The Hepatic Circulation and Portal Hypertension

Child, Charles G.

doi:10.1097/00007611-195408000-00047

Cited by 81 publications

(63 citation statements)

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“…Child's classification remains the most successful factor in predicting the operative mortality and estimating the surgical risk accrued in patients undergoing porta-systemic shunting procedures (8,9). Elevated preoperative bilirubin levels and the presence of peroperative ascites have been shown to differentiate between probable survivors and nonsurvivors in several studies examining the prognosis of nonshunt laparotomy in cirrhotic patients (9).…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Cuervas-Mons¹,

Millán²,

Gavaler³

et al. 1986

Hepatology

168

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Twenty-seven clinical and laboratory data and the subsequent clinical course of 93 consecutive adult patients who underwent orthotopic liver transplantation for various chronic advanced liver diseases were analyzed retrospectively to assess the risk factors of early major bacterial infection and death after the procedure. Forty-one patients (44%) had early major bacterial infection during hospitalization for orthotopic liver transplantation. The mortality rate was 70.7% in patients with early major bacterial infection and was 7.7% in patients without early major bacterial infection (p < 0.001). Total serum bilirubin, total white blood cell count and polymorphonuclear cell count, IgG (all p < 0.05) and plasma creatinine level (p < 0.001) were higher in patients that developed early major bacterial infection than in those who did not. By step-wise discriminant analysis, the strongest risk factor for early major bacterial infection was the serum creatinine level, which achieved an accuracy of 69% for a creatinine level greater than 1.58 mg per dl.Seven variables (ascites, hepatic encephalopathy, elevated white blood and polymorphonuclear cell count, decreased helper to suppressor T cell ratio and elevated plasma creatinine and bilirubin levels) were associated with a significant increased risk for death. A step-wise discriminant analysis of these seven factors resulted in the demonstration of serum creatinine as the greatest risk factor for mortality. A preoperative serum creatinine either less than or greater than 1.72 mg per dl accurately predicts survival or death, respectively, in 79% of cases. These data suggest that the baseline preoperative serum creatinine level provides the best indication of the short-term prognosis after liver transplantation than does any other preoperatively obtained index of the patient's status.Orthotopic liver transplantation (OLTx) has dramatically altered the otherwise fatal outcome for some patients with advanced chronic liver disease and has been reported to obtain a 70.8% survival in adult patients at 1 year after OLTx (1). Because both economic and human resources are limited within the health care system of most countries and institutions, liver transplantation ideally should be restricted to those patients with the greatest possibility of survival after the procedure, so the selection of appropriate candidates for OLTx has become an issue of considerable concern both for physicians and surgeons involved in the management of patients with advanced hepatic disease.In a recent series of adult patients with OLTx, 75% of the deaths occurred during the first 60 days post-transplantation (2). In this series, infectious complications were the most common cause of death. Ninety percent of the deaths due to infection following OLTx occurred during NIH Public Access Author ManuscriptHepatology. Author manuscript; available in PMC 2010 November 8. Published in final edited form as:Hepatology. 1986 ; 6(5): 922-927. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author M...

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Section: Discussionmentioning

confidence: 99%

Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Cuervas-Mons¹,

Millán²,

Gavaler³

et al. 1986

Hepatology

168

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“…Cirrhosis of the liver, irreversible fibrosis of liver tissue leading to hepatic dysfunction, is a known risk factor for complications after THA and TKA. However, studies of patients with cirrhosis undergoing THAs and TKAs generally have numerous shortcomings, including lack of a control group [8], small sample sizes [7,8,15], contradictory results (increased [8,15] versus no increased risk [7] of complications), and the use of the Child-Pugh [5,14] classification as a measure of disease severity [7-9, 12, 15].…”

Section: Introductionmentioning

confidence: 99%

“…The Child-Pugh [5,14] system has limited clinical use for orthopaedic surgeons for preoperative risk assessment of THAs and TKAs because it involves a subjective assessment of ascites and encephalopathy, entities that rarely are assessed by many orthopaedic surgeons. The Model for End-stage Liver Disease (MELD) [11] score originally was developed to predict survival in patients undergoing transjugular intrahepatic portosystemic shunts, but subsequently was deemed a valid measure of mortality and risk disease severity for patients with end-stage liver disease [10].…”

Section: Introductionmentioning

confidence: 99%

“…The purposes of our study were to determine the differences between patients undergoing elective THAs or TKAs with cirrhosis compared with matched control subjects in (1) hospital length of stay, discharge disposition, and readmission within 90 days; (2) early postoperative (90 days) medical complications potentially related to liver disease (urinary tract infection, acute renal failure, blood transfusion, gastrointestinal hemorrhage); (3) surgical complications (infection, dislocation, reoperation, revision) within 90 days and any time after the procedure; (4) mortality; and in addition, (5) to use the MELD score as a predictor for risk of complications and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Increased Complication Rates After Hip and Knee Arthroplasty in Patients With Cirrhosis of the Liver

Tiberi

Hansen

El-Abbadi

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Risk stratification is critical in patients with cirrhosis undergoing THAs and TKAs, as they may be more likely to have serious medical and surgical complications. As opposed to the Child-Pugh scoring system, which has limited use for orthopaedic surgeons inexperienced in assessing ascites and hepatic encephalopathy, the Model for End-stage Liver Disease (MELD) is an easily calculated, validated scoring system for severity of liver disease based on common laboratory values; however, its usefulness for predicting complications after elective arthroplasty has not been studied. Questions/purposes The purposes of this study were to determine the differences between patients with cirrhosis and control subjects in (1) hospital length of stay, discharge disposition, and readmission within 90 days; (2) early postoperative (90 days) medical complications potentially related to liver disease; (3) surgical complications within 90 days and any time after the procedure; (4) mortality rates after THA and TKA; and in addition, (5) to use the MELD score as a predictor for risk of complications and mortality. Methods Institutional database query software used coding data identified 115 patients with liver cirrhosis before having THAs or TKAs from 2000 to 2012 and 115 control subjects without cirrhosis matched by age, sex, procedure, and year of surgery. Early postoperative and longer-term medical and surgical complications were compared. Regression analysis was used to determine a MELD score that predicted greater risk of complications. Results Compared with matched control subjects, patients with cirrhosis had prolonged length of stay and higher rates of discharge to nursing facilities, readmission in 90 days, and urinary tract infections (p \ 0.01), renal failure (p = 0.03), blood transfusions (p \ 0.01), gastrointestinal hemorrhage (p = 0.04), dislocations (p = 0.01), infections (p = 0.02), and revisions (p = 0.04) within 90 days.One-year (p = 0.01) and longer-term (p = 0.0002) mortality rates were greater in patients with cirrhosis. A MELD score of 10 or greater predicted a three times increased likelihood (odds ratio [OR]) of any complication (95% CI, 1.28-7.00; p = 0.01) and 4.1 times Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research. Informed consent was deemed unnecessary by our institutional review board.

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“…The underlying liver disease of remaining two patients was as follows: chronic active hepatitis C in 1 and non-B, non-C chronic persistent hepatitis in 1. All patients were classified on admission A large number of small hepatocellular carcinomas (HCCs) according to Child's grade for portal hypertension 24 ; for Child C, a less than 3 cm in diameter have been detected by an early single worst criterion was used (albumin°3 g/dL, total bilirubin detection screening program for HCC in endemic regions. [1][2][3] ¢3 mg/dL, massive ascites, or hepatic encephalopathy).…”

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confidence: 99%

Treatment of nodular hepatocellular carcinoma larger than 3 cm with ultrasound-guided percutaneous acetic acid injection

et al. 1996

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achieve complete necrosis of HCC. [9][10][11][12][13][14] The long-term survival To assess the efficacy of ultrasound-guided percutanerate for patients with large HCC after TAE is low. [15][16][17] Thus, ous acetic acid (15%, 20%, 30%, 40%, and 50% in concenthere is a strong demand for other effective therapies and for tration) injection for a large nodular hepatocellular carimprovement of TAE results in the treatment of large HCC. cinoma (HCC), percutaneous acetic acid injection wasRecently, we developed a technique called ultrasound (US)-performed using 15% to 50% acetic acid in 28 patients guided percutaneous acetic acid injection (PAI) in which 15% who had one single nodular HCC larger than 3 cm or to 50% acetic acid is used for the treatment of small HCC one main tumor with fewer than two HCCs smaller than and reported that this was effective in the treatment of HCC 3 cm during the past 7.5 years; the main tumor was smaller than 3 cm 19,20 because none of the tumors treated slightly hypervascular in nine patients and was highly with PAI grew again, and the survival rates for patients after hypervascular, showing viable cancer cells despite PAI were better than those for untreated patients. 19-23 transcatheter arterial embolization in 19 patients. DurHerein, we report our experience of US-guided PAI in 28 ing the series of treatment sessions for each patient, the patients with nodular HCC larger than 3 cm that was slightly same concentration of acetic acid was used. Eight (89%) hypervascular (n Å 9) or was highly hypervascular and of nine slightly hypervascular main tumors, 18 (95%) of showed viable cancer cells despite TAE (n Å 19). highly hypervascular main tumors, and all 14 small tumors were treated successfully. No serious complica-PATIENTS AND METHODS tions occurred as a direct sequela to acetic acid injec-Twenty-eight patients with nodular HCC ú3 cm in diameter untion. The 1-, 2-and 3-year recurrence rate from the origiderwent US-guided PAI using concentrations of a 15%, 20%, 30%, nal main tumor was 0%, 20%, and 20%, respectively, in 40%, and 50% acetic acid solution at the Third Department of Medipatients treated with percutaneous acetic acid injection cine, Saitama Medical School, Japan, and two affiliated hospitals in alone and 12%, 24%, and 24% in patients treated with Chiba City, Japan, during the past 7.5 years. Informed consent was percutaneous acetic acid injection after transcatheter obtained from each patient and a family member before treatment. arterial embolization (P Å NS). The 1-, 2-, 3-, 4-, and 5-Percutaneous acetic acid injection was performed on an inpatient year survival rates were 100%, 80%, 80%, 80%, and 0%, basis. Criteria for treatment with PAI included the following: (1) respectively, in the former and 90%, 81%, 81%, 61%, and nodular HCC lesion with a diameter ú3 cm, occurring singly or in association with no more than two small HCCs õ3 cm, (2) US detec-61% in the latter (P Å NS). Percutaneous acetic acid intion of the lesion, and (3) no evidence of portal vein thrombosis or j...

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The Hepatic Circulation and Portal Hypertension

Cited by 81 publications

References 0 publications

Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Increased Complication Rates After Hip and Knee Arthroplasty in Patients With Cirrhosis of the Liver

Treatment of nodular hepatocellular carcinoma larger than 3 cm with ultrasound-guided percutaneous acetic acid injection

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