Dissection of the Hepatic Artery: A Rare Cause of Late Ischemia After Liver Transplant.

Hepatic artery dissection is an infrequent vascular complication that can arise after orthotopic liver transplant. Most patients with this complication are diagnosed during the intraoperative period or the first days after liver transplant, with an association shown with living-donor liver transplant. In this study, we discuss a rare case of an extrahepatic artery dissection that was successfully managed through surgical excision and arterial revascularization that was diagnosed 4 years after orthotopic liver transplant. Furthermore, we hypothesize on the potential causes of its occurrence.

Cognitive changes in patients with aneurysmal subarachnoid hemorrhage before and early posttreatment: differences between surgical and endovascular.

INTRODUCTION: The main purpose of occluding a ruptured aneurysm is preventing rebleeding, which may be fatal. Microsurgical or endovascular treatments are the main approaches adopted to prevent new bleeding. Among patients presenting with aneurysmal subarachnoid hemorrhage, about 50% had permanent injuries. Cognitive changes are one of the main morbidities from that illness. The type of treatment for the aneurysm (clipping or coil embolization) can also contribute to the genesis of those complications. OBJECTIVE: Assessing language and verbal memory changes resulting from the aneurysmal lesion occlusion procedures, as well as establish which treatment offers less cognitive sequels. METHOD: This investigation was carried out in Hospital da Restauraão, Recife-PE, from May 2007 to November 2009. One hundred fifty-one patients were divided into two groups, surgical and endovascular, and had their language, fluency, and verbal memory functions tested at two time points, pre- and postoperation. The results of the initial assessment and of the one occurring after the treatment were compared, between both groups and to each other. RESULTS AND CONCLUSIONS: One hundred fifty-one patients were assessed, distributed as 122 surgical and 29 coil embolized. The performances in both groups did not differ in the initial assessment. However, endovascular treatment does not show additional cognitive impairment and had a better performance in language and verbal memory, compared with patients submitted to surgical treatment in an early postoperative period.

Language, memory, and verbal fluency changes in patients with aneurysmal subarachnoid hemorrhage: results of a preoperative investigation.

OBJECTIVE: To detect changes in speech, verbal fluency, and memory in patients with subarachnoid hemorrhage (SAH) caused by ruptured aneurysms and to analyze the results before surgical or embolization procedure. METHODS: During the period May 2007 to November 2009, 193 patients with anterior aneurysmal SAH admitted to the Department of Neurosurgery, Hospital da Restauração, Recife, Brazil, were tested for speech, verbal fluency, and memory disturbances after the first week of bleeding and compared with a control group with similar demographics. RESULTS: Patients with aneurysmal SAH differed significantly from the control group in language, verbal fluency, and memory functions before clipping or coiling procedures. There were differences in cognitive performance between patients with different aneurysm sites. CONCLUSIONS: It was possible to characterize the cognitive impairments of each area affected early on in the preoperative period, confirming the assumptions that the aneurysm site could be a determining factor of cognitive impairment.

Laparoscopic common bile duct injury managed by a multidisciplinary approach: case report

Surgical management of extrahepatic biliary tract injury may be difficult and is a hard challenge. The authors present a case ol laparoscopic common bile duct injury which was successfully treated by non-operative multidisciolinary approach