ABSTRACT
Combined injuries of the aorta and inferior vena cava are rare. Mortality is over 70%, primarily from exsanguinating hemorrhage. Post-traumatic aortocava fistula can develop in survivors, who present in the postoperative period with manifestations of high output heart failure. This is a retrospective review of five male patients, age from 9 to 39 years, with aortocava fistulas that were referred with congestive heart failure, 2 days to 6 months after abdominal penetrating injuries. They had undergone surgery at another hospital and several organ injuries were treated. Retroperitoneal hematomas were not seen or were seen and left undisturbed. Four patients received a gunshot injury, had the fistula at the infrarenal level, and survived surgical repair. In one of the survivors, a left popliteal artery bullet embolism also occurred and was treated. Another patient sustained a thoracoabdominal stab injury and an aortocava fistula developed at the suprarenal level; he was in severe congestive heart failure and died during surgery. There are very few reports on this sequelae of vascular injuries at the abdominal level. Patients with aortic and cava injuries have a high mortality rate and arteriovenous fistula may develop with communicating pseudoaneurysms. If high output heart failure develops in a patient with a history of abdominal penetrating injury, an arteriovenous fistula must be suspected and arteriography will disclose the location of the fistula. Surgical treatment is necessary to prevent further heart damage. In the future endovascular procedures may have a role in the management of these difficult conditions.
Subject(s)
Aorta, Abdominal/injuries , Arteriovenous Fistula/surgery , Vena Cava, Inferior/injuries , Adolescent , Adult , Aorta, Abdominal/surgery , Aortic Rupture/complications , Arteriovenous Fistula/etiology , Arteriovenous Fistula/mortality , Child , Heart Failure/etiology , Heart Failure/mortality , Heart Failure/surgery , Humans , Male , Retrospective Studies , Survival Analysis , Vascular Surgical Procedures , Vena Cava, Inferior/surgery , Wounds, Gunshot/complicationsABSTRACT
Kidney transplants are carried out as any other surgical procedure at specialized third level hospitals. For over 20 years, in Mexico, transplants have been done with kidneys originating from cadavers. Even though this has been of tremendous help, there is still a shortage of donors. Two successful cases of kidney transplants are presented where the donor was an anencephalic neonate and where segments of the aorta and vena cava were used to keep alive the kidney tissue enough for the corporal surface of a child and also that of an adult.
Subject(s)
Anencephaly/surgery , Kidney Transplantation , Child , Female , Humans , Infant, Newborn , Tissue DonorsSubject(s)
Kidney Transplantation , Adolescent , Adult , Child , Child, Preschool , Evaluation Studies as Topic , Female , Humans , Male , Mexico , Middle AgedSubject(s)
Aorta, Abdominal/surgery , Blood Vessel Prosthesis , Adult , Aged , Aortic Aneurysm/surgery , Arteriosclerosis/complications , Arteriosclerosis/surgery , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis/mortality , Evaluation Studies as Topic , Female , Femoral Artery/surgery , Humans , Iliac Artery/surgery , Intermittent Claudication/surgery , Male , Middle Aged , SpainSubject(s)
Antihypertensive Agents/therapeutic use , Hemodynamics/drug effects , Hypertension, Portal/drug therapy , Propanolamines/therapeutic use , Adult , Aged , Female , Humans , Hypertension, Portal/etiology , Liver Cirrhosis/complications , Male , Middle Aged , Nadolol , Propanolamines/pharmacologySubject(s)
Kidney Transplantation , Adult , Cadaver , Child , Humans , Methods , Postoperative Complications/prevention & control , Tissue DonorsSubject(s)
Kidney Transplantation , Adolescent , Adult , Child , Evaluation Studies as Topic , Histocompatibility , Humans , Immunosuppression Therapy , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/rehabilitation , Kidney Failure, Chronic/therapy , Major Histocompatibility Complex , Middle Aged , Postoperative Complications , Spain , Tissue Donors , Transplantation ImmunologyABSTRACT
En el tratamiento de la insuficiencia renal cronica el trasplante renal es un procedimiento aceptado en pacientes seleccionados. Se requiere de un enfoque multidisciplinario en el que participan internistas, inmunologos, patologos y cirujanos entre otros. En el Hospital General del Centro Medico Nacional del IMSS, recibieron 160 trasplantes de rinon 155 pacientes en el lapso de 1976 a 1981. Se obtuvieron 102 rinones de donador vivo emparentado y 58 de cadaver. La supervivencia con buena funcion renal cuando el rinon se obtuvo de donador consanguineo a un ano fue de 79 por ciento y a los 5 anos de 68 por ciento. Cuando se implantaron organos de cadaver la supervivencia a un ano fue de 68 por ciento y a los 5 anos de 40 por ciento. En esta serie todos los pacientes recibieron inmunosupresion a base de esteroides y azatioprina o ciclofosfamida
Subject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Transplantation , Kidney , Renal Insufficiency, Chronic , Postoperative ComplicationsABSTRACT
Se estudio el efecto del nadolol, un nuevo bloqueador betaadrenergico no cardioselectivo, sobre la presion portal en siete pacientes con cirrosis hepatica con hipertension portal. Se encontro que el nadolol disminuye significativamente la presion portal cuando se administra a dosis suficientes para disminuir la frecuencia cardiaca basal en 20 a 25 por ciento
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Adrenergic beta-Antagonists , Hypertension, Portal , Liver CirrhosisABSTRACT
El transplante renal es una modalidad terapeutica efectiva para los ninos con estadio final de la enfermedad renal. No hay contraindicaciones absolutas para ofrecer el procedimiento a estos ninos y sus familias; sin embargo los enfermos con retraso mental profundo u otro factor de alto riesgo deben ser considerados de acuerdo a las necesidades y criterios de cada programa. El mayor obstaculo lo constituye el fenomeno de rechazo inmunologico que sera de menor magnitud y racional inmunosupresion. El crecimiento estatural en ninos transplantados es suboptimo. Varios factores han sido implicados; entre los mas importantes, senalamos el efecto indeseable de los corticosteroides. No obstante la necesidad de adquirir mayor experiencia en el terreno de la inmunologia del transplante y el escepticismo que sostienen algunos grupos, pensamos que el transplante renal es el mejor metodo de rehabilitacion para los ninos con enfermedad renal terminal. Transplante renal, insuficiencia renal cronica
Subject(s)
Humans , Histocompatibility , Kidney , Renal Insufficiency, Chronic , Transplantation , Transplantation ImmunologySubject(s)
Hypertension/surgery , Adenoma/surgery , Adolescent , Adrenal Gland Neoplasms/surgery , Adult , Aneurysm/surgery , Aortic Coarctation/surgery , Arteriovenous Fistula/surgery , Female , Humans , Hypertension/etiology , Male , Middle Aged , Pheochromocytoma/surgery , Renal Artery Obstruction/surgerySubject(s)
Lymphedema/pathology , Adolescent , Adult , Female , Humans , Leg , Lymphedema/diagnostic imaging , Lymphography , Male , Middle AgedABSTRACT
A case of aortic thrombosis is reported in a 14 days old newborn after extensive review of the world literature is made. It was secondary to sepsis and hypercoagulability syndrome. Emphasis is placed on the early diagnosis, on the usefulness of the Doppler system when studying the vascular system as a non-invasive method in critically ill pediatric patients; likewise, on the determinant surgical procedure during the initial stages of the establishment of the aortic thrombosis.
