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Purpose: Comparison of color Doppler sonography and venous portography in patients with a transjugular intrahepatic portosystemic stent shunt (TIPSS)., Materials and Methods: In a prospective study 40 consecutive patients with TIPSS underwent venous portography and color Doppler sonography on the same day as follow-up. Shunt velocities were recorded within the TIPSS at the proximal (hepatic vein segment) and distal part (portal vein segment)., Results: In 28 patients with functioning TIPSS the mean shunt velocity ranged between 30 and 120 cm/s (median 60 cm/s) at the portal vein segment and between 60 and 155 cm/s (median 82 cm/s) at the hepatic vein segment. There was a significant increase of the mean shunt velocity in the hepatic vein segment (P < 0.001). In 12 patients with compromised TIPSS the mean shunt velocity was reduced to 26 +/- 7 cm/s at the portal venous end (P < 0.0001)., Conclusion: Because of an accelerated shunt velocity in the hepatic vein segment a site-specific evaluation of both TIPSS endings is necessary with color Doppler sonography. In compromised TIPSS the shunt velocity is reduced at the portal venous end. Color Doppler sonography is a valid non-invasive means for follow-up of patients with TIPSS.

Purpose: to demonstrate and document TIPSS-induced changes of the perfusion pattern of the liver with special reference to several rheologic, morphologic, functional and biochemical parameters. Our analysis was based on a study in 100 consecutive cases., Patients and Methods: Evaluation and assessment of the following parameters before and within a 30-day post TIPSS period: portosystemic gradient; morphologic delineation of the portal circulation; invasive scintigraphic determination of the portal perfusion fraction (PPF) and the total liver perfusion (GLP); transcatheter intraarterial flow change measurement; serum levels of albumin and bilirubin; assessment of hepatic encephalopathy by appropriate testing; assessment of recurrent variceal bleeding, Results: by TIPSS variceal filling was widely reduced; as assessed morphologically and rheologically portal liver perfusion was significantly reduced. However, there was immediate onset of compensated liver perfusion by increased arterial inflow. Total liver perfusion was not significantly altered. In TIPSS portal decompression was readily achieved with reduction of the portosystemic gradient from an average of 24 mmHg to 10.5 mmHg. In our series we could not demonstrate an increased incidence of hepatic encephalopathy during the 30-day post TIPSS period. Bilirubin levels were significantly increased after TIPSS from 2.45 to 2.61 mg/dl (p = 0.0067), while albumin levels were not altered. Early mortality was 4% and early re-bleeding rate 3%, respectively., Conclusion: the concept of TIPSS represents an individually calibrated H-shunt. The significant reduction of post TIPSS portal perfusion appears to be compensated by increased arterial inflow. This is reflected by invasive flow measurement results and by the clinical results. Letality of TIPSS is low.

In a 500-bed general hospital the incidence of highly resistant strains of Klebsiella pneumonia was examined. About 20% of examined patients in the surgical and medical departments were carriers. Spread of the organism was via the hands of personnel and patients as well as various objects. The use of broad-spectrum antibiotics, especially ampicillin and cefalotin is thought to be the chief cause of the high incidence of Klebsiella emergence. About 90% of carriers had previously received antibiotics.

A polyclonal, monospecific antiserum raised against a nicotinic acetylcholine receptor protein affinity-purified from insect nervous tissue, was employed to demonstrate the localization of antigenic sites in the neuropile of the terminal (sixth) abdominal ganglion of the cockroach Periplaneta americana. In agreement with previously published autoradiographic mapping of specific [125I]alpha-bungarotoxin binding sites, specific areas of the central neuropile of this ganglion were densely stained, but not the cercal afferent axons. No staining was detected corresponding to the dense, peripheral, partly non-specific binding of alpha-bungarotoxin seen in autoradiographs of the same tissue. Certain peripherally located neuronal cell bodies, including the cell body of giant interneuron 2, contained intracellularly located antigenic sites.