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"Wir sehen uns vor Gericht!" – Oft eskalieren Konflikte zu einem Rechtsstreit, ohne dass die Beteiligten nachgedacht haben, ob dies der beste Weg ist. Im Verhältnis zwischen Bürger und Staat gibt es wenig zu überlegen: Binnen Monatsfrist muss klagen, wer eine Entscheidung der Verwaltung nicht bestandskräftig werden lassen will. Dabei ist ein Rechtsstreit manchmal langwierig und oft teuer. Das Urteil am Ende des Instanzenzuges kann schließlich "Steine statt Brot" bedeuten, selbst wenn der Rechtsstreit gewonnen ist. Seit Langem etablieren sich daher "alternative" Konfliktlösungsverfahren, allen voran die Mediation: Die Konfliktparteien erarbeiten freiwillig und selbstbestimmt eine von ihnen akzeptierte, interessenorientierte Lösung, indem sie kooperativ verhandeln mit einem Mediator an ihrer Seite, einem neutralen und allparteilichen Dritten.
Pathophysiological role of prostanoids in coagulation of the portal venous system in liver cirrhosis
(2019)
Background: Prostanoids are important regulators of platelet aggregation and thrombotic arterial diseases. Their involvement in the development of portal vein thrombosis, frequent in decompensated liver cirrhosis, is still not investigated.
Methods: Therefore, we used pro-thrombotic venous milieu generation by bare metal stent transjugular intrahepatic portosystemic shunt insertion, to study the role of prostanoids in decompensated liver cirrhosis. Here, 89 patients receiving transjugular intrahepatic portosystemic shunt insertion were included in the study, and baseline levels of thromboxane B2, prostaglandin D2 and prostaglandin E2 were measured in the portal and the hepatic vein.
Results: While the hepatic vein contained higher levels of thromboxane B2 than the portal vein, levels of prostaglandin E2 and D2 were higher in the portal vein (all P<0.0001). Baseline concentrations of thromboxane B2 in the portal vein were independently associated with an increase of portal hepatic venous pressure gradient during short term follow-up, as an indirect sign of thrombogenic potential (multivariable P = 0.004). Moreover, severity of liver disease was inversely correlated with portal as well as hepatic vein levels of prostaglandin D2 and E2 (all P<0.0001).
Conclusions: Elevated portal venous thromboxane B2 concentrations are possibly associated with the extent of thrombogenic potential in patients with decompensated liver cirrhosis.
Trial registration: ClinicalTrials.gov identifier: NCT03584204.