[Liver transplantation in children: initial experience of the Instituto da Criança of the Hospital das Clínicas of Universidade de São Paulo]. / Transplante de fígado em criança: experiência inicial do Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo.

The initial experience at the Instituto da Criança do Hospital das Clínicas--School of Medicine of São Paulo University with liver transplantation in children is presented. A staff experienced in the management of children, including pediatric surgeons, hepatologists, critical care specialists, anesthesiologists, and other has been joined to draw therapeutic protocols. Afterward, more than 100 experimental liver transplant were performed in animals of medium size (dogs and pigs). From September, 1989 to July 1991, 12 liver transplants were performed on 9 children (3 retransplants) ranging in age from 2.5 to 17 years, being 5 boys and 4 girls. The donors had been selected according to the ABO blood group and body weight. Just once a blood A+ recipient received a liver from a blood O+ donor. The regular postoperative immunosuppression consisted of triple therapy with cyclosporin, prednisone and azathioprine. The postoperative stay in the Intensive Care Unit ranged from 3 to 24 days, according to the necessity of ventilatory support. These was no intraoperative mortality, arterial or venous thromboses, or early biliary complications. The overall survival is 78% (7/9). Primary non-function of the graft was the cause of death in two of our children. Although the number of cases is still small our results are comparable to those of the best liver transplant centers in the world.

[Cystic dilatation of the common bile duct in adults. Report of 4 cases]. / Dilatações císticas do colédoco em adulto. Relato de quatro casos.

The authors report four cases of patients who presented congenital choledochal cysts. They discuss the incidence, classification, pathophysiology, diagnosis, clinical presentation and current treatment based in their own experiences and in a review of the literature on the subject.

[Bilio-digestive fistulas]. / Fístulas bílio-digestivas.

The authors report upon 5 cases of biliary-enteric fistulas, all of them detected preoperatively in a General Surgery Service during a relatively short period of time (6 months). Two cholecysto-duodenal and one cholecysto-ileal fistula were complications of a pre-existent cholelithiasis. A choledocho-duodenal fistula was caused by a penetrating peptic ulcer and a choledocho-colonic fistula was a iatrogenic traumatic one. The review of the literature demonstrates generally a lower incidence of this pathology in different surgical centers, one or two cases a year. More than 50 per cent of the biliary-enteric fistulas were unexpectedly found during operations on the biliary tract or stomach. This forces the surgeon to change his programmed surgical procedure without adequate preoperative preparation. The consequence is a higher morbidity rate in such operations. The continuing refinement of diagnostical procedures have led to a progressive and more frequent preoperative assessment of these fistulas. Adequate diagnostic methods and surgical procedures adopted in different cases of biliary enteric fistulas are discussed, emphasizing the good results obtained and the lower morbidity.