scholarly journals VALUE OF CLINICAL, LABORATORY PARAMETERS AND ANALYSIS OF RETINAL VASCULARIZATION IN PEDIATRIC PATIENTS WITH PORTAL HYPERTENSION

2020 ◽  
Vol 57 (2) ◽  
pp. 121-125
Author(s):  
Mariana Batista GONÇALVES ◽  
Bruno de Queiroz ALVES ◽  
Bruna Ferraço MARIANELLI ◽  
Murilo Ubukata POLIZELLI ◽  
Ramiro Anthero de AZEVEDO ◽  
...  
Keyword(s):  
Platelet Count ◽  
Portal Hypertension ◽  
Pediatric Patients ◽  
Fundus Photography ◽  
Aspartate Transaminase ◽  
Digestive Endoscopy ◽  
Gastroesophageal Varices ◽  
Laboratory Parameters ◽  
Vascular Tortuosity ◽  
Retinal Vascular Tortuosity

ABSTRACT BACKGROUND: Portal hypertension is one of the complications of cirrhosis and is associated with numerous systemic manifestations, including renal, brain, pulmonary, cardiac and vascular changes. In routine ophthalmological examinations performed at our service, we observed that some children diagnosed with portal hypertension had increased retinal vascular tortuosity. OBJECTIVE: 1. To evaluate the presence of retinal vascular abnormalities (vascular tortuosity) in children diagnosed with portal hypertension; 2. To investigate the association between retinal vascular tortuosity and the presence of gastroesophageal varices in these children; 3. To evaluate the use of clinical and laboratory parameters to predict the presence of gastroesophageal varices in children with portal hypertension. METHODS: This was a cross-sectional and observational study that included patients aged <18 years with a diagnosis of portal hypertension. The participants included were submitted to dilated fundus examination and fundus photography with Visucam (Carl Zeiss Meditec AG) device. Besides, clinical and laboratorial data were collected from the patients’ medical records. RESULTS: A total of 72 patients were included in this study, and 36% of them had an increase in retinal vascular tortuosity. Platelet count (P=0.001), bilirubin dosage (P=0.013) and aspartate transaminase dosage (AST) (P=0.042) were associated with the presence of gastroesophageal varices in digestive endoscopy. There was no association between retinal vascular tortuosity and the presence of gastroesophageal varices (P=0.498). CONCLUSION: The results of this study suggest that platelet count, bilirubin dosage, and aspartate transaminase dosage were associated with the presence of gastroesophageal varices in digestive endoscopy. Regarding the retinal findings, we found that there was an increase in retinal vascular tortuosity in 36% of pediatric patients, but no association was found with the presence of gastroesophageal varices.

scholarly journals Acute Macular Neuroretinopathy in a Patient with Retinal Vascular Tortuosity

2021 ◽  
pp. 412-417
Author(s):  
Izabella Karska-Basta ◽  
Weronika Pociej-Marciak ◽  
Bożena Romanowska-Dixon ◽  
Barbara Bukowska-Mikos
Keyword(s):  
Rare Case ◽  
Imaging Techniques ◽  
Fundus Photography ◽  
Common Finding ◽  
Retinal Vessels ◽  
Vascular Tortuosity ◽  
Acute Macular Neuroretinopathy ◽  
The Right ◽  
Retinal Vascular Tortuosity

We report a rare case of a young woman with acute macular neuroretinopathy (AMN) in the right eye and concomitant retinal vascular tortuosity in both eyes. A 19-years-old woman presented with a sudden loss of central vision in the right eye. Apart from flu-like infection 2 weeks before the onset of symptoms, she reported overall good health. She used oral contraceptive pills. Multimodal imaging techniques including color fundus photography, fundus autofluorescence, infrared reflectance imaging, fluorescein angiography, swept-source optical coherence tomography (SS-OCT), and visual field assessment were used for the diagnosis of AMN as well as disease monitoring during follow-up. At presentation, ophthalmoscopy revealed a reddish parafoveal lesion, while SS-OCT showed hyper-reflectivity in the outer plexiform and outer nuclear layers with a slightly disrupted inner segment/outer segment junction. All these imaging findings indicated AMN, but the interpretation was slightly difficult due to the presence of tortuous retinal arteries in both eyes. During the disease course, functional and morphological recovery was documented at 1- and 6-month follow-up. However, as the abnormal appearance of the retinal vessels did not change, congenital retinal vascular tortuosity was diagnosed. Since the pathogenesis of AMN has not been fully elucidated, there is currently no effective treatment. Numerous studies have emphasized a vascular origin and the key role of ischemia in AMN. Our rare case suggests that congenital tortuosity of the retinal vessels, although constituting a common finding in healthy individuals, may be involved in the pathophysiology of the disease.

Determinants of platelet count in pediatric patients with congenital cyanotic heart disease: Role of immature platelet fraction

2017 ◽  
Vol 13 (1) ◽  
pp. 118-123 ◽  
Author(s):  
Randa M. Matter ◽  
Iman A. Ragab ◽  
Alaa M. Roushdy ◽  
Ahmed G. Ahmed ◽  
Hanan H. Aly ◽  
...  
Keyword(s):  
Platelet Count ◽  
Heart Disease ◽  
Pediatric Patients ◽  
Cyanotic Heart Disease ◽  
Immature Platelet Fraction ◽  
Congenital Cyanotic Heart Disease

Comparison of Thrombocyte Count Between Pediatric Patients With Migraine or Tension-Type Headache: A Retrospective Cohort Study

2019 ◽  
Vol 34 (13) ◽  
pp. 824-829 ◽  
Author(s):  
Aviv Benedick ◽  
Avraham Zeharia ◽  
Tal Eidlitz Markus
Keyword(s):  
Negative Correlation ◽  
Pediatric Patients ◽  
Tension Type Headache ◽  
Thrombocyte Count ◽  
Laboratory Parameters ◽  
Pediatric Headache ◽  
Increased Risk ◽  
Migraine Group ◽  
Headache Clinic ◽  
Type Headache

Hypercoagulability may explain the increased risk of thromboembolic cerebrovascular events in patients with migraine. Thrombocytes play a crucial part in the coagulation process, and some studies have demonstrated hyperaggregation of thrombocytes in adult migraineurs. We aimed to compare thrombocyte count between pediatric patients with migraine or tension-type headache and to evaluate the correlation of thrombocyte count with headache parameters. The electronic database of a tertiary pediatric headache clinic was retrospectively searched for all children and adolescents diagnosed with migraine or tension-type headache in 2016-2018. Data on thrombocyte counts were collected from the medical files and compared between the groups by parametric and nonparametric statistical tests. The cohort included 299 patients, 176 girls (59.0%) and 123 (412.0%) boys, of mean age 12.2 ± 3.4 years; 198 had migraine and 101 had tension-type headache. Among the laboratory parameters evaluated, a significantly lower mean thrombocyte number was found in the migraine group than in the tension-type headache group (282 ± 60 vs 304±71 ×103/μL, P = .004). Within the migraine group, there was a significant negative correlation between the thrombocyte count and the duration of headache attacks in hours ( P < .05). No significant between- or within-group differences were found in other laboratory parameters. The low relative thrombocyte count in pediatric headache clinic patients with migraine and its negative correlation with duration of migraine suggest that migraine may be associated with a different underlying pathogenesis from tension-type headache.

scholarly journals Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Du Kong ◽  
Wei Wang ◽  
Gang Du ◽  
Binyao Shi ◽  
Zhengchen Jiang ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Function ◽  
Blood Loss ◽  
Laparoscopic Splenectomy ◽  
Postoperative Bleeding ◽  
Gastroesophageal Varices ◽  
Liver Retraction ◽  
Significant Difference ◽  
Cirrhotic Patients

Background. Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension. Methods. Thirty-nine gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension patients were included in our study. We performed LSD in the presence of NBCA glue (n = 22, NBCA group) and absence of NBCA glue (n = 17, n-NBCA group), respectively. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the two groups. Results. There was no mortality during the operation. One patient in non-NBCA group received open surgery due to parenchyma hemorrhage. Postoperative pleural effusion occurred in 2 cases of the NBCA group and 1 of the non-NBCA group. One showed left subphrenic abscess in the non-NBCA group. No postoperative bleeding occurred after 9-30 months of follow-up. The time of operation in NBCA group was significantly shorter than those in n-NBCA group (198.86±17.86 versus 217.81±20.25min, P<0.01). Blood loss in NBCA group was significantly lower than non-NBCA group (159.09±56.98 versus 212.50±88.51 ml, P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after LSD and decreased to normal level on day 7 after LSD in both groups. There was no significant difference in postoperative hospitalization and liver function between the two groups. Conclusion. Liver retraction using NBCA glue during LSD for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension is safe, effective, and feasible.

Retinal Vascular Tortuosity and Recurrent Retinal Haemorrhages in a Patient with Non-Chromaffin Paraganglioma

1985 ◽  
Vol 191 (1) ◽  
pp. 57-60
Author(s):  
Erling Grønvold Olsen ◽  
Amund Ringvold ◽  
Sigvald B. Refsum
Keyword(s):  
Vascular Tortuosity ◽  
Retinal Vascular Tortuosity ◽  
Retinal Haemorrhages

scholarly journals Splenomegaly and thrombocytopenia in patients with liver cirrhosis

2010 ◽  
Vol 67 (2) ◽  
pp. 166-169 ◽  
Author(s):  
Jelena Djordjevic ◽  
Petar Svorcan ◽  
Dusica Vrinic ◽  
Branka Dapcevic
Keyword(s):  
Risk Factors ◽  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Hepatic Dysfunction ◽  
Spleen Size ◽  
Hepatitis Viruses ◽  
Decompensated Liver Cirrhosis ◽  
Splenic Sequestration ◽  
Frequent Finding

Backgroud/Aim. Splenomegaly is a frequent finding in patients with liver cirrhosis and portal hypertension and may cause hypersplenism. The occurrence of thrombocytopenia in those patients can be considered as an event with multiple etiologies. Two mechanisms may act alone or synergistically with splenic sequestration. One is central which involves either myelosuppression because of hepatitis viruses or the toxic effects of alcohol abuse on the bone marrow. The second one involves the presence of antibodies against platelets. It also depends upon the stage and etiology of liver disease. The aim of the study was to investigate a correlation between the platelet count and spleen size and the risk factors for thrombocytopenia in patients with liver cirrhosis. Methods. We studied 40 patients with decompensated liver cirrhosis who were hospitalized in the Department of Gastroenterohepatology. The liver function was graded according to Child Pugh score. Spleen size was defined ultrasonografically on the basis of craniocaudal length. Suspicion of portal hypertension was present when longitudinal spleen length was more than 11 cm. Thrombocytopenia was determined by platelet count under 150 000/mL. Results. We did not find any significant correlation between hepatic dysfunction and spleen size (p = 0.9), and between hepatic dysfunction and thrombocytopenia (p = 0.17). Our study did not find any significant correlation between spleen size and peripheral platelet count (p = 0.5), but we found a significant correlation between thrombocytopenia and etiology of cirrhosis - decreased platelet count was more common among patients with cirrhosis of alcoholic etiology than in other etiologies of cirrhosis (p = 0.001). Conclusion. According to our study, liver cirrhosis, portal hypertension and thrombocytopenia could be present even in the absence of enlarged spleen suggesting the involvement of other mechanisms of decreasing platelet account.

scholarly journals Noninvasive assessment of oesophageal varices presence and size in patients with liver cirrhosis using right liver lobe/serum albumin concentration

2007 ◽  
Vol 64 (7) ◽  
pp. 453-457
Author(s):  
Tamara Alempijevic ◽  
Vladislava Bulat ◽  
Nada Kovacevic ◽  
Rada Jesic ◽  
Srdjan Djuranovic ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Oesophageal Varices ◽  
Digestive Endoscopy ◽  
Liver Lobe ◽  
Albumin Ratio ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Upper Digestive Endoscopy ◽  
The Right

Background/Aim. Liver cirrhosis is a chronic, progressive disease and it is usually accompanied by portal hypertension. The development of oesophageal varices (OV) is one of the major complications of portal hypertension. Cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed. In order to reduce the increasing burden that endoscopy units have to bear, some studies have attempted to identify parameters for noninvasive prediction of OV presence. The aim of our study was to evaluate the value of biochemical and ultrasonography parameters for prediction of OV presence. Methods. This study included 58 cirrhotic patients who underwent a complete biochemical workup, ultrasonography examination and upper digestive endoscopy. Right liver lobe diameter/albumin ratio was calculated and its correlation to the presence and degree of OV, and Child-Pugh score of liver cirrhosis explored. Results. The mean age of the patients included in the study was 53.07?13.09 years; 40 were males and 18 females. In the Child-Pugh class A were 53.4% patients, class B 39.7%, whereas 6.9% were in the class C. In 24.1% of the patients no OV were identified by upper digestive endoscopy, 19% had OV grade I, 34.5% grade II, 20.7% grade III, and 1.7% OV grade IV. The mean value of the right liver lobe diameter/ albumin ratio was 5.43?1.79 (range of 2.76?11.44). Statistically significant correlation (p < 0.01) was confirm by Spearman's test between OV grade and calculated index (? = 0.441). Conclusion. The right liver lobe diameter/albumin ratio is a noninvasive parameter which provides an accurate information pertinent to the determination of OV presence and their grading in patients with liver cirrhosis. .

scholarly journals Endoscopic Management of Portal Hypertension

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Said A. Al-Busafi ◽  
Peter Ghali ◽  
Philip Wong ◽  
Marc Deschenes
Keyword(s):  
Portal Hypertension ◽  
Endoscopic Ultrasound ◽  
Capsule Endoscopy ◽  
Interventional Therapy ◽  
Gastric Varices ◽  
Active Management ◽  
Endoscopic Management ◽  
Diagnostic Modality ◽  
Gastroesophageal Varices ◽  
Life Threatening

Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices.

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