Domino liver transplantation using FAP grafts. HUC experience--hopes and realities.

Domino liver transplantation using FAP livers (DLTx/FAP) has become a worldwide strategy that is contributing significantly to the increase in liver grafts offered in Portugal. The safety of the procedure both in the FAP donors and in the recipients is emphasized in the series of 64 DLTx/FAP that has already been performed in the Hospital of the University of Coimbra (HUC). The occurrence of amyloidosis in the long-term survivors after DLTx/FAP is a serious possibility, although after 6 and 7 years post-transplant no symptoms have been reported by any of the patients. Indeed, amyloid deposits, although small, have been found in the skin and nerve biopsies of the first domino recipients (HUC unpublished data). Hopes that the disease will have a slow course in non-genetically affected patients still awaits the proof of time. Thus, DLTx/FAP should be considered an experimental procedure, although there is good reason to expect that the amyloidosis in the DLTx/FAP recipients will have a longer time course than in the genetically affected donors. The ethical implications of all these facts and expectations are discussed. A case by case approach is recommended. In such an approach, individual prognosis, urgency, graft shortage and the will of very well-informed patients or their legal representatives are determinants for judicious decisions when considering DLTx/FAP in patients under 50 years of age.

Tumor de ureter diagnosticado por biópsia transrectal ecoguiada / Ureteric tumor diagnosed by transrectal ultrasound guided biopsy

The transrectal route is currently the preferred one for the performance of prostatic and seminal vesicles biopsies, and its safety and good tolerance are well proved. Transrectal ultrasound, further to be commonly used to guide these biopsies, enables this route to be used for the biopsy of other pelvic organs or masses. However, this has been used only rarely for other organs than prostate or seminal vesicles. We reported a case where a transrectal biopsy was used to diagnose a suspected ureteral metastasis from a rectal adenocarcinoma. The anatomo-pathological study showed that the mass was an urothelial carcinoma of the ureter

Are transrectal ultrasonically guided biopsies required for the accurate diagnosis of carcinoma of the prostate? Can digitally guided systematic biopsies offer an acceptable alternative?

OBJECTIVE: To compare the diagnostic yield of ultrasonically guided and digitally guided systematic biopsies of the prostate. PATIENTS AND METHODS: Fifty two patients with suspected but unproven carcinoma of the prostate underwent simultaneous transrectal ultrasonography (TRUS)-guided and digitally guided systematic biopsies of the prostate. A mean of 12 cores was obtained from each patient. On average more cores were obtained with TRUS guidance (mean 6.7) than with digital guidance (mean 5.3). RESULTS: Cancer was detected in 19 patients and the diagnosis was made by both techniques in 16. Two patients had tumour detected only with TRUS guidance and one only with digital guidance. No complications occurred. CONCLUSION: This study indicates that there is no significant difference between TRUS guidance and digital guidance to direct systematic biopsies of the prostate. The use of routine TRUS in screening programmes is now in doubt.

Retro-umbilical ectopic testicle: report of a case.

A case of a retro-umbilical ectopic testicle in a 13-year-old cryptorchid boy is reported. To our knowledge this has not been reported previously. There is no definite explanation for this highly aberrant ectopia. During the neonatal period the boy had an umbilical suppuration that required drainage. This may offer a possible explanation since the consequent healing process could have pulled the peritoneum upwards, dragging the testicle with it. Despite the high position of this testicle (and previous operation on the other side) it was easy to cross over both testes successfully to the heterolateral scrotum.