[The clinical efficacy and complications of the transjugular intrahepatic portosystemic shunt-stent]. / Eficacia clínica y complicaciones del shunt-stent portosistémico intrahepático transyugular.

TIPSS is a new therapeutic modality for decompressing the portal tree and its use has broadened in the last five years. From February 1993 to August 1994 a prospective study was performed to evaluate its efficacy and safety. Nineteen cirrhotic patients (Child A-5, B-10, and C-4) with a TIPSS placed were included. The mean follow-up was 7.2 months. The indication was therapy of esophageal variceal bleeding in 18 patients (acutely in 8 and elective in 10 patients) and refractory ascites in one. In all cases could the "stent" be placed and the portocaval gradient decreased from 22.8 +/- 3.71 to 9.3 +/- 2.27 mmHg. In the first thirty days the mortality rate was 10.5%, with the following complications: two portal thromboses, two acute non-lithiasic cholecystitis, one hemoperitoneum, one spontaneous bacterial peritonitis, and one hepatic encephalopathy. During the follow-up period two patients developed hemorrhagic relapses and two additional patients subclinical encephalopathy. TIPSS dysfunction was observed in 57.8%.

[Effects of blood volume expansion on atrial natriuretic factor and the renin-aldosterone axis in experimental cirrhosis]. / Efectos de la expansión de la volemia sobre el factor auricular natriurético y el eje renina-aldosterona en la cirrosis experimental.

Serum concentrations of ANF, Renin and Aldosterone were measured in animals with experimental cirrhosis and volume overload. We studied 75 Wistar rats divided in five groups. Group I: rats with hepatic cirrhosis induced by CCl4; Group II: Control rats; Group III: rats with hepatic cirrhosis and continuous infusion of saline serum; Group IV: control rats with continuous infusion and Group V: cirrhotic rats and bolus infusion of saline. There were no statistical differences in serum concentrations of ANF (232 +/- 75 vs 195 +/- 42 pg/ml) and Renin concentration (182 +/- 24 vs 171 +/- 34 ng/ml/hour) between controls and rats with cirrhosis. However, Aldosterone levels were elevated in cirrhotic rats in basal conditions as compared to controls (1197 +/- 287 vs 475 +/- 88 pg/ml; p < 0.001). The volume overload caused a paradoxical decrease of ANF in cirrhotic rats (124 +/- 15 and 122 +/- 17; p < 0.001). On the other hand, no changes were observed in Renin and Aldosterone after volume expansion. These results suggest the existence of a hemodynamic response to compensate the volume overload. Other studies are necessary to confirm this hypothesis.

[Importance of portal hypertension in the release of tissue plasminogen activator (t-PA): experimental study in the rat]. / Importancia de la hipertensión portal en la liberación de activador tisular del plasminógeno (t-PA): estudio experimental en la rata.

Tissue plasminogen activator (t-PA) activity was studied in three different experimental models of male Wistar rats; hepatic lesion without portal hypertension, portal hypertension without hepatic lesion and portal hypertension plus function liver suppression by ligation of both portal vein and hepatic artery. t-PA activity was higher in animals with portal hypertension alone than in animals with only hepatic lesion (146%). Maximal values were present in animals with functional liver suppression (1.774% vs. controls, 248% vs. hepatic lesion and 169% vs. portal hypertension only). These results suggest that both reduced hepatic t-PA clearance and portal hypertension could be involved in the increased t-PA activity normally appearing in chronic liver disease.