Recombinant activated factor VII in critical bleeding after orthotopic liver transplantation.

Critical bleeding throughout the intraoperative phase of orthotopic liver transplantation (OLT) strongly increases patient mortality and intensive care unit (ICU) stay. The aim of this study was to report our experience on the use of recombinant activated factor VII (rFVIIa) in postoperative critical bleeding after OLT. In 7 patients with persistent severe bleeding after application of a standard transfusion protocol, we administered a 90 microg/kg bolus of rFVIIa and if necessary eventually repeated it after 3 hours. We recorded the blood loss and the need for transfusions before and after the rFVIIa therapy. Blood losses and need for platelets significantly decreased after rFVIIa administration; a nonsignificant decrease in red blood cells and fresh frozen plasma transfusions also occurred. In 6 patients treatment with rFVIIa was effective; only 1 patient died because of hemorrhagic shock and no thromboses were detected among the treated patients. Awaiting stronger evidence from randomized controlled trials, we suggest that in some challenging cases of massive bleeding rFVIIa should be considered a useful option to control bleeding.

[Endometriosis of the ileum and colon complicated by intestinal obstruction. Report of two cases]. / Endometriosi dell'ileo e del colon complicata da occlusione intestinale. Due casi clinici.

The authors report two cases of intestinal occlusion, one ileal and the other colic, caused by endometriosis. Both patients underwent surgery. Following a review of data in the literature regarding the frequency, pathogenesis, diagnosis and management, the authors conclude that pre- and intraoperative diagnosis is often impossible in these cases and must be postponed to histological analysis. Full remission was achieved after surgery.

Thyroid cancer in childhood.

From 1956 to 1975 21 patients (13 females and 8 males) with thyroid cancer developed by age 14 have been observed at the Istituto Nazionale Tumori of Milan. Follicular adenocarcinoma was diagnosed in 4 cases and papillary adenocarcinoma in 17. Five patients (24%) had been given previous cervical irradiation for benign conditions. At admission lung metastases were evident in 2 patients (one affected by follicular and the other by papillary adenocarcinoma). All patients were submitted to surgical treatment, which in most cases consisted in total thyroidectomy plus elective lymph node dissection; serious postoperative complications were not observed. External irradiation was given to 4 patients, since surgery had not been radical. Radioiodine treatment was performed in the 2 patients with lung metastases: in the patient with follicular adenocarcinoma metastases disappeared after 131I treatment, whereas in the other one they still persist unmodified 10 years later. A local recurrence occurred in 3 cases and pulmonary metastases in one: all of them made an apparent recovery after surgical and/or radioiodine treatment. All patients are alive and, except one, without evidence of disease after a follow-up period from 14 months to 21 years. Although differences in evolution have been noted according to the histotype, the prognosis of thyroid cancer in childhood is good, even if distant metastases are present.