RESUMO
A leiomyosarcoma of the inferior vena cava is reported in a 52 year old female, located in the para-renal segment of the vena cava. The tumor was resected and the vena cava was replaced by a 20 mm PTFE anelar prosthesis, with reimplantation of the right renal vein. The left renal vein was ligated. One year later CT-scans showed patency of the graft. The authors discuss the therapeutic options for this type of tumor and analyse the 5 and 10 years survival rates, following treatment.
Assuntos
Leiomiossarcoma , Neoplasias Vasculares , Veia Cava Inferior , Feminino , Humanos , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Vasculares/cirurgiaRESUMO
BACKGROUND: Transplantation is the treatment of choice for many patients with end-stage liver disease. We evaluated the results of liver transplantation in Galicia, an autonomous community in Northwest Spain. METHODS: We analyzed 452 patients and 490 grafts from 1996 to 2000 for causes of loss with respect to recipient and donor variables using the actuarial method, Kaplan-Meier curves, log-rank test, and Cox proportional risks model. RESULTS: The overall graft survival was 77% and 64% at 1 and 5 years, respectively; while that of the patients was 83% and 69%. The risk factors for graft loss were donation in heart failure (HR = 4.91, CI:2.51-9.61); donor age (HR = 1.70, CI:1.01-2.85 between 40 and 60 years; HR = 2.37, CI:1.37-4.10 in those over 60 years, as compared to patients under 40); urgent transplant (HR = 3.95, CI:2.07-7.54); and transplant due to acute liver failure (HR = 3.53, CI:1.72-7.25) as compared to alcoholic cirrhosis. For patient death the risk factors were age of recipient over 60 years, compared to those under 40 (HR = 2.42, CI:1.11-5.28); foreign place of origin (HR = 2.02, CI:1.14-3.59); transplant due to viral cirrhosis (HR = 1.76, CI:1.03-3.02) and transplant due to acute liver failure (HR = 4.62, CI:2.12-10.06), as compared to alcoholic cirrhosis; urgent transplant (HR = 2.65, CI:1.48-4.72), and age of donor over 60 years, as compared to those under 40 (HR = 2.65, CI:1.48-4.72). Infections were the principal cause of death (45%), mostly in the first month (72%); while after the first year, 74% were due to recurrence of the primary disease and de novo malignancy. CONCLUSIONS: Graft and patient survivals were comparable to international registries. The donor characteristics had a greater influence on graft survival than on patient survival.
Assuntos
Sobrevivência de Enxerto/fisiologia , Transplante de Fígado/fisiologia , Adolescente , Adulto , Fatores Etários , Causas de Morte , Criança , Pré-Escolar , Feminino , Insuficiência Cardíaca/complicações , Humanos , Lactente , Infecções/mortalidade , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Espanha , Taxa de Sobrevida , Doadores de Tecidos/estatística & dados numéricosRESUMO
O transplante hepatico e atualmente um procedimento cirurgico indicado para o tratamento de uma serie de enfermidades hepaticas terminais. O transplante hepatico ortotopico em enfermos pediatricos e frequentemente limitado pela disponibilidade de doadores pediatricos. A utlizacao de enxerto parcial e uma opcao para este problema. No transplante hepatico, a compatibilidade entre o doador e o receptor esta baseada somente em 2 criterios: grupo sanguineo e tamanho corporal, pois nao e possivel transplantar na fossa hepatica um figado com importante discrepancia de tamanho. Em muitas ocasioes, e dificil encontrar o doador ideal no momento adequado. Este problema e mais intenso no caso das criancas
