Magnetic resonance cholangiography in the diagnosis of biliary complications after orthotopic liver transplantation.

OBJECTIVE: The aim of our study was to evaluate the role of magnetic resonance cholangiography (MRC) in the diagnosis of biliary tract complications (BC) after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Among 21 OLT patients who underwent routine follow-up MRC using a breath-hold T2-weighted turbo spin-echo sequence with half-Fourier acquisition (HASTE), 5 had an elevated serum alkaline phosphatase level. Diagnostic confirmation was obtained with endoscopic retrograde cholangiography (ERC) (n = 11), surgery (n = 3), or clinical and laboratory follow-up of at least 1 year (n = 8). RESULTS: In 13 patients, no abnormality of the biliary tract was detected using MRC. In 8 patients, anastomotic strictures were diagnosed, 7 of which were confirmed at surgery or using ERC. One patient with normal findings at MRC and abnormal liver function test results was found to have a stricture at ERC. All patients with normal MRC and liver function tests had 1 year of uneventful follow-up and were considered true-negative cases. We found that MRC had 87.5% sensitivity, 92.3% specificity, 87.5% positive predictive value, 92.3% negative predictive value, and 90.4% accuracy for the diagnosis of BC. CONCLUSION: MRC is a valuable examination to detect BC after OLT. It provides useful information for planning interventional procedures.

Primary splenic lymphoma in patient with hepatitis C virus infection: case report and review of the literature.

Primary splenic lymphoma is uncommon, constituting only 1-2% of all patients with malignant lymphoma. Despite the rarity of this malignancy, the number of primary splenic lymphoma being reported has increased due to its ambiguous definition used in the literature. We describe a case of a 41-year-old man with chronic hepatitis C virus infection presenting abdominal discomfort in the upper left quadrant, weakness, nausea and vomiting. Abdominal computed tomography revealed nodules in the congested splenic parenchyma. Splenectomy was performed and an analysis of the spleen diagnosed B-cell non-Hodgkin's lymphoma. Biopsy of the liver showed evidence of hepatitis C virus. Bone marrow biopsy revealed no tumor infiltration. The patient has been followed to date, has progressed quite well and remains essentially asymptomatic. Recently, an etiologically important role has been suggested for hepatitis C virus infection in the development of B-cell non Hodgkin's lymphoma. Lymphotropism of hepatitis C virus may play a pathological role in the development of non Hodgkin's lymphoma. It is important to add lymphoma to the list of differential diagnosis of extrahepatic disorders in patients with chronic hepatitis C virus infection.

Spontaneous hematoma of the rectus abdominis sheath: a review of 177 cases with report of 7 personal cases.

Hematoma of the rectus abdominis muscle sheath is a little known and rarely diagnosed condition, in spite of its definite clinical setting and treatment. It is very important to the surgeon, as it may be mistaken frequently for acute inflammatory abdominal conditions and should be considered in the differential diagnosis of intra-abdominal tumors. The literature on 177 cases of non-traumatic hematomas of the rectus abdominis muscle sheath is reviewed, including seven personal cases reported by the authors. Its epidemiology, pathogenesis, clinical features, diagnostic examinations and treatment are discussed.

Lipossarcomas abdominais / Abdominal liposarcomas

Lipossarcomas àbdominais constituem um grupo de tumores pouco freqüentes e, por isso, os princípios de tratamento desses tumores baseiam-se em experiências acumuladas no passado em séries retrospectivas. OBJETIVO. Apresentar sete casos de lipossarcomas abdominais de grandes proporçöes e discutir os principais aspectos diagnósticos e terapêuticos desses tumores na atualidade.MÉTODOS. Foram estudados sete doentes operados com lipossarcoma abdominal em um período de dois anos e meio na Disciplina de Gastroenterologia Cirúrgica da Escola Paulista de Medicina. Foram coletados os principais aspectos clínicos, ultrasonográficos e tomográficos, bem como os achados cirúrgicos e histopatológicos decada caso. RESULTADOS. Os autores chamam a atençäo para a raridade desses tumoree para sua tendência, quando primários, a crescer localmente, sem invadir os tecidos ao seu redor ou metastizar a distância, e, quando recidivantes, a exibir maior multicentricidade e malignidade mais agressiva. Consideram a tomografia computadorizada e mais útil procedimento diagnóstico e descartam a necessidade de biópsia percutânea, dirigida ou näo, no pré-operatório. Ressaltam o papel fundamental da cirurgia excisional radical no tratamento desses tumores e chamam a atençäo para a importância da ressecçäo com margens de segurança adequadas, mesmo quepara tal haja necessidade de ressecçäo associada de vísceras. Consideram a radioterapia e a quimioterapia como métodos pouco eficazes, no momento, para o tratamento adjuvante desses tumores. CONCLUSÄO. É importante um seguimento acurado dospacientes operados, com a indicaçäo, quando necessário, de repetidas cirurgias de ressecçäo, mesmo paliativas (cirurgias citorredutoras), no sentido de melhoriana expectativa de sobrevida.

[Abdominal liposarcomas]. / Lipossarcomas abdominais.

Abdominal liposarcomas are a rare group of tumors and their principles of treatment are based in accumulated experiences of retrospective series. PURPOSE--To report seven cases of abdominal liposarcomas and to discuss the main diagnostic and therapeutic aspects of these tumors nowadays. METHODS--Seven patients operated for abdominal liposarcomas were in the Surgical Gastroenterology Discipline of Escola Paulista de Medicina (UFESP) during 30 months. The major clinic, ultrasonographic, tomographic, surgical and histopathological features were collected in each case. RESULTS--Authors call attention to the unusualness of these tumors, their propensity (while primary) to grow in their own place, without invading the tissues around or metastasizing, and when they are recurrent to their more aggressive malignity. They consider that computerized tomography is the most useful diagnostic procedure and they discard the need of percutaneous biopsy (guided or not) in the preoperative period. They emphasize the fundamental role of radical excision surgery in these tumors treatment and also emphasize the importance of the resection with proper margins, even if an associated resection of visceral organs is necessary. They consider that now radiotherapy and chemotherapy are not very effective methods to the adjuvant treatment of these tumors. CONCLUSION--It is important an accurate follow-up of the operated patients in order to indicate, when necessary, repetitive resection surgeries, even if they are palliative (citoredution surgeries), with the purpose of improving the expectation of life.