[The angiofollicular lymph node hyperplasia Castleman--casuistic and review of the literature]. / Die angiofollikuläre Lymphadenopathie Castleman.

The Castleman Disease, also known as angiofollicular lymph node hyperplasia is a rare disorder that results in abnormal proliferation of B-lymphocytes and plasma cells in lymphoid organs. It was first described as a pathologic entity in 1954 and later defined by Castleman et al. in 1956. The Castleman's disease is characterised by lymph node hyperplasia with vascular proliferation and endothelial hyperplasia. On the basis of histologic criteria it has been divided into hyaline-vascular and plasma cell variant. The hyaline-vascular type (90 % of cases), generally benign, occurs in younger patients with a localised mediastinal mass - surgical excision is curative. The plasma cell variant (10 % of cases), localised or multicentric, is generally aggressive, and occurs in older patients with generalised lymphadenopathy, hepatosplenomegaly, systemic symptoms, anaemia, elevated inflammatory indices, and a polyclonal rise in immunoglobulins. The prognosis is poor despite the Chemotherapy. Surgery is not indicated. We present two cases of unicentric Castleman Tumor of hyaline-vascular type. The patients were cured by surgical resection.

Mesocaval interposition shunt with small-diameter polytetrafluoroethylene grafts in sclerotherapy failure.

Fifty-seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty-one patients had Child-Pugh grade A disease and 26 grade B; all had a liver volume of 1000-2500 ml. Follow-up ranged from 16 months to 6 years 3 months. Three patients (5 per cent) died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child-Pugh grade A 88 per cent and for grade B 67 per cent. Small-lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.