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Selective and total shunts in the treatment of bleeding varices. A randomized controlled trial.
N Engl J Med. 1976 Nov 11; 295(20):1089-95.NEJM

Abstract

Two types of surgical therapy of bleeding esophageal varices were evaluated in 48 patients by a randomized controlled trial: 24 were randomized for a total shunt and 24 for the selective shunt. In two of the latter, a total shunt had to be performed for technical reasons. The fatality rates (six in the 24 total, and six in 22 selective [performed], and seven in 24 selective [randomized]), the frequency of shunt occlusion (two in each group), and of recurrent gastronintestinal bleeding (three in each group) were similar. Encephalopathy developed more often after a total shunt -- 10 of 24, or one per 58 patient-months -- than after selective (performed) -- one of 22, or one per 593 patient-months (P less than 0.005). Total shunts consistently diverted the hepatopetal mesenteric-portal flow from the liver. Deterioration of hepatic function (maximum rate of urea synthesis) was greater after total than selective shunt (P less than 0.05).

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

1086428

Citation

Galambos, J T., et al. "Selective and Total Shunts in the Treatment of Bleeding Varices. a Randomized Controlled Trial." The New England Journal of Medicine, vol. 295, no. 20, 1976, pp. 1089-95.
Galambos JT, Warren WD, Rudman D, et al. Selective and total shunts in the treatment of bleeding varices. A randomized controlled trial. N Engl J Med. 1976;295(20):1089-95.
Galambos, J. T., Warren, W. D., Rudman, D., Smith, R. B., & Salam, A. A. (1976). Selective and total shunts in the treatment of bleeding varices. A randomized controlled trial. The New England Journal of Medicine, 295(20), 1089-95.
Galambos JT, et al. Selective and Total Shunts in the Treatment of Bleeding Varices. a Randomized Controlled Trial. N Engl J Med. 1976 Nov 11;295(20):1089-95. PubMed PMID: 1086428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selective and total shunts in the treatment of bleeding varices. A randomized controlled trial. AU - Galambos,J T, AU - Warren,W D, AU - Rudman,D, AU - Smith,R B,3rd AU - Salam,A A, PY - 1976/11/11/pubmed PY - 1976/11/11/medline PY - 1976/11/11/entrez SP - 1089 EP - 95 JF - The New England journal of medicine JO - N Engl J Med VL - 295 IS - 20 N2 - Two types of surgical therapy of bleeding esophageal varices were evaluated in 48 patients by a randomized controlled trial: 24 were randomized for a total shunt and 24 for the selective shunt. In two of the latter, a total shunt had to be performed for technical reasons. The fatality rates (six in the 24 total, and six in 22 selective [performed], and seven in 24 selective [randomized]), the frequency of shunt occlusion (two in each group), and of recurrent gastronintestinal bleeding (three in each group) were similar. Encephalopathy developed more often after a total shunt -- 10 of 24, or one per 58 patient-months -- than after selective (performed) -- one of 22, or one per 593 patient-months (P less than 0.005). Total shunts consistently diverted the hepatopetal mesenteric-portal flow from the liver. Deterioration of hepatic function (maximum rate of urea synthesis) was greater after total than selective shunt (P less than 0.05). SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/1086428/Selective_and_total_shunts_in_the_treatment_of_bleeding_varices__A_randomized_controlled_trial_ L2 - https://www.nejm.org/doi/10.1056/NEJM197611112952001?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -