DISTAL SPLENORENAL VS PORTALSYSTEMIC ANASTOMOSIS
(1983)
Abstract :
Interest in alternatives to portacaval shunting for the management of portal hypertension has been the natural consequence of disaffection arising from the publication of controlled trials of that procedure. In the United States, these prospective investigations performed by three separate groups have shown no significant survival benefit when each study is examined separately. Moreover, surgical treatment of the cirrhotic patient with bleeding varices appears to facilitate hepatic failure and metabolic encephalopathy. The mechanism of this post-shunt syndrome has been considered to reflect deprivation of hepatic blood flow and possible hepatotropic pancreatic hormones. In an effort to avoid these sequelae of total shunting, Warren and his colleagues devised the operation of distal splenorenal shunt; this procedure would be anticipated to lower variceal pressure while maintaining prograde portal venous flow to the liver. The technique employed is designed to disconnect the gastrosplenic venous circulation from the splanchnic venous flow. The present study therefore evolved to examine prospectively the benefit/risk ratio for total (portasystemic) shunt versus the selective (Warren or distal splenorenal) shunt in the context of a controlled trial. The experimental design calls for a collaborative arrangement between Boston and New Haven investigators involving a number of hospital teams in the two cities.
| Project Number : | 5R01AM018702-06 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | SGYB |
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| Project Terms : | CARDIOVASCULAR SURGERY, CARDIOVASCULAR SHUNTS, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, GASTROINTESTINAL CIRCULATORY DISORDERS, HEMORRHAGE, GASTROINTESTINAL, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, SURGERY AND BIOENGINEERING STUDY SECTION, THERAPY EVALUATION CARDIOVASCULAR FUNCTION, BLOOD CIRCULATION DYNAMICS (GENERAL), DISEASES, COMPLICATIONS, DISEASES, COMPLICATIONS, POSTOPERATIVE, LIVER CIRCULATORY DISORDERS, PORTAL HYPERTENSION, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, LIVER CIRRHOSIS, LIVER DISORDERS, LIVER FAILURE, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, cooperative study, liver circulation CARDIOVASCULAR VISUALIZATION, ANGIOGRAPHY, HUMAN, CLINICAL, LIVER CIRCULATION, PORTOGRAPHY |
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DISTAL SPLENORENAL VS PORTALSYSTEMIC ANASTOMOSIS
(1983)
Abstract :
Interest in alternatives to portacaval shunting for the management of portal hypertension has been the natural consequence of disaffection arising from the publication of controlled trials of that procedure. In the United States, these prospective investigations performed by three separate groups have shown no significant survival benefit when each study is examined separately. Moreover, surgical treatment of the cirrhotic patient with bleeding varices appears to facilitate hepatic failure and metabolic encephalopathy. The mechanism of this post-shunt syndrome has been considered to reflect deprivation of hepatic blood flow and possible hepatotropic pancreatic hormones. In an effort to avoid these sequelae of total shunting, Warren and his colleagues devised the operation of distal splenorenal shunt; this procedure would be anticipated to lower variceal pressure while maintaining prograde portal venous flow to the liver. The technique employed is designed to disconnect the gastrosplenic venous circulation from the splanchnic venous flow. The present study therefore evolved to examine prospectively the benefit/risk ratio for total (portasystemic) shunt versus the selective (Warren or distal splenorenal) shunt in the context of a controlled trial. The experimental design calls for a collaborative arrangement between Boston and New Haven investigators involving a number of hospital teams in the two cities.
| Project Number : | 5R01AM018702-07 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | SGYB |
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| Project Terms : | CARDIOVASCULAR SURGERY, CARDIOVASCULAR SHUNTS, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, GASTROINTESTINAL CIRCULATORY DISORDERS, HEMORRHAGE, GASTROINTESTINAL, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, SURGERY AND BIOENGINEERING STUDY SECTION, THERAPY EVALUATION CARDIOVASCULAR FUNCTION, BLOOD CIRCULATION DYNAMICS (GENERAL), DISEASES, COMPLICATIONS, DISEASES, COMPLICATIONS, POSTOPERATIVE, LIVER CIRCULATORY DISORDERS, PORTAL HYPERTENSION, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, LIVER CIRRHOSIS, LIVER DISORDERS, LIVER FAILURE, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, cooperative study, liver circulation CARDIOVASCULAR VISUALIZATION, ANGIOGRAPHY, HUMAN, CLINICAL, LIVER CIRCULATION, PORTOGRAPHY |
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DISTAL SPLENORENAL VS PORTALSYSTEMIC ANASTOMOSIS
(1983)
Abstract :
Interest in alternatives to portacaval shunting for the management of portal hypertension has been the natural consequence of disaffection arising from the publication of controlled trials of that procedure. In the United States, these prospective investigations performed by three separate groups have shown no significant survival benefit when each study is examined separately. Moreover, surgical treatment of the cirrhotic patient with bleeding varices appears to facilitate hepatic failure and metabolic encephalopathy. The mechanism of this post-shunt syndrome has been considered to reflect deprivation of hepatic blood flow and possible hepatotropic pancreatic hormones. In an effort to avoid these sequelae of total shunting, Warren and his colleagues devised the operation of distal splenorenal shunt; this procedure would be anticipated to lower variceal pressure while maintaining prograde portal venous flow to the liver. The technique employed is designed to disconnect the gastrosplenic venous circulation from the splanchnic venous flow. The present study therefore evolved to examine prospectively the benefit/risk ratio for total (portasystemic) shunt versus the selective (Warren or distal splenorenal) shunt in the context of a controlled trial. The experimental design calls for a collaborative arrangement between Boston and New Haven investigators involving a number of hospital teams in the two cities.
| Project Number : | 5R01AM018702-08 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | SGYB |
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| Project Terms : | CARDIOVASCULAR SURGERY, CARDIOVASCULAR SHUNTS, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, GASTROINTESTINAL CIRCULATORY DISORDERS, HEMORRHAGE, GASTROINTESTINAL, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, SURGERY AND BIOENGINEERING STUDY SECTION, THERAPY EVALUATION CARDIOVASCULAR FUNCTION, BLOOD CIRCULATION DYNAMICS (GENERAL), DISEASES, COMPLICATIONS, DISEASES, COMPLICATIONS, POSTOPERATIVE, LIVER CIRCULATORY DISORDERS, PORTAL HYPERTENSION, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, LIVER CIRRHOSIS, LIVER DISORDERS, LIVER FAILURE, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, cooperative study, liver circulation CARDIOVASCULAR VISUALIZATION, ANGIOGRAPHY, HUMAN, CLINICAL, LIVER CIRCULATION, PORTOGRAPHY |
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DISTAL SPLENORENAL VS PORTALSYSTEMIC ANASTOMOSIS
(1983)
Abstract :
Portacaval anastomosis (PCA) has been the standard treatment of patients who have bled from varices for more than 25 years. Recent controlled investigations of PCA have shown that although this operation has virtually eliminated hemorrhage from varices, it failed to improve survival significantly. In effect it substituted deaths from hepatic failure and portal-systemic encephalopathy (PSE) for death from hemorrhage. It has been postulated that post-shunt hepatic failure and PSE result from deprivation of hepatotrophic substances in the portal blood. Warren et al devised the distal splenorenal shunt (DSRS) to decompress varices without interrupting portal blood flow to the liver. Preliminary reports indicate that DSRS, although more difficult and of higher operative mortality than PCA, prevents further bleeding without inducing PSE. In 1975 we undertook a controlled, randomized investigation comparing PCA and DSRS in patients who have survived variceal hemorrhage jointly with our associates at Yale University. In the past 33 months we have operated on 28 patients, and the operative mortality and occurrence of PSE in the two groups is similar. We propose to continue this study for 4 years to achieve a total of 80 randomized patients. In the course of this study we propose to compare prospectively the frequency and pathogenesis of a number of "complications" of portacaval anastomosis that have been attributed to portal-systemic shunting and from deprivation of portal blood flow. These include 1) PSE, 2) post-shunt hepatic failure, 3) peptic ulcer disease, 4) hemosiderosis, 5) diabetes. In addition, we will compare the effects of these two operations on hypersplenism and will compare objectively methods for the assessment of shunt patency.
| Project Number : | 2R01AM018702-05 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | SGYB |
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| Project Terms : | CARDIOVASCULAR SURGERY, CARDIOVASCULAR SHUNTS, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, GASTROINTESTINAL CIRCULATORY DISORDERS, HEMORRHAGE, GASTROINTESTINAL, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, SURGERY AND BIOENGINEERING STUDY SECTION, THERAPY EVALUATION CARDIOVASCULAR FUNCTION, BLOOD CIRCULATION DYNAMICS (GENERAL), DISEASES, COMPLICATIONS, DISEASES, COMPLICATIONS, POSTOPERATIVE, LIVER CIRCULATORY DISORDERS, PORTAL HYPERTENSION, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, LIVER CIRRHOSIS, LIVER DISORDERS, LIVER FAILURE, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, cooperative study, liver circulation CARDIOVASCULAR VISUALIZATION, ANGIOGRAPHY, HUMAN, CLINICAL, LIVER CIRCULATION, PORTOGRAPHY |
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DISTAL SPENORENAL VS PORTALSYSTEMIC ANASTOMOSIS
(1979)
Abstract :
Portacaval anastomosis (PCA) is the standard treatment for cirrhotic patients who have bled from esophageal varices. Recent controlled investigations have shown that PCA, which is frequently complicated by postshunt hepatic failure and encephalopathy, does not appreciably prolong survival. The hepatic failure-encephalopathy syndrome has been attributed to the total diversion of portal blood from the liver. Warren and Britton have devised distal splenorenal shunts (SRS) that permit portal venous flow to the liver. The present investigation is a collaborative study by experienced groups from the Lemuel Shattuck Hospital in Boston and the West Haven Veterans Administration Hospital to compare in a prospective, controlled trial SRS and PCA in the management of portal hypertension. We plan to evaluate survival, longevity, recurrence of variceal hemorrhage and the incidence of hepatic failure and portalsystemic encephalopathy. All patients will have pre- and postinclusion angiographic and hepatic hemodynamic evaluations and prolonged followup.
| Project Number : | 1R01AM018702-01 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | SGYB |
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| Project Terms : | CARDIOVASCULAR SURGERY, CARDIOVASCULAR SHUNTS, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, SURGERY STUDY SECTION DISEASES, COMPLICATIONS, POSTOPERATIVE, LIVER CIRCULATORY DISORDERS, PORTAL HYPERTENSION, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, THERAPY EVALUATION, cooperative study CARDIOVASCULAR VISUALIZATION, ANGIOGRAPHY*, HUMAN, CLINICAL |
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DISTAL SPLENORENAL VS PORTALSYSTEMIC ANASTOMOSIS
(1979)
Abstract :
Portacaval anastomosis (PCA) is the standard treatment for cirrhotic patients who have bled from esophageal varices. Recent controlled investigations have shown that PCA, which is frequently complicated by postshunt hepatic failure and encephalopathy, does not appreciably prolong survival. The hepatic failure-encephalopathy syndrome has been attributed to the total diversion of portal blood from the liver. Warren and Britton have devised distal splenorenal shunts (SRS) that permit portal venous flow to the liver. The present investigation is a collaborative study by experienced groups from the Lemuel Shattuck Hospital in Boston and the West Haven Veterans Administration Hospital to compare in a prospective, controlled trial SRS and PCA in the management of portal hypertension. We plan to evaluate survival, longevity, recurrence of variceal hemorrhage and the incidence of hepatic failure and portalsystemic encephalopathy. All patients will have pre- and postinclusion angiographic and hepatic hemodynamic evaluations and prolonged followup.
| Project Number : | 5R01AM018702-02 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | SGYB |
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| Project Terms : | CARDIOVASCULAR SURGERY, CARDIOVASCULAR SHUNTS, DISEASES, COMPLICATIONS, POSTOPERATIVE, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, SURGERY STUDY SECTION CARDIOVASCULAR FUNCTION, BLOOD CIRCULATION DYNAMICS (GENERAL), LIVER CIRCULATION, PORTOGRAPHY, LIVER CIRCULATORY DISORDERS, PORTAL HYPERTENSION, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, LIVER CIRRHOSIS, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, THERAPY EVALUATION, cooperative study CARDIOVASCULAR VISUALIZATION, ANGIOGRAPHY*, HUMAN, CLINICAL |
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DISTAL SPLENORENAL VS PORTALSYSTEMIC ANASTOMOSIS
(1979)
Abstract :
For three decades portacaval anastomosis (PCA) represented the standard surgical therapy for cirrhotic patients with bleeding esophageal varices. Dissatisfaction with this approach could be most clearly ascertained by examining the results of three prospective controlled trials in the USA. These studies reveal that this operation provides only marginal benefit in terms of overall survival and is associated with postshunt hepatic failure and encephalopathy. The total diversion of portal venous inflow from the liver and possibly the systemic shunting of hepatotrophic pancreatic hormones have been considered to be major factors in the pathogenesis of the hepatic injury-encephalopathy syndrome. To obviate these consequences of PCA, Warren and Britton have advocated a distal splenorenal (SRS) shunt; this surgical procedure would theoretically decompress esophagogastric varices while preserving prograde flow to the liver via the portal venous system. The purpose of the present study, therefore, is to allow, by means of prospective controlled investigation, a comparative assessment of portasystemic and SRS in the management of portal hypertension. The study proposal calls for a collaborative effort of two experienced teams of investigators based at the Lemuel Shattuck-Faulkner Hospitals (Boston) and the West Haven VA Hospital (New Haven). BIBLIOGRAPHIC REFERENCES: Shurberg J. L, Resnick RH, Koff RS, Ros E, Baum RA, Pallotta JA: Serum lipids, insulin and glucagon after portacaval shunt in cirrhosis. Gastroenterology 72: 301-304, 1977. Eckardt VF, Grace ND, Osborne MP, Fischer JE: Lower esophageal sphincter pressure and serum gastrin levels after mapped antrectomy. Arch Int. Med, in press, 1977.
| Project Number : | 5R01AM018702-03 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | SGYB |
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| Project Terms : | CARDIOVASCULAR SURGERY, CARDIOVASCULAR SHUNTS, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, GASTROINTESTINAL CIRCULATORY DISORDERS, HEMORRHAGE, GASTROINTESTINAL, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, SURGERY STUDY SECTION, THERAPY EVALUATION CARDIOVASCULAR FUNCTION, BLOOD CIRCULATION DYNAMICS (GENERAL), DISEASES, COMPLICATIONS, DISEASES, COMPLICATIONS, POSTOPERATIVE, LIVER CIRCULATORY DISORDERS, PORTAL HYPERTENSION, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, LIVER CIRRHOSIS, LIVER DISORDERS, LIVER FAILURE, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, cooperative study, liver circulation CARDIOVASCULAR VISUALIZATION, ANGIOGRAPHY*, HUMAN, CLINICAL, LIVER CIRCULATION, PORTOGRAPHY |
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DISTAL SPLENORENAL VS PORTALSYSTEMIC ANASTOMOSIS
(1979)
Abstract :
For three decades portacaval anastomosis (PCA) represented the standard surgical therapy for cirrhotic patients with bleeding esophageal varices. Dissatisfaction with this approach could be most clearly ascertained by examining the results of three prospective controlled trials in the USA. These studies reveal that this operation provides only marginal benefit in terms of overall survival and is associated with postshunt hepatic failure and encephalopathy. The total diversion of portal venous inflow from the liver and possibly the systemic shunting of hepatotrophic pancreatic hormones have been considered to be major factors in the pathogenesis of the hepatic injury-encephalopathy syndrome. To obviate these consequences of PCA, Warren and Britton have advocated a distal splenorenal (SRS) shunt; this surgical procedure would theoretically decompress esophagogastric varices while preserving prograde flow to the liver via the portal venous system. The purpose of the present study, therefore, is to allow, by means of prospective controlled investigation, a comparative assessment of portasystemic and SRS in the management of portal hypertension. The study proposal calls for a collaborative effort of two experienced teams of investigators based at the Lemuel Shattuck-Faulkner Hospitals (Boston) and the West Haven VA Hospital (New Haven).
| Project Number : | 5R01AM018702-04 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | SGYB |
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| Project Terms : | CARDIOVASCULAR SURGERY, CARDIOVASCULAR SHUNTS, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, GASTROINTESTINAL CIRCULATORY DISORDERS, HEMORRHAGE, GASTROINTESTINAL, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, SURGERY AND BIOENGINEERING STUDY SECTION, THERAPY EVALUATION CARDIOVASCULAR FUNCTION, BLOOD CIRCULATION DYNAMICS (GENERAL), DISEASES, COMPLICATIONS, DISEASES, COMPLICATIONS, POSTOPERATIVE, LIVER CIRCULATORY DISORDERS, PORTAL HYPERTENSION, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, LIVER CIRRHOSIS, LIVER DISORDERS, LIVER FAILURE, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, cooperative study, liver circulation CARDIOVASCULAR VISUALIZATION, ANGIOGRAPHY, HUMAN, CLINICAL, LIVER CIRCULATION, PORTOGRAPHY |
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INTERHOSPITAL COOPERATIVE STUDIES OF CIRRHOSIS
(1974)
| Project Number : | 5R01AM009128-09 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | EDC |
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| Project Terms : | GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, GASTROINTESTINAL SURGERY, COLON SURGERY, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, LIVER CIRRHOSIS, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY ADRENAL CORTEX HORMONES ANALOGS, PREDNISONE, BLOOD TREATMENT, HEMODIALYSIS, EPIDEMIOLOGY AND DISEASE CONTROL STUDY SECTION, GASTROINTESTINAL DISORDERS, PEPTIC ULCER, LIVER DISORDERS, HEPATITIS, POPULATION STUDIES HUMAN, MORBIDITY, THIOPURINES, 6-MERCAPTOPURINE, AZATHIOPRINE HUMAN, CLINICAL* |
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INTERHOSPITAL COOPERATIVE STUDIES OF CIRRHOSIS
(1974)
Abstract :
Results of a study of the therapeutic portacaval shunt for treatment of esophageal varices indicate no significant improval in survival as a result of portal decompression. Surgical patients, however, experience significantly fewer episodes of subsequent gastrointestinal hemorrhage after randomization. When surgical patients were separated on the basis of type of shunt employed, the end-to-side shunt appeared to be associated with a trend toward longer survival than the side-to-side anastomosis and non-operative therapy. A prospective controlled trial of 6-methylprednisolone in the management of acute alcoholic hepatitis indicated no improvement in survival during an 8-week in-hospital study. Treatment failure was not associated with excessive corticosteroid toxicity, but appeared to be primarily related to the patient's state at time of selection, i.e., survival could be correlated with the feasibility of biopsy at the time of admission to the study in both the steroid and placebo groups. A prospective controlled trial of penicillamine in the management of acute alcoholic hepatitis indicated no change with respect to survival experience or liver function tests. However, tentative and preliminary data suggest a reduction in fibrosis and hepatocellular injury in penicillamine-treated subjects on the basis of "blind" interpretation of the biopsy material.
| Project Number : | 5R01AM009128-10 |
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| ICD : | NAT INST OF ARTHRITIS, DIABETES, DIGESTIVE & KIDNEY DISEASES |
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| IRG : | EDC |
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| Project Terms : | EPIDEMIOLOGY AND DISEASE CONTROL STUDY SECTION, LIVER CIRCULATION, VENOUS BYPASS OF LIVER, LIVER DISORDERS, LIVER CIRRHOSIS ADRENAL CORTEX HORMONES ANALOGS, PREDNISONE, BLOOD TREATMENT, HEMODIALYSIS, GASTROINTESTINAL CIRCULATORY DISORDERS, ESOPHAGEAL VARICES, GASTROINTESTINAL DISORDERS, PEPTIC ULCER, GASTROINTESTINAL SURGERY, COLON SURGERY, LIVER DISORDERS, HEPATIC COMA-ENCEPHALOPATHY, LIVER DISORDERS, HEPATITIS, POPULATION STUDIES HUMAN, LONGITUDINAL STUDY, POPULATION STUDIES HUMAN, MORBIDITY, THIOPURINES, 6-MERCAPTOPURINE, AZATHIOPRINE HUMAN, CLINICAL* |
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