Donación y trasplante de órganos: propuesta desde la Academia Chilena de Medicina / A proposal of the Chilean Academy of Medicine to improve organ procurement and transplantation in Chile

The Chilean Academy of Medicine designated a group of specialists to evaluate the practice and to propose reforms for organ donation and transplantation, due to the general insufficiencies at the national level with these procedures. In the last six years the mean number of organ transplants in Chile was 340 cases per year while effective cadaveric donors ranged between 6 and 10 per million inhabitants. These averages remained stable during this period and are among the lowest in the region. Our analysis attributed these deficient results mainly to low organ donation and inefficient procurement due to lack of compliance with protocols and little accountability. The committee proposes several measures for improvement. These are a systematic and obligatory report of potential organ donors by all emergency and critical care centers, frequent evaluation of results, empowering of health authorities to correct insufficiencies in organ procurement, education programs for primary, secondary, technical and university students to improve their knowledge about the social significance and solidarity required for transplantation policies and specialized updated training of all health professionals involved. Organ donation and transplantation must be based on clear and fair ethical considerations in order to be accepted by the general public.

Hepatocarcinoma, porfiria y hemosiderosis. Una asociación no reportada en nuestro país: caso clínico / Porphyria cutanea tarda, hemosiderosis and hepatocellular carcinoma: report of one case

Porphyria cutanea tarda (PCT) is a hereditary or acquired disease. It can be unleashed by iron overload, alcohol, estrogens and other conditions. In these patients, hepatic involvement can be associated to cirrhosis, iron overload or C and B viral infections, that are predisposing factors for hepatocellular carcinoma. We report a 69-year-old man with PTC, hemosiderosis and hepatocarcinoma. The tumor was diagnosed during a routine ultrasound examination for early detection of malignant lesions. The patient was subjected to a right hepatic excision. The pathological examination of the surgical piece confrmed the diagnosis and disclosed free surgical margins. After 18 months of follow up, the patient had a relapse and a liver transplantation was performed.

Trasplante hepático en Chile: Aspectos generales, indicaciones y contraindicaciones (Documento de consenso) / General considerations, indications and contraindications for liver transplantation in Chile: A multicenter consensus development document

Liver transplantation is an excellent therapeutic option for terminal liver disease. During the last decades the results of liver transplantation have improved significantly with a patient survival rate of nearly 90 percent at one year and 80 percent at 5 years of follow-up. The main indications for liver transplantation include: end-stage liver disease associated to cirrhosis, acute liver failure, and hepatic tumors (mainly hepatocarcinoma). The absolute contraindications for a transplant are less frequent than in the past, and include: severe co-morbidity (cardiac or pulmonary), sepsis, advanced HIV disease and extra-hepatic malignancy. This document presents a Consensus of the main groups performing liver transplantation in Chile, about its indications and contraindications. It also reviews general aspects of liver transplantation, including the selection and referral of liver transplant candidates, allocation of organs and the evaluation of severity of liver disease.

Adenomiomatósis vesicular pseudotumoral: Diagnóstico ecográfico. Caso clínico / Pseudotumoral adenomyomatosis of the gallbladder diagnosed by ultrasound. Report of one case

Adenomyomatosis of the gallbladder wall is a frequent benign degenerative hyperplasia of unknown etiology. In some cases it looks like a malignant tumor. The diagnosis can be suspected during ultrasound examination. We report a 36 year-old male that presented with nonspecific dyspepsia. The ultrasound showed a gallbladder mass with small cyst and echogenic spot inside that suggested the presence of Rokitansky-Ashoff sinuses, seen in adenomyomatosis. The patient was operated and the tumor was excised. The pathological examination of the surgical specimen confirmed the presence of gallbladder adenomyomatosis.

Colecistectomía laparoscópica: casuística del Hospital Militar / Laparoscopic cholecystectomy: casuistic from the Military Hospital

Se presenta la casuística de la colecistectomía laparoscópica (CL) del Hospital Militar en la patología vesicular, revisando los resultados obtenidos en 1.102 pacientes en un lapso de 23 meses. El 22 por ciento de los pacientes son portadores de un cuadro vesicular agudo. El 10 por ciento de las CL recibieron una colangiografía endoscópica retrógrada (CER) preoperatoria en búsqueda de coledocolitiasis, encontrándola en un tercio de ellos. Durante la intervención se detecta un 1,8 por ciento de coledocolitiasis, llegando a un 5,3 por ciento de cálculos coledocianos en toda la serie. En el 1,6 por ciento de la serie se realizó exploración coledociana trancística, lo que permite resolver el 40 por ciento de los hallazgos de coledocolitiasis intraopereratoria. Se convirtió la técnica en el 6 por ciento de las CL, existiendo 3,8 por ciento de complicaciones médicas, 3,5 por ciento de complicaciones quirúrgicas, con 0,7 por ciento de reoperaciones, 06 por ciento rehospitalizaciones 0,18 por ciento de sección del colédoco y 0,09 por ciento de mortalidad. Las cifras refuerzan sólidamente el concepto de que la CL es la técnica quirúrgica para tratar la patología vesicular no neoplásica, con un adecuado margen de seguridad, buena recuperación postoperatoria y rápida rehabilitación

Extracción multiple de órganos para trasplante / Multiple organ procurement

Se describe la técnica clásica de extracción múltiple de corazón, hígado y riñones para trasplantes, la cual permite un mejor aprovechamiento de los donantes frente a la creciente necesidad de órganos. También se presenta la técnica rápida que ha permitido que la intervención de extracción de órganos se realice en un tiempo más breve, no demorando al equipo que realiza la cardiectomía, con esta técnica se puede además utilizar donantes homodinámicamente inestable que antiguamente se perdían