Flushing episodes in the context of frontal fibrosing alopecia with facial papules.

Frontal fibrosing alopecia (FFA) is a progressive frontotemporal hairline recession with eyebrow loss. Facial papules are present in up to 14% of FFA cases and can start with facial flushes. Nevertheless, these flushes are commonly associated with rosacea, a much more prevalent disease.

Impact of model for end-stage liver disease score on long-term survival following liver transplantation for hepatocellular carcinoma.

Background And Aims: Survival rates after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) have significantly increased after Milan criteria and Model for End-Stage Liver Disease (MELD) score implementation. However, few studies have reported this survival in countries with organ donor shortages over a period of 10 years and long waiting lists.

Methods: This retrospective analysis of clinical data from 93 consecutive HCC patients who underwent OLT from June 2001 to September 2011 excluded 22 who underwent living donor liver transplantation (LDLT).

Doppler sonography of maternal cerebral arteries in pregnancy: side-to-side differences.

Background/aims: To study side-to-side differences in blood flow of the common and internal carotid arteries, and the vertebral arteries (VAs) in women with uncomplicated pregnancies as a first step to build a reference values chart.

Methods: A total of 155 healthy pregnant women between 20 and 40 weeks' gestation were included. Doppler sonography of the common and internal carotid arteries and VAs was performed on both sides.

Grynfelt hernia: case report and literature review.

Back lumbar hernia is a rare abdominal wall defect that usually presents spontaneously after trauma or lumbar surgery or, less frequently, during infancy (congenital). Few reports have been published in the literature describing primary lumbar hernia. A general surgeon will have the opportunity to repair only one or a few lumbar hernia cases in his/her lifetime.

Right ventricular ejection fraction during orthotopic liver transplantation: does anesthetic technique make a difference?

Purpose: The objective of this study is to evaluate the right ventricular ejection fraction (RVEF) during orthotopic liver transplantation (OLT) under 2 different anesthetic regimens: propofol vs isoflurane anesthesia.

Methods: We retrospectively analyzed the hemodynamic data of 25 (n = 25) patients who underwent OLT during the last year (2008). All patients were monitored with a modified pulmonary artery catheter, which continuously measured the RVEF.

Methylene blue used as a bridge to liver transplantation postoperative recovery: a case report.

Hepatopulmonary syndrome is defined as a triad of liver disease, arterial hypoxemia, and intrapulmonary vascular dilatation. The clinical hallmark of this disorder is the impairment of pulmonary gas exchange, not necessarily correlated with the severity of the underlying liver disease. Liver transplantation (OLT) is the only definitive treatment for this syndrome.

Cellulitis and nodular skin lesions due to Fusarium spp in liver transplant: case report.

Fusariosis is one of the emerging invasive fungal infections over the last decade. However, its recent rise has been in its ability to produce disseminated infection in severely immunosuppressed patients with neutropenia. In solid organ transplantation, fusariosis remains an uncommon picture mainly with nodules, subcutaneous abscesses, ulcers, or necrotic skin lesions resembling erthyma gangrenosum.

Ectopic placement of Sengstaken-Blakemore device to correct outflow obstruction in liver transplantation: case reports.

Liver transplantation is a complex procedure that has become the treatment for some end-stage liver diseases. Some technical features are important for the success of the transplantation, including the patency of the vascular anastomoses. In cadaveric whole organ liver transplantation, a large right subphrenic space may contribute to a twist of the inferior vena cava, leading to outflow obstruction, simulating an acute Budd-Chiari syndrome.

Surgical complications in 100 donor hepatectomies for living donor liver transplantation in a single Brazilian center.

The rising demand for liver transplantation has continued to outspace the availability of deceased donor organs, leading to the need for other treatment options including living donor liver transplantation (LDLT). A precise evaluation of surgical complications is the most important issue in this setting. There are controversies about donor morbidity with reports ranging from 13%-75%.

Perioperative coagulation profile in living liver donors as assessed by rotational thromboelastometry.

Transient postoperative coagulation abnormalities frequently occur in living liver donors, particularly after right liver resection. Usually, this coagulopathy is diagnosed by alterations in conventional coagulation tests (CCTs) such as the international normalized ratio (INR) of the prothrombin time. However, recent studies using other methods of coagulation monitoring have suggested that postoperative hypercoagulability may also occur in living donors.

Panel reactive HLA antibodies, soluble CD30 levels, and acute rejection six months following renal transplant.

Background: Specific anti-human leukocyte antigen antibodies (HLA) in the post-transplant period may be present with acute rejection episodes (ARE), and high soluble CD30 (sCD30) serum levels may be a risk factor for ARE and graft loss.

Methods: HLA cross-matching, panel reactive antibodies (PRA), and sCD30 levels were determined prior to transplantation in 72 patients. Soluble CD30 levels and PRA were re-assessed at day 7, 14, 21, and 28, and monthly up to the sixth.

Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation.

Background: The pulse pressure variation (PPV) index has been shown to be a reliable predictor of fluid responsiveness (FR) in a variety of clinical settings. However, it has not been formally evaluated in the setting of orthotopic liver transplantation (OLT).

Methods: Fifteen (n=15) patients undergoing OLT were enrolled in this study.

Living donor liver transplantation for acute liver failure: a single center experience.

Objective: Orthotopic liver transplantation (OLT) is the principal therapy for acute liver failure (ALF). The mortality on the waiting list for deceased donor liver transplantation (DDLT) is high, principally in countries where donation rates are low. Living donor liver transplantation (LDLT) seems an option for the treatment of ALF, although some ethical issues need to be considered.

Treatment for recurrent hepatitis C virus infection after liver transplantation.

Cirrhosis due to hepatitis C virus (HCV) infection is the current leading indication for orthotopic liver transplantation (OLT) in the world. This series reports our program's experience with the treatment of HCV infection after the development of histological hepatitis. Between March 2002 and June 2008, patients with recurrent HCV were selected for treatment if the liver biopsy showed at least the F2 degree of Metavir score.

Protamine sulphate for treatment of severe post-reperfusion coagulopathy in pediatric liver transplantation.

In this case report, we describe a child with biliary atresia who underwent a living LDLT and developed severe coagulopathy after reperfusion of the graft. The ROTEM analysis strongly suggested the presence of either a heparin effect or severe deficiency of coagulation factors. The former diagnosis was supported by a subsequent in-vitro HEPTEM.

Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia and sedation.

Conclusion: Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia with sedation can be well tolerated by the patient, with minimum discomfort.

Objectives: To evaluate patient discomfort from pain, body/neck position, noise, and anxiety during tympanoplasties and mastoidectomies performed under local anesthesia with sedation.

Patients And Methods: This was a prospective study of 83 surgeries in 62 patients (28 type I tympanoplasties, 12 tympanoplasties with ossicular reconstruction, 40 canal wall up mastoidectomies, and 3 revision tympanoplasties).

Evaluation of the right ventricular ejection fraction during orthotopic liver transplantation under propofol anaesthesia.

Background: The right ventricular ejection fraction pulmonary artery catheter (RVEF-PAC) has been widely used to monitor the right ventricular (RV) function during orthotopic liver transplantation (OLT). However, the evaluation of the RVEF during this procedure during propofol anaesthesia has not been described.

Methods: Twenty consecutive patients undergoing OLT without veno-venous bypass were studied.

Association between nasal polyposis, Dubowitz syndrome and hyper-IgE syndrome.

Dubowitz syndrome is a rare, autosomal recessive disorder characterized by intrauterine growth retardation, short stature, microcephaly, distinct facial dysmorphism, and psychomotoric retardation. The hyper-immunoglobulin E (hyper-IgE or Job syndrome) is a primary immunodeficiency characterized by recurrent staphylococcal abscesses, recurrent cyst-forming pneumonia, and an elevated serum IgE level of >2000 IU/ml. We present the first case to our knowledge of an association between Dubowitz syndrome, hyper-IgE syndrome, and nasal polyposis (due to allergic fungal sinusitis) in a 14-year-old girl.

Liver transplantation for acute liver failure: trying to define when transplantation is futile.

Background: Recently, the model of end-stage liver disease (MELD) index has been used to select patients with acute liver failure (ALF) or transplantation. By the time the indication for orthotopic liver transplantation (OLT) is defined, the patient's clinical status may worsen.

Objective: In this study, MELD was used to define patients beyond OLT.

Selection of donors for living donor liver transplantation in a single center of a developing country: lessons learned from the first 100 cases.

The selection of donors for living donor liver transplantation (LDLT) is one of the most important features in this kind of surgery. The aim of this study is to describe our initial experience in the donor evaluation process. From December 2001 to January 2005, 104 donors were evaluated for 70 recipients (65 potential donors were evaluated for 39 adult recipients, and 39 donors for 31 pediatric recipients).

One living donor and two donations: sequential kidney and liver donation with 20-years interval.

The shortage of cadaveric donor organs remains the critical factor limiting the use of organ transplantation. In this environment of organ shortage, living donor transplantation has emerged as a reasonable therapeutic alternative. Simultaneous kidney-liver transplantation from the same donor has been described.

Liver transplantation with monosegment from a living donor.

The shortage of organ donors for low-weight liver transplant recipients, especially for small children, has led to the development of new surgical techniques to increase the donor pool. Almost all of these techniques use the left lateral segment (Couinaud's segments II and III), but even this graft could be too large for children under 10 kg. We report here the case of an 8-month-old boy, weighing 6.