A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular car...A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.展开更多
AIM:To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma,who developed serious side effects. METHODS:Serum l...AIM:To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma,who developed serious side effects. METHODS:Serum levels of budesonide,6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC/MS/MS; portosystemic shunt-index (SI) was determined by 99mTc nuclear imaging.All values were compared with a matched control patient without side effects. RESULTS:Serum levels of budesonide were 13-fold increased in the index patient.The ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH- prednisolone,respectively,and serum levels of budesonide was diminished (1.0 vs.4.0 for 6β-OH-budesonide,4.2 vs. 10.7 for 16α-OH-prednisolone).Both patients had portosystemic SI (5.7 % and 3.1%) within the range of healthy subjects.CONCLUSION:Serum levels of budesonide Vary uP to 13-fold in AIH Patients with Child A eirrhosis in the absenee ofrelevant Portosystemic shunting.Redueed hePatiemetabolism,as indicated by redueed metabolite-to-drugratio,rather than Portosystemie shunting may explainsystemic side effects of this drug in cirrhosis展开更多
Background and Aims:The association between portalsystemic shunt and hepatocellular carcinoma(HCC)development in patients who have cirrhosis is still controversial.This systematic review with meta-analysis was perform...Background and Aims:The association between portalsystemic shunt and hepatocellular carcinoma(HCC)development in patients who have cirrhosis is still controversial.This systematic review with meta-analysis was performed to systematically clarify the potential role of portal-systemic shunt in the development of HCC.Methods:The PubMed,Embase,and Cochrane Library databases were searched for potentially eligible literature.Meta-analysis with random-effects model was performed to combine the incidence rates of HCC after portal-systemic shunt.Finally,seven studies were included.In the present review,we mainly focused on 859 patients(365 in the transjugular intrahepatic portal-systemic shunt(TIPS)group and 494 in the non-TIPS group)from five studies to analyze incidence rates after TIPS.Results:At the end of follow-up,there were 66(18%,66/365)patients who developed HCC after TIPS intervention and 63(13%,63/494)patients who developed HCC after non-TIPS treatments.Pooled estimates with random-effects model did not demonstrate a significant increase of incidence of HCC after TIPS(risk ratio:1.37[confidence interval(CI):0.96 to 1.97];p=0.08)compared with non-TIPS treatments.Subgroup analyses for those patients with transplanted liver also did not detect a significant difference between the TIPS group and non-TIPS group(risk ratio:1.10[CI:0.59 to 2.07];p=0.75).Conclusions:Current evidence suggests that portal-systemic shunt is not associated with a higher risk of HCC development in cirrhotic patients.展开更多
文摘A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.
文摘AIM:To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma,who developed serious side effects. METHODS:Serum levels of budesonide,6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC/MS/MS; portosystemic shunt-index (SI) was determined by 99mTc nuclear imaging.All values were compared with a matched control patient without side effects. RESULTS:Serum levels of budesonide were 13-fold increased in the index patient.The ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH- prednisolone,respectively,and serum levels of budesonide was diminished (1.0 vs.4.0 for 6β-OH-budesonide,4.2 vs. 10.7 for 16α-OH-prednisolone).Both patients had portosystemic SI (5.7 % and 3.1%) within the range of healthy subjects.CONCLUSION:Serum levels of budesonide Vary uP to 13-fold in AIH Patients with Child A eirrhosis in the absenee ofrelevant Portosystemic shunting.Redueed hePatiemetabolism,as indicated by redueed metabolite-to-drugratio,rather than Portosystemie shunting may explainsystemic side effects of this drug in cirrhosis
文摘Background and Aims:The association between portalsystemic shunt and hepatocellular carcinoma(HCC)development in patients who have cirrhosis is still controversial.This systematic review with meta-analysis was performed to systematically clarify the potential role of portal-systemic shunt in the development of HCC.Methods:The PubMed,Embase,and Cochrane Library databases were searched for potentially eligible literature.Meta-analysis with random-effects model was performed to combine the incidence rates of HCC after portal-systemic shunt.Finally,seven studies were included.In the present review,we mainly focused on 859 patients(365 in the transjugular intrahepatic portal-systemic shunt(TIPS)group and 494 in the non-TIPS group)from five studies to analyze incidence rates after TIPS.Results:At the end of follow-up,there were 66(18%,66/365)patients who developed HCC after TIPS intervention and 63(13%,63/494)patients who developed HCC after non-TIPS treatments.Pooled estimates with random-effects model did not demonstrate a significant increase of incidence of HCC after TIPS(risk ratio:1.37[confidence interval(CI):0.96 to 1.97];p=0.08)compared with non-TIPS treatments.Subgroup analyses for those patients with transplanted liver also did not detect a significant difference between the TIPS group and non-TIPS group(risk ratio:1.10[CI:0.59 to 2.07];p=0.75).Conclusions:Current evidence suggests that portal-systemic shunt is not associated with a higher risk of HCC development in cirrhotic patients.
