ABSTRACT
Hepatopulmonary syndrome is an important clinical problem associated with chronic liver disease. Liver transplantation can result in complete resolution of the arterial hypoxemia associated with this syndrome, even in its most severe presentation. AIM: To determine the prevalence of hepatopulmonary syndrome in adult liver transplant candidates. PATIENTS AND METHODS: Fifty-four consecutives adult patients (> or = 18 years) with severe liver disease waiting for liver transplant were screened for arterial hypoxemia (PaO2 < 70 mm Hg) while they were seated, at rest, and breathing room air. Patients with arterial hypoxemia underwent contrast-enhanced two-dimensional echocardiography and pulmonary function testing. Hypoxemia (PaO2 < 70 mm Hg) was present in 7 of 54 patients (12.9%), although only 1 of them complained of dyspnea. The Child's classification of the patients were: A = 1, B = 4, and C = 1. All seven hypoxemic patients had positive contrast-enhanced two-dimensional echocardiography, consistent with hepatopulmonary syndrome. CONCLUSION: The prevalence of hepatopulmonary syndrome in adult liver transplant candidates is elevated. The screening for hepatopulmonary syndrome should be part of the routine evaluation of liver transplant candidates even in the absence of pulmonary symptoms
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Hepatopulmonary Syndrome/epidemiology , Liver Transplantation , Brazil , Hepatopulmonary Syndrome/etiology , Liver Diseases , PrevalenceABSTRACT
Hepatocellular carcinoma is one of the most common malignancies worldwide. Liver transplantation has emerged as a good option for early-stage hepatocellular carcinoma yielding survival rates as good as for recipients without this type of tumor. OBJECTIVE: To assess the outcome of cirrhotic patients with hepatocellular carcinoma undergoing liver transplantation at the Liver Transplantation Service of the "Hospital de Clinicas", Federal University of Parana, Curitiba, PR, Brazil. METHODS: Retrospective study of cirrhotic patients with hepatocellular carcinoma undergoing orthotopic liver transplantation at the mentioned Institution between September 1991 and September 2000. The diagnosis of hepatocellular carcinoma was established during the pretransplant workup in five patients and the tumor was an incidental finding in the native liver in three. The indication for liver transplantation was restricted to solitary tumor equal to or less than 5 cm or up to 3 nodules, with each nodule measuring less than 3 cm, and no evidence of vascular invasion or extrahepatic spread. Patient survival and evidence of tumoral recurrence posttransplant were evaluated. RESULTS: The most common cause for pretransplantation liver disease was hepatitis C virus (50%). On examination of the explanted liver, the majority of patients (6/8, 75%) had a single lesion; one patient had two nodules and one had a multifocal hepatocellular carcinoma found incidentally in the native liver. Tumor size ranged from 0.2 to 5.0 cm. All cases had neither vascular invasion nor linfonodal envolvement. All patients remained alive and free of tumor recurrence at the time of the study with a mean follow-up of 18.5 months (range, 5-29 months). CONCLUSION: Liver transplantation is a good therapeutic option for early stage hepatocellular carcinoma arising in cirrhotic patients. With proper selection, liver transplantation can offer excellent survival rates free of tumor recurrence
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Carcinoma, Hepatocellular , Liver Neoplasms , Liver Transplantation , Carcinoma, Hepatocellular , Follow-Up Studies , Liver Cirrhosis , Liver Neoplasms , Liver Transplantation , Neoplasm Recurrence, Local , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
A pancreatite aguda, importante causa de abdome agudo, tem etiologia multifatorial. Seu aspecto de gravidade é amplo, podendo ser extremamente grave, com mortalidade elevada. O presente trabalho avaliou 97 casos de pacientes internados com pancreatite aguda, analisando a etiologia, tratamento e complicaçöes, com o objetivo principal de determinar o momento ideal para a realizaçäo da colecistectomia em pacientes com pancreatite aguda de origem biliar. De todos os pacientes, 48 eram do sexo masculino e 49 do feminino, com idade média de 49,4 anos, sendo a pancreatite aguda leve em 68 pacientes e severa em 29. A etiologia biliar foi a mais frequente (31 pacientes); destes, 15 pacientes foram submetidos a colecistectomia precoce e 5 foram submetidos a colecistectomia tardia. Concluiu-se, entäo, que o momento ideal para a realizaçäo da colecistectomia na pancreatite aguda de origem biliar deve ser postergado até o restabelecimento do paciente, em geral após o décimo dia de internamento. Este procedimento deve ser sempre indicado devido à alta taxa de recidiva da pancreatite aguda biliar