver
function, was detected. Living-donor liver transplantation was selected for these patients.
28. Five patients were symptomatic. Three patients had intermittent bleeding from esophageal and gastric varices, and
all 5 had relative degrees of hypersplenism with enlarged spleens and thrombocytopenia (11,000 to 77,000)
Postoperative complications included ascites in 2 patients that resolved within 1 month. There were no early shunt
thromboses.
Gastrointestinal bleeding did not recur in any patient, and ascites resolved in all. Spleen size decreased significantly
(P <.01) from 9.4 ± 4.0 cm to 5.0 ± 3.7 cm below the left costal margin. Mean platelet count and white blood cell
count rose after shunting from 79 ± 42 to 176 ± 73 (P <.02) and 5.4 ± 2.3 to 7.5 ± 3.9 (P =.06), respectively. All
shunts were studied at 1 and 7 days, and 3 and 6 months after the procedure. Shunt patency was documented in all
cases. Subsequently, shunt blockage occurred in 2 patients.
Conclusions: The Rex shunt has proven to be an effective method of resolving portal hypertension caused by EPVT
including thrombosis after living donor transplantation. This shunt is preferable to other surgical procedures because
it eliminates portal hypertension and its sequelae by restoring normal portal flow to the liver
29.
30. 30 children with symptomatic CTPV that were treated by a Rex shunt between 2008 and 2015.
All children were evaluated based on symptoms, complete blood count, portal system color-flow Doppler ultrasound or
computed tomography angiography portography and gastroscopy for gastroesophageal varices pre- and postoperatively.
Children were also evaluated during follow-up. Intraoperative evaluations included liver biopsy, portography and portal
pressure.
Rex was successful in 28 patients (93.3%). The portal pressure immediately decreased significantly after placing of the
< 0.01).
During the clinical follow-up period within 2-82 months, transaminase levels were maintained in the normal range. Blood
flow velocity and diameter of the left portal vein significantly increased after surgery (P < 0.01).
In addition, leukocyte and platelet counts increased postoperatively and anemia improved significantly (P < 0.01).
Gastroscopy results indicated that the degree of gastroesophageal varices significantly alleviated postoperatively within 3
months and 1 year (P < 0.01). In 2 patients who demonstrated nodular cirrhosis and chronic active hepatitis, success of the
Rex shunt was not achieved after operation. We found that for Rex effectiveness hepatic pathology and patient age were
major determinants.
Conclusion: Rex shunt is an effective approach for the treatment of children suffering from CTPV at an early stage that do
not show additional liver lesions.