Evolution of hepatorenal syndrome after orthotopic liver transplantation: comparative analysis with patients who developed acute renal failure in the early postoperative period of liver transplantation.

OBJECTIVE: The purpose of this study was to ascertain the prognosis of patients with hepatorenal syndrome (HS) prior to orthotopic liver transplantation (OLT) by comparisons with a group of selected patients with normal renal function (NRF) pretransplantation who developed acute renal failure (ARF) in the early postoperative period. MATERIALS AND METHODS: Fifty-two OLT cases developed ARF in the early postoperative period between March 1999 and October 2004; 17 cases experienced HS prior to OLT. ARF was defined as serum creatinine level (Cr) >1.5 mg/dL or a creatinine clearance (CrCl) <50 mL/min. The immunosuppressive therapy was the same in both groups: low doses of tacrolimus were prescribed to reach trough levels of 5 ng/mL in the first week after OLT, where patients were administered monoclonal antibodies and corticosteroids. RESULTS: No differences were observed between the groups for gender, age or APACHE II Score in the first 24 hours after OLT. Patients with HS pretransplantation showed higher Cr and urea (U) levels than the other group (Cr: 2.1 +/- 0.8 HS vs 0.9 +/- 0.2, P = .000; U: 93.6 +/- 51.9 HS vs 42.1 +/- 19.3, P = .001). The ICU days of stay were similar (12.8 +/- 0.5 HS vs 19.7 +/- 15.2, P = .053). At the end of 1 year follow-up after OLT there were no differences in mortality (35% HS vs 26%), need for renal replacement therapy (23% HS vs 34%), infection (59% HS vs 51%), or rejection (6% HS vs 29%, P = .06). CONCLUSIONS: Patients with HS prior to OLT showed a similar prognosis to a group of selected patients with NRF pretransplantation, but developed ARF in the early postoperative period which was treated with monoclonal antibodies and low doses of tacrolimus.

[Paraquat poisoning and hemoperfusion with activated charcoal]. / Envenenamiento por Paraquat y hemoperfusión con carbón activado.

Paraquat is a common herbicide in Spain. In our country there are a few cases of this intoxication and it presents a high mortality even if the patients ingest a minimal amount. We present two cases of accidental poisoning with paraquat. These patients were admitted three hours after ingestion of toxin. They were treated with with orogastric lavage, activated charcoal, N-acetylcysteine, Fuller's earth, cathartics, support measures and hemoperfusion with activated charcoal. With these treatments both patients had a undetectable levels of paraquat 48 hours after and improvement of their symptoms, gastric and intestinal predominantly . We present the graphics of evolution of the plasma and urine levels of paraquat in both patients. We review the different aspects of treatment and update of this poisoning.

Envenenamiento por paraquat y hemoperfusión con carbon activado / Paraquat intoxications and hemoperfusion with activated charcoal

El Paraquat es un herbicida del grupo de los biperidilicos, de los más utilizados en nuestro pais.En España existen muy pocos casos descritos de esta intoxicación y presenta una alta mortalidad incluso con la ingestión de mínimas cantidades.Presentamos dos casos de intoxicación por ingesta accidental de este producto, que llegan a nuestro hospital en las tres horas posteriores. Se instaura tratamiento con lavado gástrico, carbón activado, N acetil cisteina, tierra de Fuller, catárticos, medidas de apoyo y hemoperfusión con carbón activado; consiguiendose niveles indetectables del tóxico 48 horas después y mejorando su sintomatología, predominantemente gastrointestinal.Se comentan los casos clínicos durante su estancia en U.C.I así como aspectos clínicos de estas intoxicaciones, su tratamiento actual y últimas tendencias y factores pronósticos (AU)

The Paraquat is a herbicide more using in Spain. In our country there are a few cases this intoxication and it presents a hight mortality even if the patients ingest a minimal amount. We present two cases of casual poisoning with paraquat. These patients were admited three hours after ingestion of toxic. They were treated with with orogastric lavage, activated charcoal, N-acetil-cysteina, Fuller´s earth, catartics, support measuring and hemperfusion with activated charcoal, with this treatments both patients had a indetectable levels of paraquat 48 hours after and yours symptoms that was gastric and intestinal predominantly had missing. We present the graphics of evolution the plasmatic and urine levels of paraquat the both patients. We review the differents aspects of treatment and update of this intoxication (AU)

[Coronary ischemia caused by pseudoxanthoma elasticum and myocardial revascularization with double arterial graft]. / Isquemia coronaria producida por seudoxantoma elástico y revascularización miocárdica con doble injerto arterial.

We present a case of an 18 year-old woman with pseudoxanthoma elasticum, who had a biopsy taken from a lesion. Although she was asymptomatic, we tried to rule out myocardial ischemia with a treadmill and cardiac gammagraphy with Talio. The isotopic studies and the ergometry were positive and the patient underwent coronariography. This study showed a severe triple-vessel disease. We did an angiography of the supraaortic arteries, mamarian artery, and mesenteric artery. These studies showed no obstructive lesions. The treatment of patient was a double by-pass with internal mammary artery and one by-pass with safena vein grafts with satisfactory results.

[Angiosarcoma of gingival presentation]. / Angiosarcoma de presentación gingival.

We present the case of a woman of 62 years old with changes history in the intestinal habit, weak, thing, anemia, violet injuries in the gums and hemoptysis of small quantity. After the various tests accomplishment of image and biopsy of the injuries gingival and of lymphadenopathy supraclavicular was demonstrated the existence of a angiosarcoma of high degree of malignity. This neoplasm is originated in the cells of vascular endothelium and constitutes 1% of all the sarcomas and solely 4% appear the the oral cavity. These tumors has a high mortality (superior to the 20%) to five years. Once diagnosed its manage must be aggressive in spite of its wrong therapeutic response.