ABSTRACT
Resumen Introducción: El trasplante hepático (TH), es una terapia establecida en el tratamiento de diversas enfermedades del hígado agudas y crónicas terminales y del carcinoma hepatocelular (CHC). Las principales indicaciones en nuestro medio son la cirrosis de diferentes etiologías, el CHC, la atresia de vías biliares en niños y la falla hepática fulminante (FHF). Menos del 10% corresponden a indicaciones inhabituales, que incluyen pacientes con una miscelánea de enfermedades entre las cuales están la enfermedad poliquística hepática (EPH), enfermedades metabólicas (Niemann-Pick, otras), el síndrome hepato/portopulmonar, metástasis de diferentes tumores, etc. Objetivo: Describir y evaluar los resultados obtenidos con el trasplante hepático en estas indicaciones. Materiales y Método: Estudio de cohorte no concurrente que incluyó los TH por indicaciones inhabituales realizados entre marzo de 1997 y diciembre de 2016. De 295 TH realizados, 34 (11,5%) fueron por estas indicaciones. Resultados: Las causas más frecuentes fueron el síndrome porto/hepatopulmonar en 11 (40,7%) pacientes y la EPH en 9 (26,5%). Las enfermedades metabólicas representaron la tercera indicación, con 5 (14,7%) casos. Siete (20,6%) pacientes eran menores de 18 años. Las complicaciones más frecuentes fueron biliares y la trombosis de arteria hepática en 6 (17,6%) y 4 (11,8%) casos respectivamente; estos últimos eran portadores de una EPH masiva. Cuatro (12,5%) pacientes requirieron retrasplante. La mortalidad a 90 días fue de 2 (5,9%) enfermos. Conclusión: El TH es una opción factible en este grupo de pacientes con resultados similares a los obtenidos en las indicaciones clásicas.
Introduction: Liver transplantation (LT) is an established therapy in the treatment of several acute and chronic end-stage liver diseases and hepatocellular carcinoma (HCC). The main indications worldwide are cirrhosis of different etiologies, HCC, biliary atresia in children, and fulminant hepatic failure (FHF). Less than 10% concerns unusual indications which include patients with miscellaneous diseases among which are hepatic polycystic disease (HPD), metabolic diseases (Niemann-Pick, others), portal/hepatopulmonary syndrome, metastasis of different tumors, among others. Aim: The objective of the study is to describe and asses the results obtained with liver transplantation in these indications. Materials and Method: We performed a non-concurrent cohort study that included all LT due to unusual indications between March 1997 and December 2016 in a university medical center. Of 295 TH performed, 34 (11.75%) were due to these indications. Results: The most frequent causes were the portal/hepatopulmonary syndrome in 11 (40.7%) patients and HPD in 9 (26.5%). Metabolic diseases accounted for the third indication in 5 (14.7%) cases. Seven (20.6%) patients were less than 18 years old. The most frequent complications were biliary and hepatic artery thrombosis (HAT) in 6 (17.6%) and 4 (11.8%) cases, respectively. Patients complicated by a HAT suffered a massive EPH. Four (12.5%), required retransplantation. Mortality at 90 days was 2 (5.9%). Conclusión: LT is a feasible option in this group of patients with results similar to those obtained in classic indications of LT.
Subject(s)
Humans , Liver Transplantation , Liver Diseases/surgery , Treatment Outcome , Liver Cirrhosis/surgeryABSTRACT
BACKGROUND: Hyperhomocysteinemia is an independent cardiovascular risk factor that depends on folate and vitamin B12 nutrition. AIM: To measure homocysteine, folic acid and vitamin B12 serum levels in healthy children with and without a family history of cardiovascular disease. SUBJECTS AND METHODS: Forty children aged 6 to 15 years with a family history of cardiovascular disease, and 40 age and sex matched children without such history were studied. Serum homocysteine, folic acid and vitamin B12 were measured in a fasting blood sample. Homocysteine was measured by a fluorescence polarization immunoassay (FPIA), vitamin B12 by enzymatic microparticle assay, covered with intrinsic factor and folic acid by ionic capture, using commercial kits. RESULTS: Children with family history of cardiovascular disease had higher homocysteine levels than their counterparts without family history (7.9 +/- 3 and 5.8 +/- 2 mumol/l respectively, p < 0.03), but similar folic acid (5.2 +/- 1.8 and 5.5 +/- 1.4 pg/ml respectively) and vitamin B12 levels (431 +/- 213 and 445 +/- 209 ng/ml respectively). There was a negative and significant correlation between homocysteine and folic acid and vitamin B12 levels. CONCLUSIONS: Children with a family history of cardiovascular disease have higher levels of serum homocysteine than those without such history, despite having similar levels of folic acid and vitamin B12.
Subject(s)
Humans , Male , Female , Child , Adolescent , Cardiovascular Diseases/blood , Homocysteine/blood , Hyperhomocysteinemia , Folic Acid/blood , Cardiovascular Diseases/genetics , Risk Factors , Lipoproteins/blood , Lipids/blood , /bloodABSTRACT
Se estudiaron en forma abierta y controlada 40 pacientes pediátricos con verrugas vulgares múltiples, resistentes a otros tratamientos. En 20 pacientes se empleó como agente terapéutico el 1-cloro-2, 4 dinitrobenceno (DNCB) y en 20 pacientes acetona como placebo. Curaron 16 pacientes tratados con DNCB y siete tratados con placebo (P < 0.025). El tiempo promedio de curación de las lesiones con DNCB fue de siete semanas. La edad, sexo, número de lesiones, localización, tratamientos previos y tiempo de evolución de las lesiones no influyeron en la respuesta terapéutica