Ameloblastoma metastásico / Metastatic ameloblastoma

77REPERT MED CIR. 2023;32(1):77-80Mario Alexander Melo MD*María Camila PiñerosbAna María TorresbFabián Parra F. MDcRafael Baracaldo A. MDda Patología. Grupo de Patología Oncológica, Instituto Nacional de Cancerología, Universidad El Bosque. Bogotá DC, Colombia. b Odontólogía, Patología Oral y Medios Diagnósticos, Universidad El Bosque, Bogotá DC, Colombia. c Radiología e Imágenes Diagnósticas, Fundación Universitaria Sanitas, Bogotá DC, Colombia. d Patología, Fundación Universitaria de Ciencias de la Salud. Bogotá DC, Colombia.Introducción: el ameloblastoma es un tumor epitelial benigno de origen odontogénico, de crecimiento progresivo, caracterizado por expansión ósea y tendencia a la recurrencia local si no se trata en forma adecuada. De acuerdo con las características clínicas y radiográficas se clasifica en ameloblastoma uniquístico, periférico/extraóseo y el metastásico. Presentación del caso: el presente manuscrito se quiere reseñar el caso clínico de un ameloblastoma metastásico, el cual es capaz de producir siembras a pesar de su apariencia histológica benigna. Discusión y conclusiones: las variadas formas clínicas y radiográficas hacen que el ameloblastoma metastásico requiera, desde su diagnóstico inicial, un estudio detallado ya que es importante entender el concepto de esta patología como lesión clínica que realiza metástasis a distancia, pero su comportamiento histológico es benigno

Introduction: ameloblastoma is a benign epithelial odontogenic tumor that progresses slowly and is characterized by bone expansion and tendency for local recurrence if not treated properly. According to the clinical and radiographic characteristics, it is classified as unicystic, peripheral/extraosseous and metastatic ameloblastoma. Case presentation: the present manuscript aims to review the clinical case of a metastatic ameloblastoma, which can metastasize in spite of a benign histological appearance. Discussion and conclusions: the various clinical and radiographic forms of metastatic ameloblastoma require, from its initial diagnosis, a detailed study, since it is important to understand the concept of this clinico-pathological entity as a lesion with distant metastases but benign histological features

Colecistectomía laparoscópica: técnica por video e-learning

Introducción: La Colecistectomía laparoscópica es una de las cirugías más frecuentes en nuestro país. Diversas dificultades han limitado una buena formación al respecto. Contar con un apoyo educativo capaz de transmitir la experiencia quirúrgica que facilite su aprendizaje, resulta imprescindible. Objetivo: Describir la técnica quirúrgica de una colecistectomía laparoscópica estándar incorporando elementos propios de la decisión quirúrgica, apoyado en tecnología e-learning. Materiales y Método: Estudio descriptivo. Se confeccionó material audiovisual de una colecistectomía laparoscópica, editado con apoyo de dibujo y animación 3D, e incorporando elementos técnicos propios del acto quirúrgico. Finalmente se redactó el texto de la técnica y se enlazó a través de códigos QR a capsulas del material audiovisual confeccionado. Resultados: Cinco pasos descriptivos claves de la colecistectomía laparoscópica apoyados con enlaces directos, tanto a través de un link asociado al texto como a través de una imagen QR anexa, a capsulas audiovisuales con información técnica y estratégica propia del ejercicio quirúrgico intraoperatorio. Conclusión: Técnica quirúrgica de una colecistectomía laparoscópica expuesta paso a paso apoyado con material audiovisual de una forma dinámica e innovadora, basado en nuevas tecnologías facilitadoras del aprendizaje.

Background: The laparoscopic cholecystectomy's technique has a great relevance in training programs. Their teaching requires a methodology that incorporates technical details that are lost with just reading or watching the procedure. Aim: This study presents the description of the surgical steps associated to an anatomical e-learning support that includes strategic and technical elements. Materials and Method: A standard laparoscopic cholecystectomy was used to make an educational video highlighting the critical aspect and concepts of its execution. The video incorporated drawings, painting and animations that fa- cilitate understanding. It was split and linked to Qr codes. Results: The detailed description of the steps of a cholecystectomy, such as a proper exposure of the surgical field, the dissection of the hepatocystic triangle, the safety view or gallbladder release, was associated with a Qr link. Conclusión: A step-by-step laparoscopic cholecystectomy in a dynamic and innovative way with an audiovisual support that facilitate learning.

Hidradenoma papilífero de la vulva con componente de carcinoma in situ: reporte de caso y revisión de la bibliografía / Papilliferous hidradenoma of the vulva with carcinoma in situ component: case report and literature review

Resumen ANTECEDENTES: El cáncer de vulva es relativamente raro, representa menos del 1% de los tumores malignos de la mujer; su incidencia aumenta con la edad. La variedad más frecuente es el carcinoma escamoso (80 al 90%), seguido del melanoma. En este reporte se revisa un carcinoma de origen glandular, como el hidradenoma papilífero del tipo glándula mamaria (mammary-like) de la vulva. CASO CLÍNICO: Paciente de 50 años, con una lesión papular en la vulva de dos años de evolución, con crecimiento lento y progresivo, ocasional sensación de masa y dolor, con colposcopia negativa, sin antecedentes de patología mamaria y con una biopsia previa que reportó hidradenoma papilífero vulvar. Se trató con resección completa de la lesión, con anestesia regional, con bordes libres, no se identificó algún componente infiltrante. En la actualidad permanece sin evidencia de recaída ni requerimiento de tratamientos adicionales durante el seguimiento. CONCLUSIÓN: El hidradenoma papilífero es una lesión benigna, poco frecuente, relacionada con las glándulas anogenitales de tipo mammary-like, con buen pronóstico. El tratamiento recomendado es la escisión quirúrgica, que casi siempre es curativa.

Abstract BACKGROUND: Vulvar cancer is relatively rare, representing less than 1% of malignant tumors in women; its incidence increases with age. The most frequent variety is squamous cell carcinoma (80 to 90%), followed by melanoma. In this report we review a carcinoma of glandular origin, such as papilliferous hydradenoma of the vulva of the mammary gland (mammary-like) type. CLINICAL CASE: We present a 50-year-old patient with 2 years evolution of a papular lesion on the vulva with slow and progressive growth, intermitent sensation of mass and pain, with negative colposcopy, no history of breast pathology and with a previous biopsy that reported vulvar papilliferous hydradenoma. She was treated with complete resection of the lesion under regional anesthesia, with free margins, without identifying an infiltrating component and currently without evidence of relapse or requirement of additional treatments. CONCLUSION: Papilliferous hidradenoma is a rare benign lesion related to the mammary-like anogenital glands, with a good prognosis and its recommended treatment is surgical excision, which is generally curative.

Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELD

Background: The Chilean allocation system for liver transplantation (LT) uses the MELD/PELD score to prioritize candidates on the waiting list. Aim: To assess if the Chilean allocation system for LT is equitable for pediatric candidates compared to their adult counterparts. Material and Methods: We used the Public Health Institute's registry between October 2011 and December 2017. We analyzed candidates with chronic hepatic diseases listed for LT. The primary outcome was the cadaveric liver transplantation (CLT) rate. Secondary outcomes were death or disease progression in the waiting list and living donor liver transplant (LDLT) rate. Results: We analyzed 122 pediatric and 735 adult candidates. Forty one percent of pediatric candidates obtained a CLT compared to 48% of adults (p = NS). Among patients aged under two years of age, the access to CLT on the waiting list there was 28% of CLT, compared to 48% in adults (p = 0.001). Fifty-seven percent of candidates aged under two years were listed for cholestatic diseases, obtaining a CLT in 18% and requiring a LDLT in 49%. The median time in the waiting list for CLT was 5.9 months in pediatric candidates and 5.1 in adults, while the median time to death in the waiting list was 2.8 and 5.6 months, respectively. The mortality rate at one year in candidates under two years old was 38.1% compared to 32.5% in adults. Conclusions: Pediatric candidates with chronic liver diseases, especially under two years of age, have greater access difficulties to CLT than adults. Half of the pediatric candidates die on the waiting list before three months. The mortality among candidates under two years of age in the waiting list is excessively high.

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.

Analysis of electronic apex locators in human teeth diagnosed with apical periodontitis

Abstract Electronic apex locators (EAL) have been used to establish the working length (WL) in root canal treatment. In teeth diagnosed with apical periodontitis, resorption of tooth apical structures can lead to difficulties to obtain an appropriate WL. The aim was to compare the capacity of three EAL's (Root ZX II, Raypex 6 and Endo-Eze Quill) to locate the tip of the K-file between 0 to -0.5 mm from the apical foramen (AF) on teeth diagnosed with asymptomatic apical periodontitis (AAP). Electronic working length was performed on 60 roots with AAP. A K-file #15 was inserted in the root canal until the apical foramen (AF) was located, and followed was re-adjusted to -0.5 mm through observation in EAL display. The K-file was fixed to the tooth with composite and teeth were extracted. The 4 apical millimeters were worn out until the K-file could be seen and were prepared and measured its distance to AF in a scanning electron microscope. Appropriate WL was when the tip of the K-file was located between 0 to -0.5 mm from AF. Results: Root ZX II showed significant difference (p<0.01) with the other two EALs. Root ZX II presented the better performance than Raypex 6 or Endo-Eze Quill in teeth with AAP.

Resumo Os localizadores eletrônicos apicais têm sido usados ​​para estabelecer o comprimento de trabalho no tratamento do canal radicular. Nos dentes diagnosticados com periodontite apical, a reabsorção das estruturas apicais dos dentes pode levar a dificuldades na obtenção de uma odontometria apropriada. Este estudo comparou três localizadores apicais (Root ZX II, Raypex 6 e Endo-Eze Quill) para localizar a ponta do instrumento K-file entre 0 a -0,5 mm do forame apical em dentes com diagnóstico de periodontite apical assintomática. O comprimento de trabalho eletrônico foi realizado em 60 dentes com periodontite apical assintomática. Uma lima K-file de número 15 foi inserida no canal radicular até a localização do forame apical, e seguida foi reajustada para -0,5 mm por meio de observação no visor do localizador eletrônico apical. A lima K-file foi fixada ao dente usando compósito, e a seguir os dentes foram extraídos. Os 4 milímetros apicais foram desgastados até que a lima K-file pudesse ser visualizada para as medidas de distância no forame apical por meio de microscópio eletrônico de varredura. O comprimento de trabalho apropriado foi determinado quando a ponta do instrumento estivesse localizada entre 0 a -0,5 mm do forame apical. O Root ZX II apresentou o melhor desempenho (p<0,01) que o Raypex 6 ou Endo-Eze Quill em dentes humanos com periodontite apical assintomática.

Tumor filoide en una mujer indígena colombiana / Phyllodes tumor in a Colombian indigenous woman

El tumor filoide es una neoplasia fibroepitelial de la glándula mamaria, constituida por la proliferación del componente estromal y epitelial. Se clasifica según sus características histológicas como benigno, de malignidad intermedia y maligno. Pese a que la presencia de tumor filoide se ha descrito en mujeres colombianas, no se encuentran reportes sobre su ocurrencia en mujeres indígenas. Se presenta un caso de un tumor filoide benigno en una indígena colombiana de la tribu Embera Chami, con la respectiva descripción clínica y quirúrgica, y el análisis histopatológico y de inmunohistoquímica.

The phyllodes tumor is a fibroepithelial mammary gland tumor, constituted of stromal and epithelial component. It is classified according to the histological features as benign, intermediate and malignant. Although the presence of phyllodes tumor has been described in Colombianwomen, the presentation of this tumor in indigenouswomen has not been reported. A case of a benign phyllodes tumor in a Colombian indigenouswoman from the Embera Chami tribe is presented with the clinical, surgical, histopathological and immunohistochemical description and analysis.

Manejo clínico de canino e incisivo inferiores fusionados e contaminados / Clinical management of fused and infected mandible canine and incisor

Introdução: “fusão dentária” é uma anomalia de desenvolvimentoem que dois germes dentários unem-se umao outro em níveis diferentes. Objetivo: relatar um casode canino inferior e incisivo lateral inferior com coroasseparadas e fusão de raiz, com seus canais radicularesconectados e periodontite apical. Métodos: um anoantes, a paciente recebeu tratamento de canal no canino,porém, não houve remissão dos sintomas. O tratamentoendodôntico foi realizado com reinstrumenta-ção, irrigação ultrassônica passiva com hipoclorito desódio, remoção de smear layer e medicação intracanalcom hidróxido de cálcio. Uma semana depois, os sintomasdesapareceram e os canais foram obturados comguta-percha e Sealapex, utilizando a técnica híbrida deTagger. Resultados: após dois anos e dois meses, o pacienteapresentou cicatrização dos tecidos periapicais.Conclusão: a detecção e manejo adequado dos casosde anomalias do desenvolvimento dentário são obrigatóriospara o sucesso do tratamento.

Implementación del Sistema Bethesda para el informe de citologia aspirativa de tiroides con seguimiento histopatológico: experiencia en un centro de tratamiento de cáncer / Implementation of the Bethesda system for cytology reporting of thyroid fine needle aspirates with histological follow-up: experience in a cancer treatment center

Objetivo: Determinar la frecuencia de los diagnósticos histológicos finales en el seguimiento de los estudios de citología por aspiración con aguja fina de tiroides implementados con el Sistema Bethesda (SB). Métodos: Se realizó un estudio de tipo corte transversal comparando los resultados de citología aspirativa de tiroides implementados con el SB y el resultado final de histopatología de pacientes con lesiones en la glándula tiroides que consultaron al Instituto Nacional de Cancerología, Colombia, durante los años 2010 a 2012. Resultados: Se revisaron informes de citopatología y de histopatología de 104 pacientes (n = 104) con nódulos tiroideos. La edad promedio de los pacientes fue de 51,59 años. Los resultados de citopatología, por categorias del SB, fueron: 37,5% categoria V, 30,8% categoria VI, 15,4% categoria IV, 6,7% categorias I y II, y 2,9% categoria III. Entre los diagnósticos de histopatología, el carcinoma papilar fue el más frecuente con 76%, seguido de bocio con 6,7% de los casos. En el análisis comparativo, las categorias IV, V y VI de la citologia tenían en el diagnóstico final de histopatologia una lesión maligna en el 89,8% de los casos, y los de citologia de categoria II, benignos, en el 77% de los mismos el resultado final de histopatologia era una lesión benigna. Conclusiones: La citologia aspirativa de la glándula tiroides interpretada con el SB en el Instituto Nacional de Cancerologia tiene una alta calidad diagnóstica en la detección de malignidad tiroidea al compararla con el diagnóstico final de histopatologia.

Objective: To determine the frequency of the final histological diagnosis in the follow-up of cytology results of thyroid fine needle aspirates implemented using the Bethesda system (BS). Methods: A cross-sectional study was conducted comparing the cytology results of thyroid fine needle aspirates implemented with the BS, and the final histopathology result in patients with thyroid gland lesions, who were seen in the Colombia National Cancerology Institute during the years 2010 to 2012. Results: A review was made of the cytopathology and histopathology reports of 104 patients with thyroid nodules. The mean age of the patients was 51.9 years. The results of the cytopathology by BS categories were: 37.5% category V, 30.8% category VI, 15.4% category IV, 6.7% categories I and II, and 2.9% category III. Papillary carcinoma was the most frequent histopathology diagnosis of all the cases, with 76%, followed by goiter with 6.7%. In the comparative analysis, the cytology categories IV, V and VI, 89.8% of the cases had a malignant lesion in the final histology report, and 77% of those of category II (benign) had the same result in the final histopathology diagnosis. Conclusions: The cytology of thyroid fine needle aspirates interpreted using the BS in the National Institute of Cancerology is of high diagnostic quality in the detection of thyroid malignancy when compared with the final histopathology diagnosis.

Diagnóstico histopatológico de colitis microscópica: enfoque práctico / A practical approach to histopathologic diagnosis of microscopic colitis

La colitis linfocítica y la colitis colagenosa son las dos formas histológicas de la colitis microscópica (CM), condición médica reconocida hace más de 30 años, habitual en pacientes adultos con diarrea crónica acuosa, sin cambios endoscópicos en la mucosa del colon y cuyo diagnóstico se establece exclusivamente en el examenhistopatológico de las biopsias de colon. El objetivo de la presente revisión es familiarizar a los médicos patólogos quirúrgicos en práctica general con la morfología de la colitis linfocítica y la colitis colagenosa, así como con la importancia de los informes de patología y la de una buena comunicación con el médico endoscopista para el correcto diagnóstico de estas entidades, y brindar a estos pacientes el tratamiento adecuado.

Lymphocytic colitis and collagenous colitis are two histologic forms of microscopic colitis, a condition whichwas first recognized over 30 years ago. It is often found in adults with chronic, watery diarrhea although endoscopic examination of the colon is frequently normal. The diagnosis is based on microscopic examination of colonic biopsies. The aim of this review is to familiarize general surgical pathologists with the morphologic features of lymphocytic and collagenous colitis. In additional, this review emphasizes good communication with the endoscopist to allow correct recognition and ensure appropriate treatment.

Tumor del estroma gastrointestinal gástrico con metástasis inusual al cráneo / Gastric gastrointestinal stromal tumor with unusual skull metastasis

Los tumores del estroma gastrointestinal GIST, se originan en la pared del tracto digestivo desde el esófago al ano. Aproximadamente 25% de los GIST gástricos son clínicamente malignos y desarrollan metástasis principalmente al hígado, menos comúnmente a tejidos blandos y hueso. Se presenta el caso de un paciente con GIST gástrico y metástasis al hígado e inusualmente al cráneo.

Gastrointestinal stromal tumors (GISTs) originate in the wall of the digestive tract from the esophagus to the anus. Approximately 25% of gastric GISTs are clinically malignant. Most often they metastasize to the liver, less commonly to soft tissues and bone. The clinical case of a patient with a gastric GIST, liver and unusual cranial metastasis is presented.

Tumor fusocelular hialinizante con rosetas gigantes: reporte de un caso / Hyalinizing spindle cell tumor with giant rosettes: case report

Introducción: El tumor fusocelular hialinizante con rosetas gigantes es una neoplasia constituida por dos componentes histológicos, uno celular con elementos fusiformes, y el segundo representado por islas bien delimitadas casi acelulares, llenas de material hialino, rodeadas de células redondas u ovales, las cuales muestran un perfil inmunohistoquímico inusual, e histogénesis incierta. Objetivo: instruir a los patólogos y clínicos sobre este tumor, su forma de presentación y diagnósticos diferenciales. Metodología y resultados: Se presenta el caso de una mujer de 42 años con masa ubicada en región inguinal, de crecimiento progresivo (1 año), que se reseca quirúrgicamente anatomía patológica informó un tumor fusocelular hialinizante con rosetas gigantes, según hallazgos morfológicos e inmuno histoquímicos, en correlación con su localización y cuadro clínico. Conclusión: Se hace necesario ampliar el conocimiento sobre esta entidad y de esta forma obtener una adecuada evaluación de sus criterios pronósticos histológicos, comportamiento clínico y tratamiento.

Introduction: The hyalinizing spindle cell tumor with giant rosettes is a neoplasia characterized by both histologic components, one of which is cellular, with spindle-shaped elements and the second represented by well defined almost acellular islands filled with hyaline material surrounded by round to oval cells, which shows an unusual immunohistochemical profile and uncertain histogenesis. Objective: Educate pathologists and clinicians about this tumor, its presentation and differential diagnosis. Methods and results: A case of a 42 year old woman with a mass located in the inguinal region, with progressive growth (1 year), surgically resected and histopathology reported as Hyalinizing spindle cell tumor with giant rosettes according to morphological, immunohistochemical findings correlates with its location and clinical. Conclusion: It is necessary to expand awareness about this condition and thus obtain a proper assessment of histological prognostic criteria, clinical behavior and treatment.

Condroblastoma pélvico / Pelvic Chondroblastoma

Este artículo describe el caso de una mujer de 24 años de edad con un condroblastoma de localización pélvica, con una masa a la altura de la cresta iliaca derecha, de seis meses de evolución y crecimiento progresivo. Los rayos X mostraron una lesión osteolítica con densidad heterogénea y extensión hacia los tejidos blandos; el estudio histopatológico evidenció un condroblastoma. Los condroblastomas son tumores óseos benignos productores de cartílago que aparecen en las epífisis de los huesos largos de personas jóvenes. Alrededor del 75% de estos tumores afectan los huesos largos, principalmente el fémur, la tibia y el húmero; excepcionalmente se localizan en los huesos planos craneofaciales y en los huesos pélvicos. Los condroblastomas tienen características radiológicas e histopatológicas distintivas, y pese a su comportamiento biológico benigno, pueden causar una alta morbilidad para los pacientes, debido a su localización y a su tratamiento exclusivamente quirúrgico.

This article describes the case of a 24-year old woman with a pelvic chondroblastoma localized at the top of the right iliac crest, with six months of evolution and progressive growth. X-rays revealed an osteolytic lesion with heterogeneous density, extending toward soft tissue; the hisopathologic study provided evidence of chondroblastoma. Chondroblastomas are benign bone tumors producers of cartilage which appears in the long bone epiphysis of young people. Nearly 75% of such tumors affect the long bones, principally the femur, the tibia, and the humerus; exceptions include those in the flat craniofacial bones and the pelvis bones. Chondroblastomas have distinct radiological and histopathologic characteristics, and despite their benign biological behavior, can cause elevated morbidity among patients due to their localization and being treated exclusively with surgery.

Sarcoma sinovial digital / Digital Synovial Sarcoma

El sarcoma sinovial es una entidad bien definida clínica y morfológicamente y, a pesar de su nombre, es muy raro en las cavidades articulares. Este sarcoma afecta zonas sin relación aparente con las estructuras sinoviales y representa entre el 5% y el 10% de todos los sarcomas de los tejidos blandos. Se encuentra con mayor frecuencia en las extremidades, especialmente en las inferiores, donde tiende a localizarse en la vecindad de las grandes articulaciones; se han informado muy pocos casos de sarcomas sinoviales en las manos o los pies, con una evolución clínica favorable. Así mismo, es más frecuente de 15 a 40 años de edad (con una edad media de 34 años). Este artículo presenta el caso de una mujer adulta a quien se le realizó el diagnóstico histopatológico e inmunohistoquímico de un sarcoma sinovial en el quinto dedo de la mano derecha.

Synovial sarcoma is a clinically and morphologically well defined entity which, in spite of its name, is rare in joint cavities. This sarcoma affects zones without any apparent relation to synovial structures and represents from 5% to 10% of all sarcomas in soft tissues. It is most frequently found in the extremities, especially the lower ones, where it tends to be located in the vicinity of the major articulations; there are very few favorable reports on the clinical evolution of synovial sarcomas in the hands or feet. It is most frequent between the ages of 15 to 40 (median age, 34). This article presents the case of an adult woman who underwent histopathologic and immunohistochemical diagnosis of a synovial sarcoma on the little finger of her right hand.

Fenómeno de acomodación inmunológica: Trasplante hepático ABO incompatible. Caso clínico / Accomodation process: ABO-incompatible liver transplantation. Report of one case

We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accomodation opens the possibility of using ABO-incompatible organs as a definitive grafts.

"Síndrome pequeño para su tamaño", (small-for-size), como complicación de un trasplante hepático con donante vivo adulto relacionado / Small-for-size syndrome: report of one case

Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the "small-for-size syndrome" one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.

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.

Eficacia de la asociación rituximab-vindesina en el tratamiento de un caso de púrpura trombótico-trombopénico (PTT) adquirido idiopático refractario / Successful treatment of idiopathic acquired refractory thrombotic thrombocytopenic purpura with an association of rituximab - vindesine. Report of one case

We report a 23 years old female who presented a second episode of thrombotic thrombocytopenic purpura (TTP). She was treated with fresh frozen plasma infusions and 14 plasma exchange (PE) sessions without response. Therefore a second-line therapy was started, associating a weekly cycle administration of vindesine (Vds) 2 mg/m2 and rituximab (R) 375 mg/m2. Five cycles of this association plus one cycle of R exclusively, were administered. After the third course, biological signs of improvement were observed and complete normalization of blood cell counts and other specific parameters was seen after 8 weeks. From the beginning of her second relapse we detected a severe deficit (<5%) in von Willebrand-cleaving factor (ADAMTS13) associated to the presence of ADAMTS13 inhibitors. The combined treatment induced an improvement in ADAMTS13 values without detectable inhibitors. After 21 months of follow-up the patient was well, without signs of relapse but ADAMTS13 values were still under normal, which may be an unfavorable prognostic factor. PE is the treatment of choice for acquired idiopathic TTP, but for refractory cases or TTP cases with severe ADAMTS13 values/high inhibitor titers, PE associated to an immunosuppressive treatment should be considered.