[Acute liver failure in a hospital with a liver transplantation program]. / Fallo hepático agudo en un hospital con programa de trasplante hepático.

INTRODUCTION: Acute hepatic failure (AHF) is an uncommon entity but with high mortality. Liver transplantation has improved prognosis but is an aggressive treatment with high risk. Currently, there are no accurate criteria to differentiate between irreversible AHF and the possibility of hepatic regeneration. The aim of this study is to review the clinical characteristics indicating transplantation and the outcome of AHF in patients at our institution. PATIENTS AND METHOD: Descriptive and retrospective study of cases of AHF at our institution in the last 3 years. RESULTS: Eleven patients were studied. Mortality was lower in transplant recipients (23%; 2 out of 8) than in non-transplanted patients (67%; 2 out 3). Hepatic regeneration occurred in one patient. Overall mortality was 36% with a perioperative mortality of 13%. CONCLUSION: The indication of hepatic transplantation in patients with a poor prognosis, early stage acute liver failure, and a low grade of encephalopathy, and prior to the development of multiorgan failure could improve the results of transplantation and reduce perioperative mortality.

[Transient ischemic attacks as the only manifestation of a dural arteriovenous fistula]. / Accidentes isquémicos transitorios como única manifestación de una fístula arteriovenosa dural.

INTRODUCTION: Transient ischemic attacks (TIA), as the only clinical manifestation of a dural arteriovenous malformation, are very seldom seen in clinical practice. CASE REPORT: We describe the case of a 68 year old male with recurring bouts of right hemiparesis, due to haemodynamic alterations stemming from a dural arteriovenous malformation located in the right middle fossa, with cortical venous drainage towards the superior longitudinal sinus, which hampers the drainage of the left parietal cortical veins. Computerized tomography and magnetic resonance scans performed on admission to hospital revealed blood in the left parietal sulcus, with no parenchymatous lesions. This dural arteriovenous fistula was initially treated by the endovascular administration of polyvinyl alcohol in 150 250 mm particles, but after 11 days the patient again presented symptoms of right hemiparesis which became increasingly frequent and intense. This led to the search for a definitive treatment for the dural arteriovenous fistula with cyanoacrylates. No similar symptoms have been observed in the five years follow up carried out after the embolization. CONCLUSIONS: In cases of dural arteriovenous fistulas the arterialized cortical vein can impede the drainage of other veins towards the common venous sinus. On very rare occasions this can lead to the appearance of symptoms of transient ischemic attacks in territories that are a long way from the location of the abovementioned arteriovenous malformation.