| Selective variceal decompression and its role relative to other therapies. | |
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MedLine Citation:
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PMID: 2368877 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Seventy patients, selected from 265 patients with proved variceal bleeding, underwent a distal splenorenal shunt (DSRS) procedure with or without splenopancreatic disconnection (SPD). Alcoholic cirrhosis was the cause of portal hypertension in 57% of the patients. The operative mortality was 13% (Child's classes A and B 2%, class C 66%). Despite fewer varices in all of the patients, variceal rebleeding and death occurred in one patient (2%). Late portal perfusion was observed in 91% of the patients, with worsening in 23%, compared with the preoperative study. Persistent hepatocyte necrosis and incomplete SPD were the most significant prognostic factors for decreased perfusion (presence and absence of necrosis, 38% and 12%, respectively; DSRS and DSRS with SPD, 43% and 12%, respectively). SPD also decreased ongoing hepatocyte damage. Post-shunt encephalopathy was clinically evident in 7% of the patients, but after electroencephalographic evaluation, it increased to 24.6%. Significant factors in its development included decreased portal perfusion (62% versus 14%), active hepatitis (48% versus 17%), and incomplete SPD (43% versus 14%). The higher late liver-related mortality was associated with a lack of or decreased portal perfusion and the absence of SPD. |
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Authors:
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A Maffei-Faccioli; G E Gerunda; D Neri; R Merenda; F Zangrandi; F Meduri |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: American journal of surgery Volume: 160 ISSN: 0002-9610 ISO Abbreviation: Am. J. Surg. Publication Date: 1990 Jul |
Date Detail:
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Created Date: 1990-08-16 Completed Date: 1990-08-16 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0370473 Medline TA: Am J Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 60-6 Citation Subset: AIM; IM |
Affiliation:
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Institute of Second Surgical Pathology, University of Padova, Italy. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Esophageal and Gastric Varices
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complications,
mortality,
surgery* Female Gastrointestinal Hemorrhage / etiology, surgery* Hepatic Encephalopathy / etiology Humans Male Middle Aged Postoperative Complications Splenorenal Shunt, Surgical* / adverse effects, methods |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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