Histopathology of early and late human allograft rejection

✍ Scribed by Boris H. Ruebner; Mary Patricia Pauly; Neville Pimstone; Richard E. Ward; John M. Vierling; Robert H. Fennell Jr.; Antonio Monarca; Roberto Natangelo; Valeria Azzolini; B. A. Runyon; Y. Peled; J. Rattan; T. Gilat; Z. Fireman

• Publisher: John Wiley and Sons
• Year: 1987
• Tongue: English
• Weight: 481 KB
• Volume: 7
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840070148

✦ Synopsis

We agree with Reding et al. (Hepatology 1986; 698-100) about the importance of measuring both intravascular and extravascular pressures to understand further the mechanism of variceal rupture, but have considerable reservations about their chosen parameters of measurement. They measured intravascular pressure in the abdomen and compared this with extravascular pressure in the thorax. These measurements prevent comment on essential information such as the intra/extravascular pressure differences within the abdomen or within the thorax. For example, an. internal reference point instead of the authors' external reference point would have been more appropriate to calculate the pressure difference across the portal vein wall. Similarly, the simultaneous measurement of intravariceal and extravariceal pressures would be more useful in predicting variceal rupture. We have performed this latter study (Hosking, S.W. and Johnson, A.G. Gut 1985; 26:A1144, Abstract) and found that while intravariceal and extravariceal pressures both rose during Valsalva's maneuver, the pressure difference across the varix wall rose in some patients but fell in others.

Recognizing that abdominal and thoracic pressures differ, we now measure intraabdominal pressure at the same time as the other measurements. We remain uncertain about the usefulness of measuring portal vein and esophageal lumen pressure alone.