RESUMEN
At the present time several therapeutic options are used for the treatment of bleeding esophageal varices in patients with portal hypertension. We will review the main medical publications on transjugular intrahepatic portosystemic shunt (TIPS), a procedure seldom used among us. TIPS works as a portocaval side-to-side shunt and decreases the risk of esophageal bleeding through lowering of the portal system pressure and a decrease of the portal hepatic pressure gradient. TIPS consists in the percutaneous insertion, through the internal jugular vein, of a metallic stent under fluoroscopic control in the hepatic parenchyma creating a true porta caval communication. There are several studies demonstrating the efficacy of TIPS, although only a few of them are randomized and control-matched to allow us to conclude that this procedure is safe, efficient and with a good cost benefit ratio. In this review, we search for the analysis of the TIPS utilization, its techniques, its major indications and complications. TIPS has been used in cases of gastroesophageal bleeding that has failed with pharmacologic or endoscopic treatment in patients Child-Pugh B and C. It can be used also as a bridge for liver transplantation. Others indications for TIPS are uncontrolled ascites, hepatic renal syndrome, and hepatic hydrothorax. The main early complications of TIPS using are related to the insertion site and hepatic encephalopathy and the stent occlusion is the chief late complication.
Asunto(s)
Hipertensión Portal/terapia , Derivación Portosistémica Intrahepática Transyugular/normas , Ascitis/complicaciones , Ascitis/terapia , Contraindicaciones , Várices Esofágicas y Gástricas/complicaciones , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Hemodinámica , Síndrome Hepatorrenal/etiología , Síndrome Hepatorrenal/terapia , Humanos , Hidrotórax/etiología , Hidrotórax/terapia , Hipertensión Portal/complicaciones , Cirrosis Hepática/complicaciones , Trasplante de Hígado , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Derivación Portosistémica Intrahepática Transyugular/métodosRESUMEN
Bronchoalveolar lavage (BAL) was performed in a group of 25 patients with pulmonary sarcoidosis in order to monitor variations in alveolar lymphocytes (AL) in comparison to the clinical evolution of the disease. Two BAL were performed in each patient, the second 6-12 months after the first (8.9 +/- 3, M +/- SD). Twelve patients were classified as improved and 13 as unimproved on the basis of a score of changes in the clinical picture, x-ray, respiratory function, immunological and biochemical tests. There was a significant decrease (p less than 0.001) of the percentage of AL in 66% of cases in the improved group, but not in the unimproved group, where, on the contrary, it was possible to observe an increase in the percentage of AL in 46% of these cases (n.s.). In 9 of 11 patients followed for 1-5 years with at least 3 BAL, AL behaviour correlated with clinical evolution. On the basis of the parameters studied, it was possible to show a correlation between lymphocytes, alveolitis and clinical evolution, especially in patients with an improved course. While a single BAL does not seem to be sufficient to show the course of the disease, repeated long-term washings allow a more accurate staging of sarcoidosis and can give early warning of relapses even when the conventional parameters (clinical, radiological and functional) are unchanged. Our aim was to look for a simpler parameter, which could be used routinely by even unspecialized laboratories, who are not able to type lymphocytes.