{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T20:49:25Z","timestamp":1765658965237,"version":"3.48.0"},"reference-count":21,"publisher":"BMJ","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1989,10]]},"abstract":"<jats:p>It is well known that chronic encephalopathy may be a major complication after the establishment of a surgical portal caval shunt for an episode of variceal haemorrhage. In an effort to minimise this problem Warren and colleagues developed the distal splenorenal shunt where the portal and mesenteric blood flow to the liver was left intact. It is now recognised, however, that the longterm incidence of encephalopathy may be no different with this type of shunt compared with conventional surgical portal systemic shunts. Acquired chronic hepatocerebral degeneration has not been reported after such a selective shunt. A patient with primary biliary cirrhosis is reported who developed the clinical features of this syndrome eight years after a successful distal splenorenal shunt.<\/jats:p>","DOI":"10.1136\/gut.30.10.1419","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"1419-1423","source":"Crossref","is-referenced-by-count":4,"title":["Development of chronic hepatocerebral degeneration eight years after a distal splenorenal (Warren) shunt."],"prefix":"10.1136","volume":"30","author":[{"given":"A F","family":"Bleasel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R C","family":"Waugh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G W","family":"McCaughan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1989,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/00000658-196709000-00011","article-title":"Seectivc transspienic decompression of gastroesophageal variccs by distal spleno-veral shunt","volume":"166","author":"Warren, W.D.; Foman, Zeppa R.; J.J.","year":"1967","unstructured":"Warren WD, Zeppa R. Foman JJ. Seectivc transspienic decompression of gastroesophageal variccs by distal spleno-veral shunt. Ann Surg 1967; 166: 437-55.","journal-title":"Ann Surg"},{"key":"ref_2","series-title":"Gastroenterology 1986; 91","first-page":"1021","article-title":"Variceal bleeding: which shunt?","author":"Henderson, M.J.","unstructured":"Henderson MJ. Variceal bleeding: which shunt?. [Editorial]. Gastroenterology 1986; 91: 1021-3."},{"key":"ref_3","first-page":"345","volume":"44","author":"Medicine (Balti","year":"1965","unstructured":"Medicine (Balti) 1965; 44: 345-96."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1002\/ana.410170421","article-title":"Lateonset Wilson's disease with neurological involvement in the absence of Kayser-Fleicher rings","volume":"17","author":"Ross, M.E.; Jacobson, I.M.; Dienstag Jl. Martin, J.B.","year":"1985","unstructured":"Ross ME, Jacobson IM, Dienstag Jl. Martin JB. Lateonset Wilson's disease with neurological involvement in the absence of Kayser-Fleicher rings. Ann Neurol 1985; 17: 411-3.","journal-title":"Ann Neurol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1212\/WNL.19.1.37","article-title":"Myxedema and ataxia","volume":"19","author":"Cremer, G.M.; Golstein, N.P.; Paris, J.","year":"1969","unstructured":"Cremer GM, Golstein NP, Paris J. Myxedema and ataxia. Neurology 1969; 19: 37-46.","journal-title":"Neurology"},{"edition":"3rd ed","article-title":"Princip)les of neurolog_y","key":"ref_6","unstructured":"Princip)les of neurolog_y 3rd ed. New York: McGrawHill Book Company. 1985: 76t)-86."},{"key":"ref_7","first-page":"135","article-title":"The neuro-psychiatric syndromes associated with chronic liver disease and an extensive portal-systemic collateral circulation","volume":"36","author":"JG, Read A.F.Sherlock S.ILaidlaw J.Walker","year":"1967","unstructured":"Read AF. Sherlock S. ILaidlaw J. Walker JG. The neuro-psychiatric syndromes associated with chronic liver disease and an extensive portal-systemic collateral circulation. QJ Med 1967; 36: 135-50.","journal-title":"QJ Med"},{"key":"ref_8","first-page":"349","article-title":"The neurological complications of liver disease","volume-title":"Handbook of clinical neurology; Metabolic and deficiency diseases of thce nervous system Part 1","volume":"Vol","author":"Plum, F.; Hindfelt, B.","year":"1976","unstructured":"Plum F, Hindfelt B. The neurological complications of liver disease. In: Vinken PJ, Bruny GW, eds. Handbook of clinical neurology, Vol 27. Metabolic and deficiency diseases of thce nervous system Part 1. 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Acta Neurol Scand 1978; 58: 9-144.","journal-title":"Acta Neurol Scand"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1093\/brain\/104.1.79","article-title":"Distribution of cerebral lesions in acquired hepatocerebral degeneration","volume":"104","author":"Finlaysan, M.H.; Superville, B.","year":"1981","unstructured":"Finlaysan MH, Superville B. Distribution of cerebral lesions in acquired hepatocerebral degeneration. Brain 1981; 104: 79-95.","journal-title":"Brain"},{"issue":"30","key":"ref_12","first-page":"358","article-title":"Choreathetosis in porto-systemic encephalopathy","volume":"1967","author":"Toghill, P.J.; Johnson, A.W.; Smith, J.F.","unstructured":"Toghill PJ, Johnson AW, Smith JF. Choreathetosis in porto-systemic encephalopathy. J Neurol Neurosurg Psychiatry 1967: 30: 358-63.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref_13","first-page":"95","article-title":"Hereditary hemorrhagic telangiecstasia. A case with hepatocellular carcinoma and acquired hepatocerebral degeneration","volume":"99","author":"Sussman, E.B.; Steinberg, S.S.","year":"1975","unstructured":"Sussman EB, Steinberg SS. Hereditary hemorrhagic telangiecstasia. A case with hepatocellular carcinoma and acquired hepatocerebral degeneration. Arch Pathol 1975; 99: 95-100.","journal-title":"Arch Pathol"},{"key":"ref_14","first-page":"424","article-title":"Further report of a prospective randomized trial comparing distal spieno-renal shunt with end to side portacaval shunt","volume-title":"Gastroeinerolog, g","volume":"88","author":"Langer, B.; Taylor, B.R.; MacKenzie, D.R.; Gilas, T.; Stone, R.M.; Blendis, L.","year":"1985","unstructured":"Langer B, Taylor BR, MacKenzie DR, Gilas T, Stone RM, Blendis L. Further report of a prospective randomized trial comparing distal spieno-renal shunt with end to side portacaval shunt. Gastroeinerolog,g 1985; 88: 424-9."},{"key":"ref_15","first-page":"712","article-title":"ei til. The Emory prospective randomizcd trial: scicctivc vcrsus non-sciective shunt to control variccal blecding ten year follow up","author":"Millikar, W.J.; Warren, W.D.; Hendcrson, J.M.","year":"1985","unstructured":"Millikar WJ, Warren WD, Hendcrson JM, ei til. The Emory prospective randomizcd trial: scicctivc vcrsus non-sciective shunt to control variccal blecding ten year follow up. Ann Sturg 1985; 201: 712-22."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1001\/archsurg.1981.01380210009002","article-title":"Longtcrm loss of Warren's shunt selectivity","volume":"116","year":"1981","unstructured":"Beighih J, Greiner P. Novel 0, Nahami H, Fckctc F. Longtcrm loss of Warren's shunt selectivity. 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QJ Med 1970; 39: 515-27.","journal-title":"QJ Med"},{"key":"ref_21","first-page":"685","article-title":"Rcversal of sevcrc neurological manifestations of Wilsons disease following orthotopic livcr transplantation","volume":"64","author":"Polsen, R.J.; Rolles, K.; Calnc, R.Y.; Williams, R.; Marsdcn, D.","year":"1987","unstructured":"Polsen RJ, Rolles K, Calnc RY, Williams R, Marsdcn D. Rcversal of sevcrc neurological manifestations of Wilsons disease following orthotopic livcr transplantation. QJ Med 1987; 64: 685-9 1.","journal-title":"QJ Med"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.30.10.1419","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T20:45:22Z","timestamp":1765658722000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.30.10.1419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1989,10]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[1989,10,1]]},"published-print":{"date-parts":[[1989,10]]}},"alternative-id":["10.1136\/gut.30.10.1419"],"URL":"https:\/\/doi.org\/10.1136\/gut.30.10.1419","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"type":"print","value":"0017-5749"},{"type":"electronic","value":"1468-3288"}],"subject":[],"published":{"date-parts":[[1989,10]]}}}