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Noninvasive investigation of hepatopulmonary syndrome in children and adolescents with chronic cholestasis
Early detection of hepatopulmonary syndrome (HPS) may be delayed because of invasiveness of the diagnostic procedures. In this pilot study, we prospectively investigated the usefulness of determining transcutaneous O2 tension after 100% O2 (TcPO2100) breathing using a transcutaneous hyperoxia test (...
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| Published in: | Pediatric pulmonology 2002-05, Vol.33 (5), p.374-379 |
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| creator | Santamaria, Francesca Sarnelli, Paola Celentano, Luigi Farina, Vincenzo Vegnente, Angela Mansi, Antonio Montella, Silvia Vajro, Pietro |
| description | Early detection of hepatopulmonary syndrome (HPS) may be delayed because of invasiveness of the diagnostic procedures. In this pilot study, we prospectively investigated the usefulness of determining transcutaneous O2 tension after 100% O2 (TcPO2100) breathing using a transcutaneous hyperoxia test (THT) in 11 children with chronic cholestasis and without primary cardiopulmonary disease. These patients also underwent alveolar‐arterial O2 gradient testing (AaDO2) at an inspired oxygen fraction (FiO2) of 0.21, lung scintiscan, and contrast transthoracic echocardiography (TTE). Three of them had a liver transplantation because of the downhill course of their liver disease and respiratory status.
THT transcutaneous O2 tension at 21% FiO2 (TcPO221) was 75 ± 13 mmHg, and increased to 488 ± 106 mmHg after 100% O2 breathing (TcPO2100). Both mean values were not significantly different from those found in 8 age‐matched controls (P = 0.9 and P = 0.5, respectively). However, one patient, in spite of her stable liver function, showed an abnormal TcPO221 and TcPO2100 (45 mmHg and 210 mmHg, respectively). This same subject was also the only patient with abnormalities of AaDO2 (54.2 mmHg; normal value, |
| doi_str_mv | 10.1002/ppul.10088 |
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THT transcutaneous O2 tension at 21% FiO2 (TcPO221) was 75 ± 13 mmHg, and increased to 488 ± 106 mmHg after 100% O2 breathing (TcPO2100). Both mean values were not significantly different from those found in 8 age‐matched controls (P = 0.9 and P = 0.5, respectively). However, one patient, in spite of her stable liver function, showed an abnormal TcPO221 and TcPO2100 (45 mmHg and 210 mmHg, respectively). This same subject was also the only patient with abnormalities of AaDO2 (54.2 mmHg; normal value, < 20 mmHg), lung scintiscan (brain/lung ratio of technetium‐99 fixation (B/L SI) = 9, normal value < 1), and TTE, suggesting intrapulmonary vasodilatations and shunts. Given the clinical development of cyanosis and platypnea, all criteria for HPS were fulfilled, and timing of her liver transplantation was therefore accelerated. This resulted in HPS regression.
In children with chronic cholestasis, repeated transcutaneous bedside measurements are a rapid and reliable noninvasive test for characterizing the severity of abnormal oxygenation, and may prove useful also in liver posttransplantation monitoring. Pediatr Pulmonol. 2002; 33:374–379. © 2002 Wiley‐Liss, Inc.</description><identifier>ISSN: 8755-6863</identifier><identifier>EISSN: 1099-0496</identifier><identifier>DOI: 10.1002/ppul.10088</identifier><identifier>PMID: 11948983</identifier><identifier>CODEN: PEPUES</identifier><language>eng</language><publisher>New York: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adolescent ; Biological and medical sciences ; Blood Gas Monitoring, Transcutaneous ; Child ; Child, Preschool ; Cholestasis - blood ; Chronic Disease ; chronic liver disease ; Echocardiography ; Female ; gas exchange abnormalities ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatopulmonary Syndrome - blood ; Hepatopulmonary Syndrome - physiopathology ; heptopulmonary syndrome ; Humans ; intrapulmonary shunts ; Liver, biliary tract, pancreas, portal circulation, spleen ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Other diseases. Semiology ; Pilot Projects ; Prospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; transcutaneous oxygen tensions</subject><ispartof>Pediatric pulmonology, 2002-05, Vol.33 (5), p.374-379</ispartof><rights>Copyright © 2002 Wiley‐Liss, Inc.</rights><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3938-fd2b2f813dde2c3e99b13eb467ac687f334c0775d936549e7b15d1cf11930d223</citedby><cites>FETCH-LOGICAL-c3938-fd2b2f813dde2c3e99b13eb467ac687f334c0775d936549e7b15d1cf11930d223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13626569$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11948983$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Santamaria, Francesca</creatorcontrib><creatorcontrib>Sarnelli, Paola</creatorcontrib><creatorcontrib>Celentano, Luigi</creatorcontrib><creatorcontrib>Farina, Vincenzo</creatorcontrib><creatorcontrib>Vegnente, Angela</creatorcontrib><creatorcontrib>Mansi, Antonio</creatorcontrib><creatorcontrib>Montella, Silvia</creatorcontrib><creatorcontrib>Vajro, Pietro</creatorcontrib><title>Noninvasive investigation of hepatopulmonary syndrome in children and adolescents with chronic cholestasis</title><title>Pediatric pulmonology</title><addtitle>Pediatr. Pulmonol</addtitle><description>Early detection of hepatopulmonary syndrome (HPS) may be delayed because of invasiveness of the diagnostic procedures. In this pilot study, we prospectively investigated the usefulness of determining transcutaneous O2 tension after 100% O2 (TcPO2100) breathing using a transcutaneous hyperoxia test (THT) in 11 children with chronic cholestasis and without primary cardiopulmonary disease. These patients also underwent alveolar‐arterial O2 gradient testing (AaDO2) at an inspired oxygen fraction (FiO2) of 0.21, lung scintiscan, and contrast transthoracic echocardiography (TTE). Three of them had a liver transplantation because of the downhill course of their liver disease and respiratory status.
THT transcutaneous O2 tension at 21% FiO2 (TcPO221) was 75 ± 13 mmHg, and increased to 488 ± 106 mmHg after 100% O2 breathing (TcPO2100). Both mean values were not significantly different from those found in 8 age‐matched controls (P = 0.9 and P = 0.5, respectively). However, one patient, in spite of her stable liver function, showed an abnormal TcPO221 and TcPO2100 (45 mmHg and 210 mmHg, respectively). This same subject was also the only patient with abnormalities of AaDO2 (54.2 mmHg; normal value, < 20 mmHg), lung scintiscan (brain/lung ratio of technetium‐99 fixation (B/L SI) = 9, normal value < 1), and TTE, suggesting intrapulmonary vasodilatations and shunts. Given the clinical development of cyanosis and platypnea, all criteria for HPS were fulfilled, and timing of her liver transplantation was therefore accelerated. This resulted in HPS regression.
In children with chronic cholestasis, repeated transcutaneous bedside measurements are a rapid and reliable noninvasive test for characterizing the severity of abnormal oxygenation, and may prove useful also in liver posttransplantation monitoring. Pediatr Pulmonol. 2002; 33:374–379. © 2002 Wiley‐Liss, Inc.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Blood Gas Monitoring, Transcutaneous</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cholestasis - blood</subject><subject>Chronic Disease</subject><subject>chronic liver disease</subject><subject>Echocardiography</subject><subject>Female</subject><subject>gas exchange abnormalities</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepatopulmonary Syndrome - blood</subject><subject>Hepatopulmonary Syndrome - physiopathology</subject><subject>heptopulmonary syndrome</subject><subject>Humans</subject><subject>intrapulmonary shunts</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Other diseases. Semiology</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. 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Liver. Pancreas. Abdomen</topic><topic>Hepatopulmonary Syndrome - blood</topic><topic>Hepatopulmonary Syndrome - physiopathology</topic><topic>heptopulmonary syndrome</topic><topic>Humans</topic><topic>intrapulmonary shunts</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Other diseases. Semiology</topic><topic>Pilot Projects</topic><topic>Prospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>transcutaneous oxygen tensions</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Santamaria, Francesca</creatorcontrib><creatorcontrib>Sarnelli, Paola</creatorcontrib><creatorcontrib>Celentano, Luigi</creatorcontrib><creatorcontrib>Farina, Vincenzo</creatorcontrib><creatorcontrib>Vegnente, Angela</creatorcontrib><creatorcontrib>Mansi, Antonio</creatorcontrib><creatorcontrib>Montella, Silvia</creatorcontrib><creatorcontrib>Vajro, Pietro</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric pulmonology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Santamaria, Francesca</au><au>Sarnelli, Paola</au><au>Celentano, Luigi</au><au>Farina, Vincenzo</au><au>Vegnente, Angela</au><au>Mansi, Antonio</au><au>Montella, Silvia</au><au>Vajro, Pietro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Noninvasive investigation of hepatopulmonary syndrome in children and adolescents with chronic cholestasis</atitle><jtitle>Pediatric pulmonology</jtitle><addtitle>Pediatr. Pulmonol</addtitle><date>2002-05</date><risdate>2002</risdate><volume>33</volume><issue>5</issue><spage>374</spage><epage>379</epage><pages>374-379</pages><issn>8755-6863</issn><eissn>1099-0496</eissn><coden>PEPUES</coden><abstract>Early detection of hepatopulmonary syndrome (HPS) may be delayed because of invasiveness of the diagnostic procedures. In this pilot study, we prospectively investigated the usefulness of determining transcutaneous O2 tension after 100% O2 (TcPO2100) breathing using a transcutaneous hyperoxia test (THT) in 11 children with chronic cholestasis and without primary cardiopulmonary disease. These patients also underwent alveolar‐arterial O2 gradient testing (AaDO2) at an inspired oxygen fraction (FiO2) of 0.21, lung scintiscan, and contrast transthoracic echocardiography (TTE). Three of them had a liver transplantation because of the downhill course of their liver disease and respiratory status.
THT transcutaneous O2 tension at 21% FiO2 (TcPO221) was 75 ± 13 mmHg, and increased to 488 ± 106 mmHg after 100% O2 breathing (TcPO2100). Both mean values were not significantly different from those found in 8 age‐matched controls (P = 0.9 and P = 0.5, respectively). However, one patient, in spite of her stable liver function, showed an abnormal TcPO221 and TcPO2100 (45 mmHg and 210 mmHg, respectively). This same subject was also the only patient with abnormalities of AaDO2 (54.2 mmHg; normal value, < 20 mmHg), lung scintiscan (brain/lung ratio of technetium‐99 fixation (B/L SI) = 9, normal value < 1), and TTE, suggesting intrapulmonary vasodilatations and shunts. Given the clinical development of cyanosis and platypnea, all criteria for HPS were fulfilled, and timing of her liver transplantation was therefore accelerated. This resulted in HPS regression.
In children with chronic cholestasis, repeated transcutaneous bedside measurements are a rapid and reliable noninvasive test for characterizing the severity of abnormal oxygenation, and may prove useful also in liver posttransplantation monitoring. Pediatr Pulmonol. 2002; 33:374–379. © 2002 Wiley‐Liss, Inc.</abstract><cop>New York</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>11948983</pmid><doi>10.1002/ppul.10088</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Biological and medical sciences Blood Gas Monitoring, Transcutaneous Child Child, Preschool Cholestasis - blood Chronic Disease chronic liver disease Echocardiography Female gas exchange abnormalities Gastroenterology. Liver. Pancreas. Abdomen Hepatopulmonary Syndrome - blood Hepatopulmonary Syndrome - physiopathology heptopulmonary syndrome Humans intrapulmonary shunts Liver, biliary tract, pancreas, portal circulation, spleen Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Other diseases. Semiology Pilot Projects Prospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system transcutaneous oxygen tensions |
| title | Noninvasive investigation of hepatopulmonary syndrome in children and adolescents with chronic cholestasis |
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