Liver failure posthepatectomy and biliary fistula: multidisciplinar treatment.

The main cause of morbimor-mortality after major liver surgery is the development of liver failure posthepatectomy(LFPH). Treatment must involve multiple options and will be aggressive from the beginning. We report a case of a patient with cholangiocarcinoma perihilar treated with surgery: right hepatectomy extended to sI + IVb with develop of LFPH and biliary fistula and being management successfully in a multidisciplinary way.

[Prognostic factors in patients with non-active treatment of hepatocellular carcinoma].

Objective: To evaluate factors associated with poor survival in patients with non-active treatment of hepatocellular carcinoma (HCC).

Material And Methods: Between May 2003 and June 2005, 50 patients with HCC were deemed unsuitable for active treatment, following the Barcelona Clinic Liver Cancer staging system. Symptomatic treatment was provided.

Tumoral response factors after radiofrequency ablation of hepatocellular carcinoma in cirrhotic liver.

Objective: Hepatocellular carcinoma (HCC) ablation by radiofrequency (RFA) is a novel technique with a great variety of methods whose efficacy and predictive factors have not been completely studied. Some of the main predictive factors in this type of treatment are analyzed in the present study.

Patients And Methods: Ninety-three patients with hepatocellular carcinoma over cirrhosis, and with no indication for surgical resection were treated by RFA.

[Bacterial translocation in intestinal transplant].

Objective: To analyse the influence of ceftriaxone on bacterial translocation and survival after small bowel transplantation in an experimental model with large animals.

Design: We performed 21 small bowel transplantation in pigs. Group 1 (n = 5): small bowel transplantation (SBT).

Hepatectomy including more than half of liver volume with intermittent portal triad occlusion.

Introduction: Liver resections over 50% of hepatic volume can be achieved with a low morbi-mortality, although occasionally they are followed by severe complications. Postoperative evolution and complications after this type of hepatic resections with intermittent occlusion of the portal triad have been studied.

Patients And Methods: 13 right hepatectomies, 5 enlarged right hepatectomies and 2 enlarged left hepatectomies were performed consecutively, with intraoperative ultrasound evaluation and intermittent portal triad occlusion.

Combined small bowel and reduced liver transplantation in pigs.

Purpose: Small bowel transplantation is a last resort treatment for intestinal insufficiency. Although the disorder is occasionally associated with chronic hepatopathy of variable severity, it may require simultaneous liver transplantation. We present a new model of heterotopic small bowel and reduced partial liver transplantation to an infrahepatic site.

[Aneurysms of the splenic artery in patients with liver transplantation].

Splenic artery aneurysms (SAA) are not uncommon in patients with hepatic transplant (HT). Three in 150 transplanted patients in our institutions were diagnosed with SAA and two of them had a spontaneous rupture. In two patients embolization with interventionist radiology was performed with excellent results.

[Arterial revascularization of liver graft with PTFE vascular prosthesis].

When the hepatic artery is not available in liver transplantation because of its bad quality or low flow, arterial grafts from the donor have to be used to obtain arterial blood flow from the aorta. The case of use of a vascular PTFE prosthesis when no vascular grafts were available is presented, with good outcome 6 months after transplantation.

[The response to hepatitis B vaccine prior to orthotopic liver transplantation].

Unlabelled: HBV hepatitis is a severe complication of orthotopic liver transplantation (OLT) due to the immunosuppression therapy.

Objectives: The aim of this study is to evaluate the efficacy of the active HBV immunization on these patients before OLT.

Patients And Methods: This was a prospective trial, with 34 patients (20 M and 14 F), that received a double dose (40 micrograms) of HBV surface proteic Ag, on the 0th, 30th and 60th days of the study and posterior control of anti-HBs levels.

[The liver transplant program of the Hospital General Universitario Gregorio Marañón: an analysis of the first 100 patients].

During a 3-year period between 1990 and 1993, 100 patients received orthotopic liver transplantation at the "Gregorio Marañón" University General Hospital. The mean age of the patients was relatively high (46.9 +/- 10 years), with an important number of cirrhotic patients (91%).

[Resection of recurrent hepatocarcinoma on a transplanted liver].

Recurrence of hepatocellular carcinoma is rarely treated by surgical resection and has not been reported in the main series of liver transplantation. In this paper we present the case of a patient transplanted for hepatocellular carcinoma on cirrhosis who developed a tumoral recurrence in the transplanted liver four months later. The new tumor was removed by hepatectomy and the patient is free of tumor 24 months after resection.

[Effect of antibiotic prophylaxis with vancomycin on methicillin-resistant Staphylococcus aureus infection following liver transplantation].

An epidemic outbreak of Methicillin-resistant Staphylococcus Aureus (MRSA) infections affecting liver transplantation patients was detected in our hospital. In this study we describe the special characteristics of the infections and the results of prophylactic treatment with Vancomycin. Between april 1990 and december 1991, 47 patients with mean age of 54.

Evaluation of surgical and anesthetic strategy as a key factor in the postoperative results of liver transplant.

Since the inauguration of our liver transplant program two years ago, retrospectively we can distinguish two different periods as regards postoperative results. The patients studied were distributed in two groups by chronological order and date of introduction of an improved surgical and anesthetic strategy: retrohepatic dissection during the veno-venous bypass phase and meticulous hemostasis in the anhepatic phase: Group A: 11 transplants in 10 patients and Group B: 22 transplants in 21 patients. Preoperatively, both groups were homogeneous with respect to the clinical situation.

[Early and late results of orthotopic liver transplantation].

Between 4/1986 to 1/1989, 74 orthotopic liver transplantation were performed in 62 patients (62 first liver transplants, 10 as second graft and two as a third graft); 57 in adults and 17 in children. The main indication for the operation was liver cirrhosis (61.4%) (the most frequent etiology was alcoholic cirrhosis, 28.

[Role of liver transplant in the treatment of hepatic hydatidosis].

Three patients are reported who had liver hydatidosis that was not resolved by conventional surgery and who eventually underwent liver transplantation. In view of the satisfactory results obtained, with 100% postoperative survival, possible indications for liver transplant in this type of patients are discussed, fundamentally for secondary sclerosing cholangitis, secondary biliary cirrhosis and acute Budd-Chiari syndrome.

[Evaluation of the socio-affective adaptation of patients with liver transplant].

The quality of the socio-affective adaptation of liver transplant patients is a fundamental assessment parameter in the context of postoperative recuperation. The patient's reinsertion into the socio-occupational environment, gradual recuperation of professional and recreational habits and psycho-affective reorganization represent, in our opinion, the most significant criteria for evaluation of the "modus vivendi" of the transplant patient. A total of 21 patients between 21 and 62 years were evaluated.

[Initial results of restoration of bile flow in liver transplant].

The initial results of biliary reconstruction in 72 liver transplants realized in 62 patients, 50 adults and 12 children, are presented. Three reconstruction techniques were used: end-to-end choledocho-choledochostomy on a Kehr tube in 44 transplants (61.1%); choledocho-jejunostomy on a Roux-en-Y loop in 24 transplants (33.

Choledochal cyst resection and reconstruction by biliary-jejuno-duodenal diversion.

From January, 1983 to December, 1986, a total of 9 patients, ranging in age from 2 years and 4 months to 36 years, with choledochal cysts were treated. Symptoms were right upper quadrant pain (n = 9), ascending cholangitis (n = 7), and jaundice (n = 6). A right upper quadrant mass was palpable in 7 patients and gallstones were present in 5 patients.