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Hendrik Vilstrup - One of the best experts on this subject based on the ideXlab platform.

  • soluble cd163 a marker of kupffer cell activation is related to portal hypertension in patients with Liver cirrhosis
    Alimentary Pharmacology & Therapeutics, 2012
    Co-Authors: Henning Grønbæk, Hendrik Vilstrup, Christian Mortensen, Thomas Damgaard Sandahl, Holger Jon Moller, Søren Møller
    Abstract:

    Summary Background Activation of Kupffer cells may be involved in the pathogenesis of portal hypertension by release of vasoconstrictive substances and fibrosis due to co-activation of hepatic stellate cells. Aim To study soluble plasma (s) CD163, a specific marker of activated macrophages, as a biomarker for portal hypertension in patients with Liver cirrhosis. Methods We measured sCD163 concentration and the hepatic venous pressure gradient (HVPG) by Liver Vein catheterisation in 81 cirrhosis patients (Child–Pugh CP-A: n = 26, CP-B: n = 29, CP-C: n = 26) and 22 healthy subjects. We also measured their cardiac output (CO), cardiac index and systemic vascular resistance (SVR). Liver status was examined by Child–Pugh and MELD-score. Results In cirrhosis, sCD163 concentration was nearly three times higher than in controls (4.7 ± 2.5 vs. 1.6 ± 0.5 mg/L, P   3.95 mg/L (upper normal limit) predicted HVPG ≥ 10 mmHg with a positive predictive value of 0.99. Conclusions Circulating sCD163 originating from activated Kupffer cells is increased in cirrhosis with increasing Child–Pugh score and with increasing HVPG, and it is an independent predictor for HVPG. These findings support a primary role of macrophage activation in portal hypertension, and may indicate a target for biological intervention.

  • Combined Liver Vein and spleen pulp pressure measurements in patients with portal or splenic Vein thrombosis
    Scandinavian journal of gastroenterology, 2004
    Co-Authors: Susanne Keiding, J. Solvig, Henning Grønbæk, Hendrik Vilstrup
    Abstract:

    Background: Patients with thrombosis of the portal or splenic Vein may develop portal hypertension with bleeding from oesophageal or gastric varices. The relevant portal pressure cannot be measured by Liver Vein catheterization or transhepatic puncture of the portal Vein because the obstruction is peripheral to the accessible part of the portal system. Methods: Liver Vein catheterization was combined with percutaneous splenic pressure measurement in 10 patients with portal or splenic Vein thrombosis and no cirrhosis, and 10 cirrhotic patients without thrombosis. The splenic pressure was measured by percutaneous puncture below the curvature of the ribs with an angle of the needle to skin of 30° in order to minimize the risk of cutting the spleen if the patient took a deep breath. Results: None of the patients in whom the described procedure was followed had complications. Pressure measurements in the spleen pulp and splenic Vein were concordant. The pressure gradient across the portal venous system (spleni...

  • budd chiari and inferior caval Vein syndromes due to membranous obstruction of the Liver Veins successful treatment with angioplasty and transcaval transjugular intrahepatic porto systemic shunt
    Scandinavian Journal of Gastroenterology, 2004
    Co-Authors: Peter Hollandfischer, Susanne Keiding, Henning Grønbæk, Lone Bording Astrup, Tonner D Nielsen, Hendrik Vilstrup
    Abstract:

    The case is presented of a 25‐year‐old Caucasian patient with Budd‐Chiari syndrome due to membranous obstruction of the Liver Veins and inferior caval Vein syndrome as a result of secondary hyperplasia of the caudate lobe of the Liver, obstructing the caval Vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and Liver Vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic Vein and subsequent transjugular intrahepatic porto‐systemic shunt (TIPS) insertion via the caval Vein was successful. After 34 months of follow‐up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic Vein stenosis and TIPS in Budd‐Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce Liver engorgement and complications ...

  • Budd-Chiari and inferior caval Vein syndromes due to membranous obstruction of the Liver Veins: successful treatment with angioplasty and transcaval transjugular intrahepatic porto-systemic shunt.
    Scandinavian journal of gastroenterology, 2004
    Co-Authors: Peter Holland-fischer, Susanne Keiding, Henning Grønbæk, Lone Bording Astrup, D. Tønner Nielsen, Hendrik Vilstrup
    Abstract:

    The case is presented of a 25-year-old Caucasian patient with Budd-Chiari syndrome due to membranous obstruction of the Liver Veins and inferior caval Vein syndrome as a result of secondary hyperplasia of the caudate lobe of the Liver, obstructing the caval Vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and Liver Vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic Vein and subsequent transjugular intrahepatic porto-systemic shunt (TIPS) insertion via the caval Vein was successful. After 34 months of follow-up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic Vein stenosis and TIPS in Budd-Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce Liver engorgement and complications of portal hypertension in selected patients with Budd-Chiari syndrome.

Susanne Keiding - One of the best experts on this subject based on the ideXlab platform.

  • A microvascular compartment model validated using 11C-methylglucose Liver PET in pigs.
    Physics in medicine and biology, 2017
    Co-Authors: Ole Lajord Munk, Susanne Keiding, Charles Baker, Ludvik Bass
    Abstract:

    The standard compartment model (CM) is widely used to analyse dynamic PET data. The CM is fitted to time-activity curves to estimate rate constants that describe the transport of a tracer between well-mixed compartments. The aim of this study was to develop and validate a more realistic microvascular compartment model (MCM) that includes capillary tracer concentration gradients, backflux from cells into the perfused capillaries and multiple re-uptakes during the passage through a capillary. The MCM incorporates only parameters with clear physiological meaning, it is easy to implement, and it does not require numerical solution. We compared the MCM and CM for the analysis of 3 min dynamic PET data of pig Livers (N  =  5) following injection of 11C-methylglucose. During PET scans, the tracer concentrations in blood were measured in the abdominal aorta, portal Vein and Liver Vein by manual sampling. We found that the MCM outperformed the CM and that dynamic PET data include information which cannot be extracted using standard CM. The MCM fitted dynamic PET data better than the CM (Akaike values were 46  ±  4 for best MCM fits, and 82  ±  8 for best CM fits; mean  ±  standard deviation) and extracted physiologically reasonable parameter estimates such as blood perfusion that were in agreement with independent measurements. The difference between model-independent perfusion estimates and the best MCM perfusion estimates was  -0.01  ±  0.05 ml/ml/min, whereas the difference was 0.30  ±  0.13 ml/ml/min using the CM. In addition, the MCM predicted the time course of concentrations in the Liver Vein, a prediction fundamentally unobtainable using the CM as it does not return tracer backflux from cells to capillary blood. The results demonstrate the benefit of using models that include more physiology and that models including concentration gradients should be preferred when analysing the blood-cell exchange of any tracer in any capillary bed.

  • Combined Liver Vein and spleen pulp pressure measurements in patients with portal or splenic Vein thrombosis
    Scandinavian journal of gastroenterology, 2004
    Co-Authors: Susanne Keiding, J. Solvig, Henning Grønbæk, Hendrik Vilstrup
    Abstract:

    Background: Patients with thrombosis of the portal or splenic Vein may develop portal hypertension with bleeding from oesophageal or gastric varices. The relevant portal pressure cannot be measured by Liver Vein catheterization or transhepatic puncture of the portal Vein because the obstruction is peripheral to the accessible part of the portal system. Methods: Liver Vein catheterization was combined with percutaneous splenic pressure measurement in 10 patients with portal or splenic Vein thrombosis and no cirrhosis, and 10 cirrhotic patients without thrombosis. The splenic pressure was measured by percutaneous puncture below the curvature of the ribs with an angle of the needle to skin of 30° in order to minimize the risk of cutting the spleen if the patient took a deep breath. Results: None of the patients in whom the described procedure was followed had complications. Pressure measurements in the spleen pulp and splenic Vein were concordant. The pressure gradient across the portal venous system (spleni...

  • budd chiari and inferior caval Vein syndromes due to membranous obstruction of the Liver Veins successful treatment with angioplasty and transcaval transjugular intrahepatic porto systemic shunt
    Scandinavian Journal of Gastroenterology, 2004
    Co-Authors: Peter Hollandfischer, Susanne Keiding, Henning Grønbæk, Lone Bording Astrup, Tonner D Nielsen, Hendrik Vilstrup
    Abstract:

    The case is presented of a 25‐year‐old Caucasian patient with Budd‐Chiari syndrome due to membranous obstruction of the Liver Veins and inferior caval Vein syndrome as a result of secondary hyperplasia of the caudate lobe of the Liver, obstructing the caval Vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and Liver Vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic Vein and subsequent transjugular intrahepatic porto‐systemic shunt (TIPS) insertion via the caval Vein was successful. After 34 months of follow‐up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic Vein stenosis and TIPS in Budd‐Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce Liver engorgement and complications ...

  • Budd-Chiari and inferior caval Vein syndromes due to membranous obstruction of the Liver Veins: successful treatment with angioplasty and transcaval transjugular intrahepatic porto-systemic shunt.
    Scandinavian journal of gastroenterology, 2004
    Co-Authors: Peter Holland-fischer, Susanne Keiding, Henning Grønbæk, Lone Bording Astrup, D. Tønner Nielsen, Hendrik Vilstrup
    Abstract:

    The case is presented of a 25-year-old Caucasian patient with Budd-Chiari syndrome due to membranous obstruction of the Liver Veins and inferior caval Vein syndrome as a result of secondary hyperplasia of the caudate lobe of the Liver, obstructing the caval Vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and Liver Vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic Vein and subsequent transjugular intrahepatic porto-systemic shunt (TIPS) insertion via the caval Vein was successful. After 34 months of follow-up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic Vein stenosis and TIPS in Budd-Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce Liver engorgement and complications of portal hypertension in selected patients with Budd-Chiari syndrome.

  • Intrahepatic Heterogeneity of Hepatic Venous Pressure Gradient in Human Cirrhosis Again
    Scandinavian journal of gastroenterology, 2002
    Co-Authors: Susanne Keiding, H Vilstrup
    Abstract:

    Background: The hepatic venous pressure gradient (HVPG) is used to evaluate portal hypertension. Methods: We measured HVPG in two separate Liver Veins in 169 Liver Vein catheterizations in 102 cirrhosis patients and in 27 patients with no Liver disease (controls). Results: In the controls, the two measurements differed by 0.0 ± 1.8 mmHg (mean ± s , n = 27), upper 95% confidence limit 3.6 mmHg (mean + 2 s ). HVPG ranged from-0.1 to 8.3 mmHg, upper 95% confidence limit 6.7 mmHg. In cirrhosis, the two measurements agreed within ± 3.6 mmHg in 39%. In 61%, the measurements differed by 4-34 mmHg. In 35%, fluoroscopy demonstrated hepatic Vein-to-hepatic-Vein shunting in Veins with low HVPG values. In some patients with HVPG measurements above 30 mmHg, Doppler ultrasound examination showed arterialization of the hepatic vasculature. Discussion: Our results demonstrate a hitherto unrecognized notable heterogeneity of the intrahepatic vasculature and HVPG measurements in cirrhosis. The presumption of interposition ...

Henning Grønbæk - One of the best experts on this subject based on the ideXlab platform.

  • Adult Presentation of Noncirrhotic Portal Hypertension and Ascites following Treatment for Wilms' Tumor in Childhood.
    Case reports in gastroenterology, 2018
    Co-Authors: Linda Kievit, Pia Kræmer, Stephen Hamilton-dutoit, Henning Grønbæk
    Abstract:

    A 37-year-old male, who at the age of 8 years had been treated for right-sided Wilms' tumor with nephrectomy, radiotherapy, and chemotherapy, presented with noncirrhotic portal hypertension (NCPH), grade 2 esophageal varices, and ascites. A CT scan demonstrated hypoplasia of Liver segments 2 and 3. A Liver biopsy showed portal tract fibrosis without cirrhosis, with histological features of NCPH. Liver Vein catheterization showed a normal portal pressure gradient of 5 mm Hg while spleen to hepatic Vein pressure was 29 mm Hg. NCPH after therapy for Wilms' tumor is described in children within the first few years after treatment. This is the first case report in which the patient first presented symptoms as an adult, many years after cancer treatment.

  • soluble cd163 a marker of kupffer cell activation is related to portal hypertension in patients with Liver cirrhosis
    Alimentary Pharmacology & Therapeutics, 2012
    Co-Authors: Henning Grønbæk, Hendrik Vilstrup, Christian Mortensen, Thomas Damgaard Sandahl, Holger Jon Moller, Søren Møller
    Abstract:

    Summary Background Activation of Kupffer cells may be involved in the pathogenesis of portal hypertension by release of vasoconstrictive substances and fibrosis due to co-activation of hepatic stellate cells. Aim To study soluble plasma (s) CD163, a specific marker of activated macrophages, as a biomarker for portal hypertension in patients with Liver cirrhosis. Methods We measured sCD163 concentration and the hepatic venous pressure gradient (HVPG) by Liver Vein catheterisation in 81 cirrhosis patients (Child–Pugh CP-A: n = 26, CP-B: n = 29, CP-C: n = 26) and 22 healthy subjects. We also measured their cardiac output (CO), cardiac index and systemic vascular resistance (SVR). Liver status was examined by Child–Pugh and MELD-score. Results In cirrhosis, sCD163 concentration was nearly three times higher than in controls (4.7 ± 2.5 vs. 1.6 ± 0.5 mg/L, P   3.95 mg/L (upper normal limit) predicted HVPG ≥ 10 mmHg with a positive predictive value of 0.99. Conclusions Circulating sCD163 originating from activated Kupffer cells is increased in cirrhosis with increasing Child–Pugh score and with increasing HVPG, and it is an independent predictor for HVPG. These findings support a primary role of macrophage activation in portal hypertension, and may indicate a target for biological intervention.

  • Combined Liver Vein and spleen pulp pressure measurements in patients with portal or splenic Vein thrombosis
    Scandinavian journal of gastroenterology, 2004
    Co-Authors: Susanne Keiding, J. Solvig, Henning Grønbæk, Hendrik Vilstrup
    Abstract:

    Background: Patients with thrombosis of the portal or splenic Vein may develop portal hypertension with bleeding from oesophageal or gastric varices. The relevant portal pressure cannot be measured by Liver Vein catheterization or transhepatic puncture of the portal Vein because the obstruction is peripheral to the accessible part of the portal system. Methods: Liver Vein catheterization was combined with percutaneous splenic pressure measurement in 10 patients with portal or splenic Vein thrombosis and no cirrhosis, and 10 cirrhotic patients without thrombosis. The splenic pressure was measured by percutaneous puncture below the curvature of the ribs with an angle of the needle to skin of 30° in order to minimize the risk of cutting the spleen if the patient took a deep breath. Results: None of the patients in whom the described procedure was followed had complications. Pressure measurements in the spleen pulp and splenic Vein were concordant. The pressure gradient across the portal venous system (spleni...

  • budd chiari and inferior caval Vein syndromes due to membranous obstruction of the Liver Veins successful treatment with angioplasty and transcaval transjugular intrahepatic porto systemic shunt
    Scandinavian Journal of Gastroenterology, 2004
    Co-Authors: Peter Hollandfischer, Susanne Keiding, Henning Grønbæk, Lone Bording Astrup, Tonner D Nielsen, Hendrik Vilstrup
    Abstract:

    The case is presented of a 25‐year‐old Caucasian patient with Budd‐Chiari syndrome due to membranous obstruction of the Liver Veins and inferior caval Vein syndrome as a result of secondary hyperplasia of the caudate lobe of the Liver, obstructing the caval Vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and Liver Vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic Vein and subsequent transjugular intrahepatic porto‐systemic shunt (TIPS) insertion via the caval Vein was successful. After 34 months of follow‐up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic Vein stenosis and TIPS in Budd‐Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce Liver engorgement and complications ...

  • Budd-Chiari and inferior caval Vein syndromes due to membranous obstruction of the Liver Veins: successful treatment with angioplasty and transcaval transjugular intrahepatic porto-systemic shunt.
    Scandinavian journal of gastroenterology, 2004
    Co-Authors: Peter Holland-fischer, Susanne Keiding, Henning Grønbæk, Lone Bording Astrup, D. Tønner Nielsen, Hendrik Vilstrup
    Abstract:

    The case is presented of a 25-year-old Caucasian patient with Budd-Chiari syndrome due to membranous obstruction of the Liver Veins and inferior caval Vein syndrome as a result of secondary hyperplasia of the caudate lobe of the Liver, obstructing the caval Vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and Liver Vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic Vein and subsequent transjugular intrahepatic porto-systemic shunt (TIPS) insertion via the caval Vein was successful. After 34 months of follow-up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic Vein stenosis and TIPS in Budd-Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce Liver engorgement and complications of portal hypertension in selected patients with Budd-Chiari syndrome.

Wojciech Cwikiel - One of the best experts on this subject based on the ideXlab platform.

  • Acute effects of Liver Vein occlusion by stent-graft placed in transjugular intrahepatic portosystemic shunt channel: an experimental study.
    Cardiovascular and interventional radiology, 2005
    Co-Authors: Inger Keussen, Lennart Bergqvist, Pehr Rissler, Wojciech Cwikiel
    Abstract:

    The purpose of this study was to evaluate the effects of hepatic Vein occlusion by stent-graft used in transjugular intrahepatic portosystemic shunt (TIPS). The experiments were performed in six healthy pigs under general anesthesia. Following percutaneous transhepatic implantation of a port-a-cath in the right hepatic Vein, TIPS was created with a stent-graft (Viatorr; W L Gore, Flagstaff, AZ, USA). The outflow from the hepatic Vein, blocked by the stent-graft was documented by injection of contrast medium and repeated injections of 99Tcm-labeled human serum albumin through the port-a-cath. After 2 weeks, the outflow was re-evaluated, the pigs were sacrificed, and histopathologic examination of the Liver was performed. Occlusion of the hepatic Vein by a stent-graft had a short and temporary effect on the outflow. Histopathological examination from the affected Liver segment showed no divergent pattern. Stent-grafts used in TIPS block the outflow from the Liver Vein, but do not have a prolonged circulatory effect and do not affect the Liver parenchyma.

  • Changes in the Distribution of Hepatic Arterial Blood Flow Following TIPS with Uncovered Stent and Stent-Graft: An Experimental Study
    CardioVascular and Interventional Radiology, 2002
    Co-Authors: Inger Keussen, Ho-young Song, Marika Bajc, Wojciech Cwikiel
    Abstract:

    Purpose: To evaluate changes in distribution of hepatic arterial blood flow in the Liver following insertion of an uncovered stent and subsequently a stent-graft in the transjugular intrahepatic portosystemic shunt (TIPS) channel. Methods: The experiments were performed in eight healthy pigs under general anesthesia. In a pilot study in one pig, scintigraphic evaluation of arterial perfusion to the Liver was done before and after inflation of a balloon in the right hepatic Vein. In the other pigs, outflow from the right Liver Vein was checked repeatedly by contrast injection through a percutaneously inserted catheter. The arterial perfusion through the Liver was examined by scintigraphy, following selective injection of macro-aggregate of 99Tc m-labeled human serum albumin 99Tc m-HSA) into the hepatic artery. This examination was done before and after creation of a TIPS with an uncovered stent and subsequently after insertion of a covered stent-graft into the cranial portion of the shunt channel. Results: In the pilot study changes in the arterial perfusion to the Liver were easily detectable by scintigraphy. One pig died during the procedure and another pig was excluded due to dislodgement of the hepatic artery catheter. The inserted covered stent obstructed venous outflow from part of the right Liver lobe. The 99Tc m-HSA activity in this part remained unchanged after TIPS creation with an uncovered stent. A reduction in activity was seen after insertion of a stent-graft (p= 0.06). Conclusion: The distribution of the hepatic arterial blood flow is affected by creation of a TIPS with a stent-graft, in the experimental pig model.

Lone Bording Astrup - One of the best experts on this subject based on the ideXlab platform.

  • budd chiari and inferior caval Vein syndromes due to membranous obstruction of the Liver Veins successful treatment with angioplasty and transcaval transjugular intrahepatic porto systemic shunt
    Scandinavian Journal of Gastroenterology, 2004
    Co-Authors: Peter Hollandfischer, Susanne Keiding, Henning Grønbæk, Lone Bording Astrup, Tonner D Nielsen, Hendrik Vilstrup
    Abstract:

    The case is presented of a 25‐year‐old Caucasian patient with Budd‐Chiari syndrome due to membranous obstruction of the Liver Veins and inferior caval Vein syndrome as a result of secondary hyperplasia of the caudate lobe of the Liver, obstructing the caval Vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and Liver Vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic Vein and subsequent transjugular intrahepatic porto‐systemic shunt (TIPS) insertion via the caval Vein was successful. After 34 months of follow‐up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic Vein stenosis and TIPS in Budd‐Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce Liver engorgement and complications ...

  • Budd-Chiari and inferior caval Vein syndromes due to membranous obstruction of the Liver Veins: successful treatment with angioplasty and transcaval transjugular intrahepatic porto-systemic shunt.
    Scandinavian journal of gastroenterology, 2004
    Co-Authors: Peter Holland-fischer, Susanne Keiding, Henning Grønbæk, Lone Bording Astrup, D. Tønner Nielsen, Hendrik Vilstrup
    Abstract:

    The case is presented of a 25-year-old Caucasian patient with Budd-Chiari syndrome due to membranous obstruction of the Liver Veins and inferior caval Vein syndrome as a result of secondary hyperplasia of the caudate lobe of the Liver, obstructing the caval Vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and Liver Vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic Vein and subsequent transjugular intrahepatic porto-systemic shunt (TIPS) insertion via the caval Vein was successful. After 34 months of follow-up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic Vein stenosis and TIPS in Budd-Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce Liver engorgement and complications of portal hypertension in selected patients with Budd-Chiari syndrome.