Transjugular intrahepatic portosystemic shunt in liver transplant recipients

AIM:To evaluate the efficacy of transjugular intrahepatic portosystemic shunts (TIPSs) after liver transplantation (LT). METHODS: Between November 1996 and December 2005, 10 patients with severe recurrent hepatitis C virus infection (n=4), ductopenic rejection (n=5) or portal vein thrombosis (n=1) were included in this analysis. Eleven TIPSs (one patient underwent two TIPS procedures) were placed for management of therapy-refractory ascites (n=7), hydrothorax (n=2) or bleeding from colonic varices (n=1). The median time interval between LT and TIPS placement was 15 (4-158) mo. RESULTS: TIPS placement was successful in all patients. The mean portosystemic pressure gradient was reduced from 12.5 to 8.7 mmHg. Complete and partial remission could be achieved in 43% and 29% of patients with ascites. Both patients with hydrothorax did not respond to TIPS. No recurrent bleeding was seen in the patient with colonic varices. Nine of 10 patients died during the study period. Only one of two patients, who underwent retransplantation after the TIPS procedure, survived. The median survival period after TIPS placement was 3.3 (range 0.4-20) mo. The majority of patients died from sepsis with multiorgan failure.CONCLUSION: Indications for TIPS and technical performance in LT patients correspond to those in non-transplanted patients. At least partial control of therapy-refractory ascites and variceal bleeding could be achieved in most patients. Nevertheless, survival rates were disappointing, most probably because of the advanced stages of liver disease at the time of TIPS placement and the high risk of sepsis as a consequence of immunosuppression.

Small bowel adenocarcinoma in Crohn's disease:A case report and review of literature

小肠腺癌为他们的稀有，困难的诊断和差的预后是显著的。这里，我们报导小肠的渗透性的腺癌在 Crohn 的疾病的 10 年的历史以后在被诊断的一个 33 岁的病人的一个不平常的案例。在最以前报导的案例中， Crohn 的疾病的察觉对小肠的癌的随后或包含的病人有疾病的甚至更长的历史。我们的文学评论建议小肠腺癌的风险比在全面人口在有 Crohn 的疾病的病人是更高的。我们传染病学以及这个稀罕疾病实体的临床、诊断的方面上的现在的细节。

Multidimensional assessment of neuro-psychiatric symptoms in patients with low-grade hepatic encephalopathy: A clinical rating scale

AIM: To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms.METHODS: Forty patients with liver cirrhosis (LC, with or without low-grade hepatic encephalopathy) were invest-igated using a clinical neuro-psychiatric rating scale based on a comprehensive list of neurological, psychomotor,cognitive, affective, behavioral symptoms, and symptoms of disturbed bioregulation.RESULTS: The analysis revealed that the majority of cirrhotic patients showed, besides characteristic neurological symptoms of hepatic encephalopathy, various psychomotor,affective and bioregulatory symptoms (disturbed sleep and sexual dysfunction). Patients were impaired in the following subscales: sleep and biorhythm disorder (75.0% of patients), Parkinsonoid symptoms (25.0%), affective symptoms (17.5%), and psychomotor retardation (12.5%).The increase of total neuro-psychiatric clinical score was significantly associated with the degree of hepatic enceph-alopathy.CONCLUSION: This study suggests that a substantial number of patients with LC and low-grade hepatic encephalopathy manifest various clinical neuro-psychiatric symptoms. The use of a rating scale, which explores clinical dimensions of hepatic encephalopathy, would improve the management of patients with LC.

Diagnostic value of fine motor deficits in patients with low-grade hepatic encephalopathy

AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rapid alternating movements in patients with liver cirrhosis and low-grade hepatic encephalopathy.METHODS: A kinematic analysis of alternating handwriting (7.5 mm) and large drawing movements (DM, 175 mm) was performed in 30 patients with liver cirrhosis (no hepatic encephalopathy: n = 10; minimal hepatic encephalopathy: n = 9; grade I hepatic encephalopathy: n = 11; healthy controls: n = 12). The correlation between kinematic parameters, clinical neuro-psychiatric symptoms of cerebral dysfunction and the grade of encephalopathy was investigated.RESULTS: Both movement types, handwriting and drawing, were significantly slower in cirrhotic patients. In contrast to large DM, the deterioration of handwriting movements significantly correlated with the increase of symptoms of motor dysfunction and differentiated significantly within the group of cirrhosis patients corresponding to the degree of hepatic encephalopathy. CONCLUSION: The deterioration of fine motor control is an important symptom of low-grade hepatic encephalopathy. The kinematic analysis of handwriting allows the quantitative analysis of alterations of motor function and is a possible tool for diagnostics and monitoring of motor dysfunction in patients with low-grade hepatic encephalopathy.

A novel modulation and direct detection scheme of optical phase shift keying

This paper introduces a new modulation and direct detection scheme of optical phase shift keying (PSK) which is simple and practical in fiber optical communication. A phase modulator is used to modulate a continuous wave (CW) laser source and return-to-zero (RZ) signal that is changed from the initial transmitting information is used to control a phase modulator to form a optical PSK signal. In the receiver terminal, just add a signal delayed a half of one bit to itself so that the initial information can be restored.