Franz Karnel

Duplex sonography of tumors of the carotid body.

Five histologically confirmed tumors of the carotid body and seven lymph node metastases in the area of the carotid bifurcation were investigated with real-time sonography. In addition, 10 patients underwent measurements of intratumorous flow by way of a pulsed Doppler system. The typically hypervascular tumors of the carotid body revealed flow signals with standardized adjustment of Doppler sonography. The hypovascularized lymph node metastases did not demonstrate flow on Doppler sonography. In all patients, either preoperative angiography or enhanced computerized tomography was done and these studies confirmed the degree of vascularization of the mass as determined by Doppler sonography. Duplex sonography permitted noninvasive demonstration of hypervascular tumors in the area of the carotid bifurcation, a finding highly suggestive of nonchromaphil paraganglioma of the carotid body.

Percutaneous angioscopy: Improved technique

Ten angioscopies with a pressure infusion set resulted in similar visualization times and irrigation volumes as 42 angioscopies with a specially constructed roller pump. Diagnostic image quality, however, was obtained almost exclusively with the roller pump. Three examinations were nondiagnostic. Total viewing time per patient was approximately 1 min with the roller pump and 2 min with the pressure infusion system. In the 30 patients examined, angioscopy changed the initially chosen form of therapy in 5 patients.

Transjugular intrahepatic portosystemic shunts (TIPS) for the prevention of variceal re-bleeding – A two decades experience

Background and aims Transjugular intrahepatic portosystemic shunts (TIPS) are used in patients with cirrhosis for the prevention of variceal rebleeding. Methods We retrospectively evaluated re-bleeding rate, patency, mortality, and transplant-free survival (TFS) in cirrhotic patients receiving TIPS implantation for variceal bleeding between 1994–2014. Results 286 patients received TIPS (n = 119 bare metal stents, n = 167 polytetrafluorethylene (PTFE)-covered stents) for prevention of variceal re-bleeding. Mean age was 55.1 years, median MELD was 11.8, and the main etiology of cirrhosis was alcoholic liver disease (70%). Median follow-up was 821 days. 67 patients (23%) experienced at least one re-bleeding event. Patients with PTFE-TIPS were at significantly lower risk for variceal re-bleeding than patients with bare metal stents (14% vs. 37%, OR:0.259; p<0.001) and had less need for stent revision (21% vs. 37%; p = 0.024). Patients with PTFE stent grafts showed lower mortality than patients with bare stents after 1 year (19% vs. 31%, p = 0.020) and 2 years (29% vs. 40%; p = 0.041) after TIPS implantation. Occurrence of hepatic encephalopathy after TIPS was similar between groups (20% vs. 24%, p = 0.449). Conclusions PTFE-TIPS were more effective at preventing variceal re-bleeding than bare metal stents due to better patency. Since this tended to translate in improved survival, only covered stents should be implemented for bleeding prophylaxis when TIPS is indicated.

Der transjuguläre intrahepatische porttosystemische Stent-Shunt “TIPSS”—erste Ergebnisse

ZusammenfassungDer transjuguläre intrahepatische portosystemische Stent-Shunt (“TIPSS”) ist eine neue, nichtoperative Methodezur Behandlung von Patienten mit Varizenblutungen. Ohne Laparotomie kann eine hämodynamisch den englumigen Interponatshunts entsprechende Verbindung zwischen einem Pfortaderhauptast und einer Lebervene etabliertund durch eine ballonexpandierbaren, Metallstent offengehalten werden. Die ersten Erfahrungen mit 3 Patienten in Wien werden berichtet. Bei 2 Patienten konnte der TIPSS erfolgreich und komplikationslos durchgeführt werden, beide sind im Follow-up (17 bzw. 3. Wochen) ohne Rezidivblutung. Beim 3. Patienten konnte wegen einer sehr kleinen Leber die Pfortader transjugulär nicht punktiert werden. Der TIPSS stellt eine Alternative zur frühzeitigen Lebertransplantation bei CHILD-B- und-C-Patienten mit schlechten Sklerotherapieergebnissen dar, möglicherweise in Zukunftauch zur Sklerotherapie im Stadium CHILD A nach Erstblutung.SummaryThe “Transjugular intrahepatic portosystemic stent-shunt” (“TIPSS”) is a new nonoperative method for the treatment of recurrent variceal bleedings in patients with portal hypertension Without a need for laporotomy an balloon-expandable sent is placed in an intrahepatic tract between a main portal branch and a hepatic vein. The first experiences with three patients in Vienna/Austria are reported. TIPSS were placed successfully and without complications in2 patients, both are without recurrent bleedings at a follow up of 17 and 3 weeks. In a third patient with a very small liver the portal vein could not be punctured. TIPSS is an potential alternative to shunt surgery in CHILD A patients and an early liver transplantation in CHILD B and C patients with poor results of endoscopic sclerotherapy.