Pediatric liver transplantation: 10 years of experience at a single center in Brazil.

OBJECTIVES: To evaluate the first 10 years' experience of the liver transplantation department at the Alfa Institute, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brazil. METHODS: A descriptive study, based on a retrospective analysis of 84 children and adolescents enrolled on a liver transplantation waiting list, from March 1995 to January 2006, based on the following variables: age, etiology of underlying liver disease, Child-Pugh, Malatack, model for end-stage liver disease (MELD) and pediatric end-stage liver disease (PELD) scores, time on waiting list, complications and survival after the procedure. RESULTS: Forty children had 42 liver transplants. Twenty six died while on the waiting list. Biliary atresia was the most frequent indication for transplant. The median age was 6.6 years (ranging from 1.9 to 16.8 years). Post liver transplant mortality was 32.5% (13 of 40 children). The median time on the liver transplant waiting list was 291 days. Complications related to the graft occurred in 24 of 42 transplants (57.1%), including vascular complications (30.8%), with thrombosis of the hepatic artery being the most frequent (16.6%); acute rejection occurred in 16.6%. CONCLUSIONS: The overall results are similar to what can be found in the literature with relation to indications and post-transplant survival. However, there were elevated rates of complications unrelated to the graft and of complications involving the hepatic artery.

Transplante hepático pediátrico: experiência de 10 anos em um único centro no Brasil / Pediatric liver transplantation: 10 years of experience at a single center in Brazil

OBJETIVOS: Avaliar a experiência dos primeiros 10 anos de transplante hepático em crianças e adolescentes do Serviço de Transplante Hepático do Instituto Alfa de Gastroenterologia do Hospital das Clínicas da Universidade Federal de Minas Gerais. MÉTODOS: Estudo descritivo de 84 pacientes menores de 18 anos inscritos em lista para transplante, no período de março de 1995 a janeiro de 2006, quanto às seguintes variáveis: idade, indicação do transplante, escores de gravidade (Child-Pugh, Malatack, PELD/MELD), tempo de espera em lista, complicações pós-operatórias e sobrevida. RESULTADOS: De 84 pacientes inscritos, 40 foram submetidos ao transplante, ocorrendo dois retransplantes. Vinte e seis faleceram na lista de espera. A atresia biliar foi a indicação mais freqüente. A mediana da idade no momento do transplante foi de 6,6 anos (variou de 1,9 a 16,8 anos). A mortalidade no pós-transplante foi de 32,5 por cento (13 de 40 crianças). O tempo de espera em lista dos 40 pacientes transplantados apresentou mediana de 291 dias. As complicações relacionadas ao enxerto ocorreram em 24 dos 42 transplantes (57,1 por cento), sendo que as vasculares representaram 30,8 por cento, prevalecendo a trombose da artéria hepática (16,6 por cento); episódio de rejeição aguda ocorreu em 16,6 por cento dos casos. CONCLUSÃO: Os resultados encontrados são semelhantes ao que é observado na literatura em relação às indicações e sobrevida no pós-transplante. No entanto, houve elevada taxa de complicações não relacionadas ao enxerto e daquelas relacionadas à artéria hepática.

OBJECTIVES: To evaluate the first 10 years' experience of the liver transplantation department at the Alfa Institute, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brazil. METHODS: A descriptive study, based on a retrospective analysis of 84 children and adolescents enrolled on a liver transplantation waiting list, from March 1995 to January 2006, based on the following variables: age, etiology of underlying liver disease, Child-Pugh, Malatack, model for end-stage liver disease (MELD) and pediatric end-stage liver disease (PELD) scores, time on waiting list, complications and survival after the procedure. RESULTS: Forty children had 42 liver transplants. Twenty six died while on the waiting list. Biliary atresia was the most frequent indication for transplant. The median age was 6.6 years (ranging from 1.9 to 16.8 years). Post liver transplant mortality was 32.5 percent (13 of 40 children). The median time on the liver transplant waiting list was 291 days. Complications related to the graft occurred in 24 of 42 transplants (57.1 percent), including vascular complications (30.8 percent), with thrombosis of the hepatic artery being the most frequent (16.6 percent); acute rejection occurred in 16.6 percent. CONCLUSIONS: The overall results are similar to what can be found in the literature with relation to indications and post-transplant survival. However, there were elevated rates of complications unrelated to the graft and of complications involving the hepatic artery.

Treatment of superior mesenteric artery embolism with a fibrinolytic agent: case report and literature review.

Successful treatment of superior mesenteric artery embolism depends on an aggressive approach in patients at risk for mesenteric ischemia. This approach favors an early diagnosis and permits the reestablishment of arterial flow within an appropriate time, with prevention of vasospasm and control of organic insufficiencies. We report here a case of superior mesenteric artery embolism in which arterial flow was reestablished by selective intra-arterial infusion of streptokinase. The literature has reported 18 similar cases thus far. This procedure could be an alternative to embolectomy in selected patients, i.e., patients with an early diagnosis, no evidence of intestinal necrosis and with partial occlusion and/or occlusion of secondary branches of the superior mesenteric artery. Frequent arteriographies and intensive care are necessary in this approach. The patient should be continuously monitored because of the possibility of treatment failure and the need for embolectomy.

Pneumatose intestinal / Pneumatosis intestinales

Pneumatosis Intestinalis (PI) is the presence of gas-filled cysts within the wall of the gastrointestinal tract (GIT). It is a clinical and/or radiological sign associated with a wide spectrum of diseases, so that it has a variable clinical significance. Probably, its prevalence is increasing. The nature of the diseases causing PI is been modifying in last decades. Peptic ulcers were its main cause in the past. Nowadays, probably, immunosuppressive conditions and states of increased permeability of the GIT mucosa (AIDS, transplanted patients or in chemotherapy, etc) are more common causes. PI can be shown on simple abdominal roentgenograms and computed tomographic scans obtained with lung windows. Its diagnosis include definition of the cause in addition to its presence. The treatment should be directed to the cause of the PI, fluctuating from expectant to emergency laparotomy. The present report is a contribution to the limited literature experience in this topic and calls attention to the importance of recognizing PI and its clinical significance in order to define the right conduct.

Pneumatose intestinal: revisão da literatura / Pneumatosis intestinales: literature review

A Pneumatose Intestinal (PI) consiste na presença de gás na parede do tubo gastrointestinal (TGI). Esse sinal clínico-radiológico associa-se a diversas doenças e apresenta significado clínico igualmente variável. Sua prevalência parece estar aumentando e a natureza das doenças associadas vêm se modificando nos últimos decênios. As ulceras pépticas já foram sua principal causa. Na atualidade, estados de imunossupressão e condições clínicas que aumentam a permeabilidade da mucosa do TGI (AIDS, pacientes transplantados, quimioterapia e outros) são as causas mais prováveis de PI. A PI pode ser demonstrada pela radiografia simples e pela tomografia computadorizada do abdome. Seu diagnóstico inclui, além da demonstração de sua presença, a definição de sua causa. O tratamento deve ser dirigido à causa da PI, podendo ser desde expectante até uma laparotomia de urgência. Terapêutica especifica da PI deve ficar restrita a protocolos de pesquisas. A revisão apresentada contribui para a pequena experiência da literatura neste assunto, especialmente considerando as mudanças que vêm ocorrendo na prevalência das principais causas da Pl. É ressaltada a importância da interpretação correta do significado clínico, que é amplamente variável, para a condução adequada dos casos de PI.

Pneumatosis Intestinalis (PI) is the presence of gas-filled cysts within the wall of the gastrointestinal tract (GIT). It is a clinical and/or radiological sign associated with a wide spectrum of diseases, so that it has a variable clinical significance. Probably, its prevalence is increasing. The nature of the diseases causing PI has modified in last decades. Peptic ulcers were its main cause in the past. Nowadays, probably, immunosuppressive conditions and states of increased permeability of the GIT mucosa (AIDS, transplanted patients or in chemotherapy etc) are the most usual causes. PI can be shown on simple abdominal roentgenograms and computed tomographic scans obtained with lung windows. Its diagnosis includes to define the cause in addition to its presence. The treatment should be directed to the cause of the PI, fluctuating from expectant to emergency laparotomy. This review contributes to limited literature experience in this field, especially because the most usual causes of PI have modified their prevalence. The importance of using the clinical significance, which is variable, in managing PI is emphasized.