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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2015;14:108-17" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 150 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 104 "PDF" => 34 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Effects of a low-fat diet on the hepatic expression of adiponectin and its receptors in rats with NAFLD" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "108" "paginaFinal" => "117" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 255 "Ancho" => 1021 "Tamanyo" => 38195 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Adiponectin (A), adipoR1 (B) and adipoR2 (C) mRNA expression in rat liver tissue. *P < 0.05 compared with the HFD2 group.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hong Ma, Guo-Ping You, Fan Cui, Lu-Fang Chen, Xiang-Jiu Yang, Li-Gang Chen, Hua-Dong Lu, Wen-Qiang Zhang" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Hong" "apellidos" => "Ma" ] 1 => array:2 [ "nombre" => "Guo-Ping" "apellidos" => "You" ] 2 => array:2 [ "nombre" => "Fan" "apellidos" => "Cui" ] 3 => array:2 [ "nombre" => "Lu-Fang" "apellidos" => "Chen" ] 4 => array:2 [ "nombre" => "Xiang-Jiu" "apellidos" => "Yang" ] 5 => array:2 [ "nombre" => "Li-Gang" "apellidos" => "Chen" ] 6 => array:2 [ "nombre" => "Hua-Dong" "apellidos" => "Lu" ] 7 => array:2 [ "nombre" => "Wen-Qiang" "apellidos" => "Zhang" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119308075?idApp=UINPBA00004N" "url" => "/16652681/0000001400000001/v1_201906010908/S1665268119308075/v1_201906010908/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Intrahepatic aneurysmal portohepatic venous shunt: what should be done?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "118" "paginaFinal" => "120" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nidhi Prabhakar, Sameer Vyas, Sunil Taneja, Niranjan Khandelwal" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Nidhi" "apellidos" => "Prabhakar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Sameer" "apellidos" => "Vyas" "email" => array:1 [ 0 => "sameer574@yahoo.co.in" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Sunil" "apellidos" => "Taneja" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Niranjan" "apellidos" => "Khandelwal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India" "etiqueta" => "*" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India" "etiqueta" => "**" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 438 "Ancho" => 504 "Tamanyo" => 36030 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Volumetric rendering technique CT image showing aneurysm, which is communicating with two vessels arising from the left portal vein and one vessel arising from the right portal vein (solid arrows), and also with a vessel draining into the middle hepatic vein (hollow arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Aneurysmal portohepatic venous shunt is communication between the branches of portal and hepatic veins that shows aneurysmal dilatation. They are rare. However with advances in cross-sectional imaging techniques and increased utilization of imaging modalities, the detection of asymptomatic intrahepatic portosystemic venous shunts has increased. Identification and characterization of the portosystemic shunts is very important for radiologists as well as hepatologists. These lesions may be mistaken for hypervascular lesions on CT or cysts on sonography (if colour doppler is not used). Patients with smaller shunts are regularly followed up whereas those with larger or symptomatic shunts (causing hepatic encephalopathy, galactosemia or hyperammonemia) have to be treated.</p><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0005">Case Report</span><p id="p0010" class="elsevierStylePara elsevierViewall">A 47-year old male presented to the emergency, with severe abdominal pain in the epigastrium. Ultrasound of the abdomen was normal. Contrastenhanced CT of the abdomen (<a class="elsevierStyleCrossRef" href="#f0005">Figures 1</a> and <a class="elsevierStyleCrossRef" href="#f0010"><span class="elsevierStyleSup">2</span></a>) revealed a communicating vessel between branches of the portal vein and middle hepatic vein suggestive of portohepatic venous shunt, which showed aneurysmal dilatation. This aneurysm measured approximately 18 x 12 x 12 mm in size. No other abnormality was seen on CT. Upper gastrointestinal endoscopy showed features of gastritis, for which he was treated with antihistaminics and antacids. Pain was completely relieved after 2 weeks of treatment. No immediate intervention was done for the shunt as it was an incidental finding and not causing any symptoms. Laboratory investigations, including complete haemogram and liver function tests, were normal. No evidence of hyperammonemia or galactosemia was seen. Patient is on regular follow up, to look for any increase in the size of the aneurysm or any evidence of hepatic encephalopathy.</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><elsevierMultimedia ident="f0010"></elsevierMultimedia></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Discussion</span><p id="p0015" class="elsevierStylePara elsevierViewall">Intrahepatic vascular shunts are broadly divided into three types: portosystemic venous, arterioportal and arteriosystemic. Most of the shunts are seen in cirrhotic patients but can also be congenital or traumatic in origin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Incidentally detected intrahepatic portal venous shunts do not usually show any symptoms or manifestations of liver disease. They are most common in left lobe and are solitary.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>–<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Intrahepatic portal venous shunts are classified into four types by Park, <span class="elsevierStyleItalic">et al</span>.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In type I portal venous shunt, a single large tubular shaped vessel that has a constant diameter is seen, which connects the right portal vein to the inferior vena cava. Type II is a peripheral shunt that is characterized by a single or multiple communications between the peripheral branches of portal and hepatic veins, in one particular hepatic segment. In type III portal venous shunt, an aneurysmal communication is noted between the peripheral portal and hepatic veins. A type IV portal venous shunt is one in which multiple, diffuse communications between peripheral portal and hepatic veins are seen, in both lobes of the liver. Our case represents the type III intrahepatic portal venous shunt. Most common shunts are the type 1 shunts. However, few case series have shown type 3 to be most common.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">Intrahepatic portohepatic venous shunts are mostly congenital. They occur due to failure of regression of connection among subcardinal venous system and vitelline venous system. In the early embryological life, these connections exist. A part of the hepatic segment of the inferior vena cava is formed by right subcardinal vein. Vitelline vein gets broken into hepatic sinusoids, which becomes the hepatic veins and the intrahepatic portal vein branches. Persistence of vitelline sinusoids and right vitelline vein may lead to development of portosystemic shunt. They are known to resolve spontaneously in infancy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Patients having portohepatic venous shunts are usually asymptomatic. However, these patients may present with hyperammonemia and hepatic encephalopathy. In addition, they may be associated with cardiac defects, hepatoblastoma, abnormal lobulation of the liver and extrahepatic biliary atresia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The physiological effects of shunt can be better predicted on the basis of shunt ratio. Iodine 123-iodoamphetamine perrectal portal scintigraphy can determine the shunt ratio. It can also be calculated by Doppler. Blood flow volume through the shunt divided by the total portal blood flow volume gives the shunt ratio.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> If the shunt ratio is less than 30%, shunt is likely to remain asymptomatic throughout life. If it is 30-60%, shunt will manifest with symptoms some time. However if it is > 60 % (in either type I, II, III or IV shunt), it needs intervention, even if the symptoms of hepatic encephalopathy are absent.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Surgical ligation, hepatic resection, splenorenal shunt and shunt embolisation are treatments which are available. Known complication of blocking the shunt is exacerbation of portal hypertension.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">Different approaches to embolisation, have been described which include retrograde, transcaval, transileocolic and percutaneous. The embolic agents which can be used are coils, gelfoam particles and polyvinyl particles. Successful use of amplatzer vascular plug for embolisation has also been described by few authors.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Funding</span><p id="p0030" class="elsevierStylePara elsevierViewall">Source(s) of funding or financial interest-Nil.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "s0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "s0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "s0015" "titulo" => "Funding" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-05-14" "fechaAceptado" => "2014-08-30" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 436 "Ancho" => 504 "Tamanyo" => 34762 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Maximum intensity projection coronal oblique CT image showing aneurysm measuring 18 x 12 x 12 mm in the liver, which is communicating with two vessels arising from the left portal vein and one vessel arising from the right portal vein (solid arrows), and also with a vessel draining into the middle hepatic vein (hollow arrow).</p>" ] ] 1 => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 438 "Ancho" => 504 "Tamanyo" => 36030 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Volumetric rendering technique CT image showing aneurysm, which is communicating with two vessels arising from the left portal vein and one vessel arising from the right portal vein (solid arrows), and also with a vessel draining into the middle hepatic vein (hollow arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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Year/Month | Html | Total | |
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2024 October | 97 | 1 | 98 |
2024 September | 158 | 16 | 174 |
2024 August | 128 | 5 | 133 |
2024 July | 167 | 4 | 171 |
2024 June | 96 | 3 | 99 |
2024 May | 109 | 8 | 117 |
2024 April | 75 | 5 | 80 |
2024 March | 110 | 5 | 115 |
2024 February | 156 | 13 | 169 |
2024 January | 207 | 5 | 212 |
2023 December | 154 | 12 | 166 |
2023 November | 167 | 27 | 194 |
2023 October | 165 | 8 | 173 |
2023 September | 112 | 2 | 114 |
2023 August | 88 | 6 | 94 |
2023 July | 83 | 12 | 95 |
2023 June | 91 | 6 | 97 |
2023 May | 118 | 13 | 131 |
2023 April | 95 | 5 | 100 |
2023 March | 79 | 12 | 91 |
2023 February | 62 | 3 | 65 |
2023 January | 68 | 3 | 71 |
2022 December | 55 | 9 | 64 |
2022 November | 59 | 9 | 68 |
2022 October | 53 | 14 | 67 |
2022 September | 59 | 7 | 66 |
2022 August | 88 | 19 | 107 |
2022 July | 55 | 8 | 63 |
2022 June | 58 | 16 | 74 |
2022 May | 65 | 10 | 75 |
2022 April | 84 | 17 | 101 |
2022 March | 111 | 10 | 121 |
2022 February | 62 | 5 | 67 |
2022 January | 84 | 6 | 90 |
2021 December | 67 | 13 | 80 |
2021 November | 62 | 8 | 70 |
2021 October | 70 | 13 | 83 |
2021 September | 69 | 8 | 77 |
2021 August | 60 | 7 | 67 |
2021 July | 47 | 7 | 54 |
2021 June | 57 | 13 | 70 |
2021 May | 73 | 9 | 82 |
2021 April | 151 | 17 | 168 |
2021 March | 59 | 7 | 66 |
2021 February | 52 | 8 | 60 |
2021 January | 43 | 10 | 53 |
2020 December | 43 | 6 | 49 |
2020 November | 48 | 17 | 65 |
2020 October | 38 | 5 | 43 |
2020 September | 36 | 6 | 42 |
2020 August | 29 | 11 | 40 |
2020 July | 22 | 4 | 26 |
2020 June | 20 | 0 | 20 |
2020 May | 34 | 6 | 40 |
2020 April | 10 | 3 | 13 |
2020 March | 14 | 4 | 18 |
2020 February | 13 | 4 | 17 |
2020 January | 19 | 1 | 20 |
2019 December | 13 | 5 | 18 |
2019 November | 16 | 5 | 21 |
2019 October | 9 | 2 | 11 |
2019 September | 3 | 0 | 3 |
2019 August | 1 | 1 | 2 |
2019 July | 5 | 9 | 14 |
2019 June | 4 | 6 | 10 |