ABSTRACT
BACKGROUND: Liver transplantation is currently the standard of care for patients with end stage liver disease. However due to the cadaveric organ shortage, live donor liver transplantation (LDLT), has been recently introduced as a potential solution. We analyzed and support our initial experience with this procedure at USC. MATERIAL AND METHODS: From September 1998 until July 2000, a total of 27 patients underwent LDLT at USC University Hospital and Los Angeles Children's Hospital. There were 12 children with the median age of 10 months (4-114) and 15 adults with the median age of 56 years (35-65). The most common indication for transplantation was biliary atresia for children and hepatitis C for adults. RESULTS: All donors did well postoperatively; the median postoperative stay was five days (5-7) for left lateral segmentectomy and seven days (4-12) for lobar donation. None of the donors required blood transfusion, re-operation or postoperative invasive procedure. However, five of them (18%) experienced minor complications. The survival rate in pediatric patients was 100% and only one graft was lost at nine months due to rejection. Two adult recipients died in the postoperative period, one from graft non-function and one from necrotizing fascitis. 37% of adult recipients experienced postoperative complications, mainly related to biliary reconstruction. Also 26% of the recipients underwent reoperation for some of these complications. CONCLUSION: LDLT is an excellent alternative to cadaveric transplantation with excellent results in the pediatric population. However, in adult patients it still carries a significant complication rate and it should be used with caution.
Subject(s)
Hospitals, University , Liver Diseases/surgery , Liver Transplantation , Living Donors , Adult , Aged , California , Child , Child, Preschool , Female , Graft Survival , Humans , Infant , Length of Stay , Liver Diseases/mortality , Male , Middle Aged , Retrospective Studies , Treatment OutcomeSubject(s)
Diagnostic Imaging , Intestinal Obstruction/diagnosis , Intestine, Small , Barium Sulfate , Contrast Media , Diagnosis, Differential , Humans , Intestinal Neoplasms/diagnosis , Intestinal Obstruction/etiology , Intestine, Small/pathology , Neoplasm Recurrence, Local/diagnosis , Predictive Value of TestsSubject(s)
Diagnostic Imaging , Liver Diseases/diagnosis , Liver Neoplasms/diagnosis , Adult , Child , Diagnosis, Differential , Humans , Liver/pathology , Liver Diseases/pathology , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Predictive Value of Tests , Tomography, X-Ray Computed , UltrasonographySubject(s)
Colorectal Neoplasms/diagnosis , Diagnostic Imaging , Mass Screening , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Risk FactorsABSTRACT
OBJECTIVE: To assess the treatment of peripancreatic fluid collections or abscess with percutaneous catheter drainage (PCD). SUMMARY BACKGROUND DATA: Surgical intervention has been the mainstay of treatment for infected peripancreatic fluid collections and abscesses. Increasingly, PCD has been used, with mixed results reported in the literature. METHODS: A retrospective chart review of 1993 to 1997 was performed on 82 patients at a tertiary care public teaching hospital who had computed tomography-guided aspiration for suspected infected pancreatic fluid collection or abscess. Culture results, need for subsequent surgical intervention, length of stay, and death rate were assessed. RESULTS: One hundred thirty-five aspirations were performed in 82 patients (57 male patients, 25 female patients) with a mean age of 40 years (range 17-68). The etiologies were alcohol (41), gallstones (32), and other (9). The mean number of Ranson's criteria was four (range 0-9). All patients received antibiotics. Forty-eight patients had evidence of pancreatic necrosis on computed tomography scan. Cultures were negative in 40 patients and positive in 42. Twenty-five of the 42 culture-positive patients had PCD as primary therapy, and 6 required subsequent surgery. Eleven patients had primary surgical therapy, and five required subsequent surgery. Six patients were treated with only antibiotics. The death rates were 12% for culture-positive patients and 8% for the entire 82 patients. CONCLUSIONS: Historically, patients with positive peripancreatic aspirate culture have required operation. This series reports an evolving strategy of reliance on catheter drainage. PCD should be considered as the initial therapy for culture-positive patients, with surgical intervention reserved for patients in whom treatment fails.
Subject(s)
Abscess/surgery , Pancreatic Diseases/surgery , AIDS-Related Opportunistic Infections/diagnostic imaging , AIDS-Related Opportunistic Infections/surgery , Abscess/diagnostic imaging , Acute Disease , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Female , HIV-1 , Humans , Male , Middle Aged , Pancreas/diagnostic imaging , Pancreas/surgery , Pancreatic Diseases/diagnostic imaging , Pancreatitis/diagnostic imaging , Pancreatitis/surgery , Radiography, Interventional , Retrospective Studies , Suction , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: This study describes a new sonographic finding in renal failure: perirenal lucency, which we call the "kidney sweat" sign. MATERIALS AND METHODS: During 1 year at our institution, 502 renal sonograms were obtained. Sonography evaluated 330 patients with renal failure. All of the examinations were retrospectively analyzed. RESULTS: An extracapsular hypoechoic rim was present in 47 (14%) of the 330 patients with renal failure. The finding, when present, was always bilateral. The hypoechoic rim was not present in the remaining 283 patients with renal failure. Forty (85%) of the 47 patients had kidneys that were hyperechoic compared with the liver. Twenty-eight (60%) of the 47 patients had kidneys that were hyperechoic compared with the spleen. In 15 (32%) of the 47 patients, the kidneys were small. Ascites was present in 11 (23%) of the 47 patients. Of the 283 patients with renal failure whose sonograms did not show the hypoechoic rim, 76 patients had normal sonographic findings. The remaining 207 patients with renal failure who did not show the kidney sweat sign had hydronephrosis, stones, cysts, echogenic kidneys, small kidneys, or ascites. CONCLUSION: An extracapsular hypoechoic rim is found in patients with renal failure. We call this finding "kidney sweat." We believe, but cannot currently prove, that the kidney sweat sign represents edema. It is an additional sonographic finding in patients with renal failure.