ABSTRACT
La hiperplasia nodular focal (HNF) del hígado es una tumoración benigna probablemente secundaria a una alteración en la vascularización del parénquima hepático, rara en la edad pedíatrica. Objeto: reportar un caso clínico de HNF que requirió transplante hepático ortotópico (THO) y revisar la literatura actual con respecto a la conducta terapéutica a seguir. Caso clínico: niño de 15 años de edad con una masa abdominal palpable. Ecografía y tomografía axial computada de abdomen demostraron un tumor multifocal en ambos lóbulos hepáticos de características irresecables. Biopsia operatoria del hígado confirmo una HNF. El paciente desarrolló hipertensión portal debido a compresión tumoral de la vena porta, con ascitis, encefalopatía hepática e insuficiencia renal, por lo que se decidió su manejo mediante un THO en injerto total, con una excelente evolución a 5 años de seguimiento. Conclusión: la decisión entre un enfoque conservador o quirúrgico depende de las características de cada caso, siendo el THO una alternativa terapéutica en pacientes con tumores hepáticos benignos e irresecables
Subject(s)
Humans , Male , Adolescent , Focal Nodular Hyperplasia , Liver Neoplasms , Liver Transplantation , Hepatic Encephalopathy/etiology , Focal Nodular Hyperplasia , Hypertension, Portal/etiology , Renal InsufficiencyABSTRACT
Background: The success of orthotopic liver transplantation (OLT) has resulted in its widespread use for different liver diseases. Aim: To report our 8 years experience with adult OLT at Clinica Alemana de Santiago. Patients and methods: In all transplantations done at the center, we recorded patient's overall data and survival, postoperative medical and surgical complications and causes of death. Results: Between November 1993 and September 2001, 51 consecutive OLT were performed in 44 patients (22 females, median age 45 years old). Thirty eight patients presented with chronic and 6 with acute or sub-acute liver failure. Cryptogenic cirrhosis and hepatitis C infection were the most common causes for OLT. Postoperative bleeding and extra-hepatic biliary complications were seen in 17.6 and 21.5 percent of cases respectively. Acute rejection, bacterial infections, CMV infection or disease and post OLT hemodialysis were the most common medical complications (51, 31, 19.6 and 19.6 percent of cases respectively). The overall 1 and 5 years survival rates were 80 percent and 73 percent respectively. Considering exclusively the last 22 OLT performed since January 1999, the 1 year survival rate has improved to 91 percent. Conclusions: Liver transplantation in Chile provides a good long term survival with acceptable morbidity, due to a multidisciplinary approach management. The survival rates have improved over the last few years probably due to better surgical techniques, ICU care and immunosuppression. These overall results are comparable with those from other Centers in developed countries
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Hepatic Insufficiency/surgery , Liver Transplantation/statistics & numerical data , Postoperative Complications , Cause of Death , Immunosuppressive Agents , Reoperation/statistics & numerical dataABSTRACT
We report a 52 year old man with a pancreatic pseudocyst, that was admitted with severe abdominal pain, severe vomiting, fever and malaise. The clinical picture was considered secondary to a pseudocyst infection and the patient was operated, draining the infected cyst performing a necrosectomy and pancreatocystojejunostomy. Forty eight hours after the operation, an ostomy bleeding was detected. A upper mesenteric artery angiography showed two pseudoaneurysms in the gastroduodenal artery, that were embolized. Bleeding stopped initially, but seven days later, it reappeard. The patient was subjected to an emergency pancreatoduodenectomy. Postoperative evolution was uneventful and the patient was discharged two weeks later. Spontaneous bleeding of pseudoaneurysms secondary to chronic pancreatitis is a complication with a 15 to 40 percent mortality that must be bore in mind
Subject(s)
Humans , Male , Middle Aged , Pancreatitis/complications , Aneurysm, Ruptured/complications , Gastrointestinal Hemorrhage/etiology , Pancreatitis/surgery , Pancreaticoduodenectomy , Aneurysm/etiology , Rupture, Spontaneous , Pancreatic Pseudocyst/complicationsABSTRACT
The charts of 17 patients (12 male), aged 7 to 65 years old, with chronic pancreatitis that were operated in three different Chilean regions, were reviewed. Results: Seven patients had previous endoscopic therapeutic procedures (papillotomy in 4 and stent placint in 3). Seven patients had been subjected to previous biliary surgical procedures. Indications for surgery were severe pain in 14 patients, the suspicion of a pancreatic carcinoma in 4 patients, an infected pseudocyst in one and massive bleeding of multiple pseudo-aneurysms in a pseudocysts in one patient. Twelve patients were subjected to decompressions and 5 to pancreatic resections. There was no operative mortality and one transient pancreatic fistula. After an average follow up of 22 months, pain improved in 94 percent of cases, pancreatic cancer was diagnosed in one patient and 79 percent of subjects gained weight. One patient became insulin dependent, one increased his insulin requirements and one bad transient steatorrhea, since she could not afford pancreatic enzyme replacement therapy. Conclusions: The multidisciplinary approach of patients with chornic pancreatitis, with selective use of surgery, may greatly improve their quelity of life
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Pancreatectomy , Pancreatitis/surgery , Pancreatitis/complications , Pancreatitis/diagnosis , Follow-Up Studies , Diabetes Mellitus/etiology , Chronic Disease , PancreaticojejunostomyABSTRACT
La pancreatitis crónica es una afección infrecuente pero no excepcional, que está íntimamente relacionada con el alcoholismo desde el punto de vista etiopatogénico. Su tratamiento no asegura siempre la detención de la evolución habitualmente progresiva de la afección. Sus fundamentos son la supresión absoluta y definitiva de la ingesta alcohólica; la sedación del dolor que se presenta en el 90 a 95%de los casos y la corrección de la insuficiencia pancreática tanto endocrina (hipoglicemiantes orales ocasionalmente útiles o insulina en la mayoría de los casos) como exocrina (extractos pancreáticos protegidos o con neutralizadores o bloqueadores de la secreción gástrica
Subject(s)
Exocrine Pancreatic Insufficiency/therapy , Pancreatitis/therapy , Chronic DiseaseABSTRACT
The biology of planktotrophic larvae of Concholepas concholepas is the main bottleneck towards developing biotechnologies to rear this muricid. Data concerning planktonic larvae development, diets and environmental signals triggering larval settlement and recuitment is scarce. We have begun the study of the molecular and cell biology of embryos, larvae and recruits having as a final goal, the development of appropriate biotechnologies to rear this gastropod. First, an inverse ratio between BuChE and AChE enzyme activities was established. This ratio may be a precise development marker for this species. Second, for the first time a phosphoinositide rlated regulatory pathway is reported in a muricid, opening a new approach to the biotechnological management of larvae. Third, the relation between sulfate in sea water and larval motility was studied. Concentration below 125 µM sulfate decreases larval motility. The sulfate is incorporated in proteoglycans which participate in different developmental phenomena. Lastly, a genomic Concholepas concholepas DNA sequence, similar to that of a human growth hormone probe was detected. This is very interesting since growth factors are key molecules during development, growth and are involved in food conversion rares in fishes and also, a in variety of marine invertebrates