These portosystemic shunts can be categorized into intrahepatic and extrahepatic types. Common extrahepatic shunts involve gastroesophageal, gastrorenal, splenorenal and paraumbilical vessels. Under most circumstances, the presence of hepatic encephalopathy is a relative contraindication to

the insertion of a transjugular intrahepatic portosystemic shunt (TIPS). However, in the patient described below, TIPS permitted closure of an unusual shunt that was followed by improvement in encephalopathy. In 2011, a woman, aged 47, was admitted to our hospital with episodes EPZ 6438 of drowsiness attributed to hepatic encephalopathy. She was known to have hepatitis B with advanced cirrhosis (Child-Pugh class C). In 2006, she was treated medically for a major gastrointestinal bleed attributed to esophageal varices but there were no subsequent episodes of bleeding. Medical treatment for hepatic encephalopathy had included dietary protein restriction, lactulose, branched-chain amino acids and a course of rifaximin. On examination, she had several spider nevi and peripheral edema. An abdominal ultrasound study and a contrast-enhanced computed tomography scan showed that the portal

selleck kinase inhibitor vein was relatively narrow. However, the splenic vein, inferior mesenteric vein, left renal vein and left gonadal vein were markedly dilated. Subsequently, a catheter was passed into the left renal vein through the inferior vena cava. The injection of contrast revealed dilatation of the left renal vein and left gonadal vein and a varicose shunt between the left gonadal vein and the left inferior mesenteric

vein. A transjugular intrahepatic portosystemic shunt was then placed within the liver to reduce the portal pressure. Direct portography at the time of insertion of the stent (Figure 1 ) shows the stent (black arrowhead), the splenic vein (white arrowhead), the inferior mesenteric aminophylline vein (solid arrow) and the varicosity (dotted arrow) linking the inferior mesenteric vein to the left gonadal vein. The shunt was successfully embolized using coils (Figure 2). The patient has now been followed for 4 months without a recurrence of encephalopathy and without dietary or drug therapy. Patency of the portosystemic shunt was confirmed by an ultrasound study. “
“Induced pluripotent stem cell-derived human hepatocyte-like cells (iHeps) could provide a powerful tool for studying the mechanisms underlying human liver development and disease, testing the efficacy and safety of pharmaceuticals across different patients (i.e. personalized medicine), and enabling cell-based therapies in the clinic. However, current in vitro protocols that rely upon growth factors and extracellular matrices (ECM) alone yield iHeps with low levels of liver functions relative to adult primary human hepatocytes (PHHs).