Top PDF Portosystemic shunt in the treatment of portal hypertension

U profilaksi prvog variksnog krvarenja šant hirurgija nije indikovana zato što je teško sa apsolutnom sigurnoš ć u odrediti bolesnika koji ima visok rizik od krvarenja iz variksa, o č uv[r]

A noninvasive evaluation of the systemic hemodynamics was performed in all participants using an esophageal Doppler device (Cardio Q). The results were compared with a control group consisting of ten participants without portal hypertension who were monitored during endoscopic evaluation for dyspepsia. The Cardio Q (Deltex Medical, Irving, TX, USA) esoph- ageal Doppler monitor consists of a continuous-wave Doppler transducer (4 MHz) at the tip of a transesophageal probe connected to a monitor displaying the blood flow velocity profile. Briefly, the probe was gently advanced after oral introduction to the mid-esophagus (approxi- mately 35 cm from the upper dental arcade) and rotated posteriorly to obtain a characteristic aortic blood flow signal [24]. The probe position was optimized to record the peak velocity by slow rotation in the long axis and the depth of insertion to generate a clear signal. The gain set- ting was adjusted to obtain the best outline of the aortic velocity waveform, and a filter elimi- nated the noise related to low-frequency vessel wall motion [24]. The stroke volume (SV) was calculated as follows [25]: SV = CSA Ao x K x V Ao (t) dt, where V Ao (t) represents the instanta-

All patients were followed by a multidisciplinary team, constituted by hepathologists and high-risk obstetricians. Antenatal visits were scheduled once a month up to 28 weeks of pregnancy, every two weeks up to 32 weeks, and thereafter weekly. A pre-conceptional liver function evaluation was performed in all cases and periodic hepatic evaluation was performed with monthly analytical evaluation. In patients with hepatic cirrhosis and portal hypertension, oesophageal varices evaluation was performed during the second trimester and prophylactic treatment applied when indicated. The type and dose of immunosuppressant drugs were noted. Fetal ultrasound evaluation was routinely performed in all pregnancies in all trimesters.

Between May-July 2007, we performed a prospec- tive, cross-sectional and observational study evaluat- ing 30 patients with hepatosplenic schistosomiasis. The sample included 15 men and 15 women (mean age 45 years; range, 25-68 years). Inclusion criteria were age ≥ 18 years and diagnosis of schistosomiasis by rectal biopsy or positive stool test. All patients had a strong epidemiological history, defined as coming from schis- tosomiasis endemic areas. Exclusion criteria were his- tory of alcohol consumption (more than 160 g per week), positive serology for hepatitis virus B or C, autoimmune hepatitis and use of hepatotoxic drugs, in order to ex- clude any other source of underlying liver disease. In ad- dition, patients with a previous history of splenectomy or portosystemic shunt surgery were not included. The study was approved by the Institutional Review Board for Human Research and all patients provided written informed consent.

The radioisotope evidence, on over one year follow-up, in 21 out of 23 patients of more than five splenic nodules shows that autologous splenic im- plantation into an omental pouch in the greater omentum is more effective than natural splenosis for maintaining functioning splenic parenchyma. However, in two patients (8.7%) there were less than five splenic nodules both of them were posi- tive for Howell Jolly bodies. This seems to indicate that the splenic filtration function is associated with the amount of remaining spleen tissue. Previous study on partial splenic embolization in children, with portal hypertension due to congenital abnor- malities, showed that the remaining 15% to 25% of pre-treatment splenomegaly was sufficient to main- tain normal hemocatheretic splenic function (Brandt et al. 1989).

The portosystemic shunt is extrahepatic in most cases and intrahepatic PSS is extremely rare. Park et al. clas- sified 14 cases of intrahepatic PSS in the literature into four morphologic categories (8). In this case, ultrason- ography, CT, and angiography revealed communica- tion between the portal vein and the middle hepatic vein, corresponding to Park’s type 2. Type 2 intrahepa- tic PSS is a localized peripheral shunt in which single or multiple communications are found between peripheral branches of the portal and hepatic veins in one hepatic segment. In the aneurysmal type, a portal aneurysm may precede the venous shunt and then rupture into the hepatic vein, resulting in the formation of commu- nication (9). Remer et al. also reported that most cases of intrahepatic PSS were located in the left lobe and had aneurysmal communication between the portal and hepatic veins (10).

Due to the frequency and bad prognosis associated with gastrointestinal bleeding in patients with portal hypertension (PH), the Governing Board of the Brazilian Society of Hepatology organized on May 6th 2009 at Salvador, Bahia, Brazil, a consensus meeting to establish national guidelines on prevention, management and treatment of portal hypertensive bleeding. A consensus committee made of four delegates was chosen, who elected a panel of 27 Brazilian researchers from different regions of the country to act as moderators or speakers of previously selected topics focused on: 1) screening of varices and prevention of the irst bleeding episode; 2) treatment of acute variceal bleeding; 3) management of treatment failure, recurrence of bleeding and secondary prophylaxis, and 4) management of special situations. All moderators were asked to provide key

According data recorded (Table 1) it was observed that 80% of the selected dogs with PSS presented portocaval shunt (Figure 1). Splenocaval shunt (Figure 2) was the second more common accounting 10%, while gastrocaval and portoazigos shunts were found in 5% each. These data confirm the findings related at veterinary literature that shows portocaval as the most frequent PSS in dogs (D’ANJOU et al., 2004; LAMB & WHITE, 1998; HUNT et al., 2000). In 15% (3/20) of dogs was not possible to obtain two different measures at two sites of main portal vein. And one of them has elevated blood flow velocity at main portal vein. The others dogs (17/20) or 85% presented elevated blood flow velocity at main portal vein before the shunting vessel origin when comparing at the site after the shunting vessel origin (Figure 2). It

ABSTRACT – Context - Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. Objective - Outline the proile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. Method - Retrospective study based on the data bank of cirrhotic patients’ medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. Results - The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age 47.7 years (age range from 16 to 85 years and SD = 13), 21 (29.2%) patients presented liver disease as cause excessive intake of alcoholic drinks; 21 (29.2%) contamination by hepatitis virus, 16 (22.2%) excessive alcohol intake associated with virus and 14 (19.4%) patients pre- sented other causes. As for initial classiication, 14 (20%) had Child-Pugh A, 33 (47.1%) Child-Pugh B and 23 (32.9%) Child-Pugh C. Initial MELD was obtained in 68 patients being 37 (54.4%) higher than 15 points while 31 (45.6%) had up to 15 points. Early death occurred in 19 (26.4%). Global mortality occurred in 41 (60.3%). Conclusions - Mortality is directly related to clinical factors of patients, being Child-Pugh and MELD classiications predictors of mortality, with more impact in patients with Child-Pugh class C and MELD > 15. The complications found were similar to those described in the literature, although the dysfunction by stent stenosis (26.4%) was lower than in the most of the studies and the encephalopathy incidence (58.3%) was higher. Probably, the high incidence of encephalopathy is explained by the low incidence of stenosis.

This study was approved by the Medical Research Ethics Committee of Jinling Hospital and Clinical School of Medical College at Nanjing University. Written informed consents were obtained from all the participants before the study. Sixteen patients (9 male, 7 female; mean age, 51.068.8 years) with cirrhosis and portal hypertension scheduled for TIPS in our research institute of general surgery were included in this prospective study. The inclusion criteria for recruitment of the patients were as follows: The patients had liver cirrhosis diagnosed on the basis of clinical and imaging features, the cirrhotic patients with recurrent esophageal varices (which cannot be controlled by internal medical and endoscopy) or ascites formation, without overt HE or any history of overt HE, without any MRI contraindication, no focal abnormality in routine structural MRI examinations, and aged 18 years or older. In this study, 11 of these 16 included patients had variceal rebleeding despite internal medical treatment with vasoconstrictive drugs and endoscopic sclerotherapy or ligation, 5 had ascites refractory to high-dose combination diuretics. Covered stent grafts (Fluency stent grafts: 8 mm66 cm, manufactured by Angiomed GmbHCo. subsidiary of C.R. Bard, Inc. Germany) were used in this study, which were inserted according to standard methods and without complications [24]. Correct stent function was ascertained by the immediate fall in the portosystemic venous pressure gradient and by Doppler ultrasonography. The stent grafts used for TIPS in this study are constructed of nitinol, which has been proved to create markedly reduced susceptibility artifact compared with stainless steel stents and be safe for patients [25,26]. Some published papers have performed MRI for visualization of these stent grafts after TIPS [25,26]. Exclusion criteria for all the subjects were any drug abuse history; or translation more than 1.0 mm or rotation more than 1.0u during MR scanning. Demographics and clinical data for all the subjects were summarized in Table 1.

Splenic artery aneurysms - the most common visceral artery aneurysms - are found most often in multiparous women and in patients with portal hypertension. Indications for treatment of splenic artery aneurysm or pseudoaneurysm include specific symptoms, female gender and childbearing age, presence of portal hypertension, planned liver transplantation, a pseudoaneurysm of any size, and an aneurysm with a diameter of more than 2.5cm. Historically, the treatment of splenic artery aneurysm has been surgical ligation of the splenic artery, ligation of the aneurysm, or aneurysmectomy with or without splenectomy, depending on the aneurysm location. There are other percutaneous interventional techniques. The authors present a case of a splenic artery aneurysm in a 51-year-old woman, detected incidentally.

delivery systems [7]. Since then it has come to encompass any use of mobile telephony technology to address healthcare challenges such as access, quality, affordability, matching of resources, and behavioral norms [1]. mHealth technologies are a valuable partner in health care’s shift towards a delivery model that is patient-centered and value- based. Mobile technologies can help to facilitate that shift among clinicians, life scientists, and consumers by defining and directing the patient-centered model towards health care that is community-based, integrated, seamless, and assimilated into the daily lives of consumers accustomed to an ’on-demand’ environment. Globally, the demand for mHealth has also been growing. The global mHealth market was estimated at $1.2 billion in 2011 and experts project that the market’s value would increase to $11.8 billion by 2018, implying that the demand is growing at an annual growth rate of 39 percent. Kenya has been on the fore front in the application of the mobile phone technology platform in providing solution to the social problems in the community. Qiang [1] in a World Bank report on mobile applications for the health sector indicated that Kenya has been the cutting edge of the use of mobile technology for development, with its M-PESA mMoney scheme having become a model for similar programs around the world. However, the report revealed that, the country’s adoption of the mHealth technology remains low, while the landscape of the industry is changing rapidly as mHealth enterprises come and go. Half of the mHealth enterprises are less than two years old, and their commercial viability is still in question; only four percent are for profit, and none from any public sector are currently operating sustainably. Several mHealth programs in the country have been launched and run not for profit by the NGOs. For Instance, the Kenyan integrated mobile Maternal and Newborn Child Health information platform (KimMNCHip) which is a national scale effort to provide affordable and accessible mobile health solutions to all pregnant women and mothers with children under 5 everywhere in Kenya. It is run by a cross-sector partnership between the Government of Kenya, Safaricom, World Vision, Care, AMREF, and NetHope [8]. The programme was launched to make use of the 29.2 million mobile subscribers in Kenya on assumption that at least every household, has a phone therefore it is easy to reach the 41 million Kenyans through the mHealth platform.

Let „S‟ be the password of length „T‟ characters. The password could be of any length and any combination of characters like lower case letters, upper case letters, and special characters. The choice of password doesn‟t affect the performance of the algorithm. It is used to enhance the security of the algorithm by one more level. This password is converted into a binary code and is used for storing one of the bits of the 2BC. It is repeated until all bits are embedded. Let E (i, j) be another randomly selected pixel from the cover image. The lower nibble of E will be used to hide the 2BC‟s obtained from the matching positions of M, in different positions as shown in Fig. 2 based on a password. If the password bit is „0‟, then the first bit of 2BC is saved in position 1, else it is saved in position 2. The second bit of 2BC can be saved using the technique described below. Save the second bit in a specific order. For example, the first 10 bits are hidden in position 1 or 2, whichever, is available after embedding the first bit of the 2BC, the next five bits are hidden in position 3 and next bit is hidden in position 4. Repeat the same pattern until all bits are embedded. By using this approach, the PSNR value can be controlled to some degree.

As state institutions, it should be possible to present and make use of electronic government in the function of serving the community. The emphasis in information technology to avoid the digital gap in at least. The provision of better government services to residents, increase interaction with the business world and industry, through access to information for community empowerment, a more efficient government or management. The results of that is expected of a reduction in corruption, the increase in transparency, the increase in comfort, and rising income or reducing expenses. Based on the results of research. Electronic government in the context of the ability to look the ability to run the function of government electronic media and build partnerships with private not optimal it is marked with the need for the allocation of fund optimally and support to work jointly with private companies to more so handling equipment and support for the success of electronic government could be achieved. As an effort to harmonize the acceleration of the completion of work, the licensing of the city of Samarinda must be able to implement the interests of citizens as well as problems faced by. No service to stop because of the support of funding led to the ability to reform it weakened to find appropriate formulations to stiffness in public service is not of stagnation. According to results of the review Khidasseli in Sutedi (2010) that norms behavior officers public service providers (a code of conduct for public officials), who set about norms in an administrative authority: 1) The obligation to work in accordance with the rules of law and standards of conduct of relevance to its function, 2) The obligation to put themselves in a neutral of or free from the

Knowledge management and data mining are still in the development phase and they represent interest- ing areas for researchers. Although there is an inte- grative framework for knowledge management in the context of marketing, there are critical research chal- lenges that should be devoted considerable attention. More information about data mining for marketing can be seen in (Berry & Linoff , 2004). Some of them are connected to data mining techniques and knowl- edge discovery process, while others are related to knowledge management. Data research through data mining techniques is an interactive process of learning similar to other processes of acquiring knowledge, like scientii c research. Selection of data mining al- gorithms, hypothesis forming, model evaluation and remodeling are the key components of the research process. Since the cycle of attempts and failures for progressive adopting are made of the most valuable knowledge through data mining, the aspect of learn- ing through experiments can be suitable for that. One of the research challenges is to make sure that this process is multi-structured, and therefore to increase the productivity of data mining trials. Furthermore, it is needed to manage the knowledge in the sense that it outlines organizational borders and further distributes towards the other partners.

technique was employed in sample selection. In the first stage, the three agricultural zones in the state were purposively selected. Aba, Umuahia and Ohafia. In the second stage three local governments actively involved in agricultural production was purposively selected from each of the agricultural zone making it a total of nine blocks. While In the third stage two communities was randomly selected from each of the local government. Twelve respondents was randomly selected from two sampling group. six each for male and female giving twelve respondents from each cell. A total of 218 respondents was selected for the study. The research instrument used for this study was structured questionnaire and scheduled interview. The result of the objective of the study was analyzed using descriptive statistics such as frequency, percentage, and mean inferential which involves the use of Z-test analysis. The formula used to compute the mean used in this study is specified below. The mean was computed by multiplying the frequency (f) of the responses under each response category by assigned value and dividing the (∑) of the product by the (N) no of respondents to the particular indicator as shown:

household, the program caused an increase of more than 11 percentage points in the probability of attending school. One possible reason for this increase in the estimated impact is the fact that his/her family is only receiving any transfers from the Bolsa Familia program because he/she is attending school. The fear of losing access to the program, which means that it may take time to come back to it in case of harder times ahead, may stimulate parents to monitor their kids’ school attendance more strongly. When these two features were combined — i.e. male youngsters who were the youngest child — the probability of attending school increased by 16.2 percentage points and it is statistically significant at the 1 per cent level.

Abstract: The research was carried with the aim to discover the existence of securing the foremost islands and state border region of the Republic of Indonesia reviewed from a legal perspective, which is directly related to the existence of security and dispute resolution methods as well as the governance of the foremost islands and border region in Kalimantan which bordering Malaysia. This study was conducted in Nunukan district and the surrounding provinces of Kalimantan, in this research method that used is normative legal analysis data with juridical and qualitative descriptive approach. The results showed that the security of foremost islands and border region of law perspective in accordance with the Law No. 34 of 2004 regarding the Indonesian National Army has not been implemented to the fullest to realize the security of foremost islands and border region as the frontline of the Republic of Indonesia. The existence of leading islands securing and the border region of the Republic of Indonesia still contain many weaknesses in terms of both governance and security.

[r]

Subbotko, Methods of distribution of tool at units based on TM software of Guhring, Production Engineering Wroc ł aw University of Technology,(2006) 273- 280 (in Polish).. Bocheński, C[r]