جستجوی مقالات مرتبط با کلیدواژه « Portal vein thrombosis » در نشریات گروه « پزشکی »
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Background
Multi-visceral transplantation (MvTx) usually refers to the transplantation of more than three intra-abdominal organs. A successful MvTx requires strong multidisciplinary teamwork of transplant surgeons, anesthesiologists, and intensivists.
Case presentationWe present five cases of MvTx with a history of short bowel syndrome admitted to the Abu-Ali Sina Hospital, Shiraz, Iran from May 2019 to January 2020 and describe anesthetic considerations in MvTx. Subjects were identified (4F/1M) with a mean age of 43 years old (range 35–51). The most frequent cause of intestinal failure was portal vein thrombosis, followed by bowel gangrene and short bowel syndrome. The mean ±SD duration of the operation was 360±60 min. The bleeding volume was approximately 2600±1474 cc, and 4±1 bags of packed red blood cells were transfused. Sepsis was the main cause of death in our series.
ConclusionCareful preoperative planning, vigilant intraoperative anesthetic management, and prevention of postoperative infection are imperative to achieve the best outcomes.
Keywords: Multi-visceral transplantation, Anesthesia, Short bowel syndrome, Portal vein thrombosis} -
Portal venous thrombosis (PVT) is an uncommon complication in post-liver transplant recipients. The reported incidence is 1-4%. It may occur within a month, called early or after one month of transplantation, known as late PVT. Early PVT has a poor prognosis, leading to graft failure in most cases. Treatment of such cases is quite challenging because of difficult alternative portal inflow es- tablishment. We performed successful thrombolysis of acute major PVT with a unique technique using ultrasound-guided percutaneous trans-splenic vein access in a post-liver transplant recipi - ent. The per-cutaneous trans- splenic vein approach-based thrombolysis described here in this report might be very helpful in similar cases. This technique minimizes the potential risk of graft loss, avoids re-exploration, has a low risk of bleeding, and is cost-effective.
Keywords: Portal vein thrombosis, Liver transplant, Thrombolysis, Trans-splenic} -
Portal Vein Thrombosis (PVT), commonly associated with cirrhosis of liver and thrombophilia, is one of the causes of severe abdominal pain. In the absence of non-cirrhotic non-malignant extrahepatic portal vein thrombosis, Myeloproliferative Disease (MPD) and an underlying thrombotic disorder should always be suspected and investigated. Hyperhomocysteinemia has been well-documented to increase the risk of arterial thrombotic events, peripheral arterial disease, and stroke. It is also a risk factor for deep-vein thrombosis. In the general population, association with portal vein thrombosis is very unusual, and only a few cases have been reported. We describe a case of Polycythemia Vera (PV) and hyperhomocysteinemia presenting with severe abdominal pain due to portal vein thrombosis. The patient underwent phlebotomy and was prescribed life-long anticoagulant, aspirin, vitamin B6, vitamin B12, and folic acid, then referred to a hematologist.Keywords: Portal vein thrombosis, Polycythemia vera, Budd-Chiarisyndrome, Hyperhomocysteinemia}
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Aim: To determine the impact of obesity on development of portal vein thrombosis in cirrhotic patients.BackgroundCirrhosis is a known risk factor for portal vein thrombosis (PVT). Evidence also points to obesity as being a risk factor for venous thromboembolism. Limited information is available on how obesity impacts the development of PVT in cirrhotic patients.MethodsThis was a retrospective cohort study using the 2013 National Inpatient Sample. Patients older than 18 years with an ICD-9 CM code for any diagnosis of liver cirrhosis were included. There was no exclusion criteria. The primary outcome was the impact of obesity on development of PVT. Obesity was also sub-classified according to body-mass index (BMI). Secondary outcomes were inhospital mortality, ICU admission, shock, TPN use, and resource utilization. Odds ratios (OR) and means were adjusted for age, gender, and ethnicity.ResultsWe included 69,934 obese cirrhotics of which, 1,125 developed PVT (mean age 59 years, 35% female). Overall in-hospital mortality rates were 9% (11% with PVT vs 5% without PVT). On multivariate analysis, obesity was not associated with a significantly different adjusted OR for development of PVT compared to non-obese. When stratifying by obesity subtype, class 1 obesity was associated with increased odds of PVT (OR: 1.45, 95%CI: 1.06-1.96, p=0.02), while class 3 obesity was associated with a decreased odds of PVT (OR: 0.72, 95%CI: 0.58-0.88, pConclusionObesity is not associated with increased odds of PVT.Keywords: Obesity, Portal vein thrombosis, Cirrhosis, ICD-9}
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Celiac disease (CD) is an immune-mediate enteropathy with variable presentations which is triggered by exposure to dietary gluten in genetically predisposed people. Here, we describe a 57 year-old woman, with no past history of CD-related features presenting with abdominal pain, iron deficiency anemia and elevated liver enzymes, as well as T cell lymphoma and portal vein thrombosis (PVT). To date, there are few reports of CD concomitant with PVT but to the best of our knowledge, none of them described the concurrent T cell lymphoma. Chronic inflammation due to the underlying CD is likely the most plausible explanation for developing both T cell lymphoma and hypercoagulability state leading to PVT.Keywords: celiac disease, T, cell lymphoma, portal vein thrombosis}
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BackgroundPortal vein thrombosis is a fairly common and potentially life-threatening complication in patients with liver cirrhosis. The risk factors for portal vein thrombosis in these patients are still not fully understood..ObjectivesThis study aimed to investigate the associations between various risk factors in cirrhotic patients and the development of portal vein thrombosis..Patients andMethodsIn this case-control study performed at the Shiraz organ transplantation center, Iran, we studied 219 patients (> 18 years old) with liver cirrhosis, who were awaiting liver transplants in our unit, from November 2010 to May 2011. The patients were evaluated by history, physical examination, and laboratory tests, including factor V Leiden, prothrombin gene mutation, Janus Kinase 2 (JAK2) mutation, and serum levels of protein C, protein S, antithrombin III, homocysteine, factor VIII, and anticardiolipin antibodies..ResultsThere was no statistically significant difference in the assessed hypercoagulable states between patients with or without portal vein thrombosis. A history of previous variceal bleeding with subsequent endoscopic treatment in patients with portal vein thrombosis was significantly higher than in those without it (P = 0.013, OR: 2.526, 95% CI: 1.200 - 5.317)..ConclusionsIn our population of cirrhotic patients, treatment of variceal bleeding predisposed the patients to portal vein thrombosis, but hypercoagulable disorders by themselves were not associated with portal vein thrombosis..Keywords: Portal Vein Thrombosis, Endoscopic Treatment, Esophageal Varices, Liver Transplantation, Iran, Liver Cirrhosis, Risk Factors}
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Govaresh, Volume:19 Issue: 3, 2014, PP 212 -216Pylephlebitis was a rare condition with high rates of morbidity and mortality. It is defined as thrombosis of the hepatic and portal veins that complicates intra-abdominal infections.however prompt diagnosis plays a significant role in the treatment of pylephlebitis and the disorder can be diagnosed by means of ultrasound or contrast tomography, it was often missed due to nonspecific clinical presentation including fever, abdominal discomfort and fatigue.When it came to treatment, despite controversies about the use of anticoagulants, administration of antibiotics and anticoagulants was still the mainstay of treatment.In this report, we described a 67-year-old man with chief complaint of bouts of high fevers and mild abdominal tenderness located in right lower quadrant.The patient suffered from pylephlebitis secondary to cecal diverticulitis. Our patient’s symptoms did not resolve with antibiotic therapy thus he had surgical resection of the infection focus and received anticoagulation.To put in a nutshell, as early diagnosis and treatment are essential steps for proper management of pylephlebitis and preventing its adverse complications, it is of high importance to keep this differential diagnosis in mind in patients with abdominal sepsis sings.Keywords: Pyle phlebitis, Portal vein thrombosis, Abdominal infection, Diverticulitis}
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سابقه و هدفبیماران تالاسمی که تحت ترانسفوزیون خون قرار می گیرند، در صورت نیاز به بیش از 20 سی سی خون به ازای هر کیلو گرم وزن بدن، نیاز به طحال برداری دارند. یکی از عوارض خطرناک و کشنده در بیماران طحال برداری شده ترومبوز ورید پورت (Portal Vein Thrombosis، PVT) می باشد. پیگیری این بیماران برای تشخیص به موقع PVT و درمان مناسب آن نقش مهمی در بقای این بیماران دارد. این مطالعه به منظور بررسی فراوانی PVT در بیماران تالاسمی طحال برداری شده، انجام شد.مواد و روش هااین مطالعه مقطعی بر روی 63 بیمار مبتلا به تالاسمی ماژور که در طی 8 سال (خرداد 1380 الی خرداد 1388) در بیمارستان شهید یحیی نژاد بابل تحت عمل جراحی طحال برداری قرار گرفتند، انجام شد. بیماران براساس سن، جنس، نوع عمل جراحی، اندیکاسیون های طحال برداری، اندازه طحال، طول مدت جراحی، علائم بالینی، فراوانی PVT، میانگین فاصله زمانی عمل جراحی تا عارضه PVT، یافته های سونوگرافی کالر داپلر، نوع درمان PVT و نحوه پیگیری مورد ارزیابی قرار گرفتند.یافته هااز 63 بیمار، 6 نفر (5/9%) دچار عارضه PVT شدند(17-1/2: 95%CI) که 4 بیمار زن و 2 بیمار مرد بودند. به طور میانگین به مدت 7/2±26/5 سال بیماران مورد بررسی قرار گرفتند. میانگین مدت زمان عمل جراحی در بیمارانی که دچار عارضه PVT شدند، 8/0±72/2 ساعت و میانگین فاصله زمانی طحال برداری و بروز عارضه PVT، 176±229 روز بود. تمامی 6 بیمار در زمان بستری تحت درمان با هپارین با وزن مولکولی کم قرار گرفتند و با تجویز وارفارین برای مدت 4 ماه ترخیص شدند. برای 2 بیمار در زمان ترخیص پروپرانولول علاوه بر وارفارین تجویز شد.نتیجه گیرینتایج مطالعه نشان داد که تشخیص به موقع PVT از طریق پیگیری بیماران طحال برداری شده و درمان مناسب با آنتی کوآگولان می تواند نقش موثری در کاهش خطرات ناشی از این عارضه داشته باشد.
کلید واژگان: تالاسمی ماژور, تالاسمی اینترمدیا, عمل جراحی طحال برداری, ترومبوز ورید پورت}Background And ObjectiveIn transfusion dependent thalassemic patients, if their transfusion requirement increases over 20 ml/Kg of whole blood, splenectomy is indicated. Portal vein thrombosis (PVT) is one of life threatening complications of splenectomy. Follow up of splenectomized patients in order to the earliest diagnosis and treatment of PVT can improve the survival of them. The aim of this study was to assess the frequency of PVT in splenectomised thalassaemia patients.MethodsThis cross sectional study was performed on 63 splenectomized thalassemic patients who referred to Yahyanejad hospital of Babol for follow up during 8 years (from June 2001 to June 2009). Patients were evaluated for age, gender, type of operation, splenectomy indication, spleen size, operation duration, clinical manifestation, PVT frequency, and time interval of splenectomy and occurrence of PVT, Color Doppler Sonography findings, PVT treatment and follow-up.FindingsPVT was identified in 6 (9.5%) patients (4 females and 2 males)(95% CI: 2.1-17). The mean time of patient’s follow up was 5.26±2.7 years. Average of surgery duration was 2.72±0.8 hours. The average of time interval of splenectomy and occurrence of PVT was 229±176 days. All of the patients treated by low molecular weight heparin during hospitalization and discharged by Warfarin for 4 months. Two patients received propranolol at the time of discharge, too.ConclusionThe results of this study show that early diagnosis of PVT by following up the patients who splenectomised and treatment of PVT with anticoagulant can reduce the adverse of this complication.Keywords: Thalassemia major, Thalassemia intermediate, Splenectomy, Portal vein thrombosis} -
مجله علوم پزشکی رازی، پیاپی 3 (پاییز 1373)، صص 184 -192
استفاده از سونوگرافی بعنوان روشی ساده، ارزان و دارای قدرت تشخیصی بالا در تشخیص بالایی برخوردار است. Specifity هیپرتانسیون پورت و بعضی از علل بوجود آورنده آن از حساسیت و برای نشان دادن خصوصیات، یافته های سونوگرافیک و میزان توانایی این روش در تشخیص هیپرتانسیون پورت، این بررسی در 15 بیمار مشکوک به عارضه انجام گرفت که در تمام بیماران یافته هایی به نفع وجود هیپرتانسیون پورت از جمله، افزایش قطر وریدهای پورت و طحالی، اسلنومگالی، وجود کلاترال ها و وجود ترومبوز در ورید پورت مشخص شد. اگر اطلاعات حاصله از انجام سونوگرافی با علائم و یافته های کلینیکی تلفیق گردد می توان با درجه اطمینان بالایی وجود یا عدم هیپرتانسیون پورت را مطرح و در صورت نیاز، به سایر ارزیابی های تشخیصی مبادرت ورزد. همچنین از آنجا که در ضمن بررسی سونوگرافیک سیستم وریدی پورت می توان وجود یا عدم وجود بعضی از علل بوجود آورنده هیپرتانسیون پورت از جمله ترومبوز وریدی پورت، تومورها، آدنوپاتی ها، کیست ها و ندولهای کبدی را بررسی و در مواردی با استفاده از پالس داپلر و کالرداپلر علل دیگری چون علل دینامیک و فیستولهای شریانی وریدی را در این سیستم بررسی کرده است. استفاده از سونوگرافی بعنوان یک وسیله ساده، بی خطر و غیر تهاجمی در مقایسه با روش هایی چون اسپلنوپورتو گرافی که دارای خطراتی مانند عوارض عروقی، خطرات استفاده از اشعه ایکس و ماده حاجب می باشد روشی بهتر و کاربردی تر می باشد لذا پیشنهاد می شود در بیماران جهت ارزیابی هیپرتانسیون پورت ابتدا از سونوگرافی و در صورت عدم موفقیت از اسپلنوپورتو گرافی و ونوگرافی بعنوان وسایل تکمیلی کمک گرفته شود.
کلید واژگان: سونوگرافی, هیپرتانسیون پورت, اسپلنوپورتوگرافی, ترومبوز ورید پورت}With considerable advances in technology, ultrasound, as a noninvasive procedure has been more frequently used for diagnosis of liver diseases and portal hypertension (P.H.). Venography and splenoportography, both are invasive procedures with considerable X-ray exposure. The information obtained from these procedures are limited only to condition of vesseles, while with ultrasonic study, diameter of main portal and splenic veins could be measured and any increases in diameter more than 2 mm would suggest P.H. Diagnosis of vessele wall thrombosis in portal system as uniform or heterogenous echogenic area also is possible with ultrasound. Pulse doppler can be used for determining blood velocity and volume, in the same vesseles, and color doppler ultrasound study will show patency of smaller vesseles when clinically indicated We studied, 15 patients who were clinically suspision to have P.H. with ultrasound to confirm P.H. . In all of cases ultrasonic findings such as increased diameter of portal and splenic veins, splenomegaly and presence of collaterals were evidences for diagnosis of P.H. In 2 cases evidences of portal vein thrombosis, were found. In another 2 cases evidences of extrinsic pressure on portal system due to hydatid cysts of liver was thought as causes of P.H.
Keywords: Ultrasound, Portal hypertension, Splenoportography, Portal vein thrombosis}
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