[Bilateral hydronephrosis secondary to ileocolic Crohn's disease]. / Hidronefrosis bilateral secundaria a enfermedad de Crohn ileocólica.

Unilateral hydronephrosis can complicate a far from negligible number of patients with Crohn's disease. Bilateral hydronephrosis associated with Crohn's disease is a much more unusual entity. In the other hand, the treatment for this condition is still controversial. We present the case of a 44 year old female with several bowel obstruction episodes caused by ileocolic Crohn's disease. During the last episode she was also diagnosed of bilateral hydroureter and hydronephrosis. After the resolution of the bowel obstruction and the placement of a double J catheter in both ureters, the patient was operated. Ileocolic resection and bilateral ureterolysis with omental wrapping were performed. Although urinary and wound infection complicated the postoperative course, and a enterocutaneous fistula had to be medically treated one year later, the patient is now free of symptoms and her renal function is normal.

Recipient factors as determinants of mortality after adult liver transplantation.

The factors that can influence the outcome of orthotopic liver transplantation (OLT) are numerous. The purpose of this study was to determine the effects of recipient preoperative factors on patient mortality. Between April 1986 and April 1998 a total of 600 OLTs were performed in our institution. We retrospectively reviewed our first 203 consecutive primary adult OLTs with at least 4 years of follow-up. A case-control comparison was performed between survivors and nonsurvivors, and differences in recipient variables were studied for their correlation with patient mortality. A logistic regression analysis was also performed. Mortality was significantly increased among those with fulminant hepatic failure (FHF) (66.6%, p = 0.003), primary cancer (63.1%, p = 0.018), females (46.1%, p = 0. 043), encephalopathy grade IV (72.7%, p = 0.012), recipients under respiratory support (69.2%, p = 0.031), and ABO-incompatible transplants (80%, p = 0.05). FHF, primary cancer, and female gender were the only variables that had a significant association with mortality in the logistic regression analysis. A higher incidence of prolonged respiratory support, bacterial and fungal infections, pneumonia, and chronic rejection contributed to the lower outcome observed in females. These results stress the need for continuous evaluation of the selection criteria of candidates for OLT suffering from primary cancer and FHF. The impact of recipient gender on mortality warrants further analysis but suggests that in the future more attention must be paid to the influence of this factor on the final outcome of OLT.

Primary dysfunction after liver transplantation. Is it possible to predict this complication?

OBJECTIVE: the aim of this study was to evaluate potential risk factors related to the development of primary liver graft dysfunction (PDF), including initial poor function (IPF) and primary nonfunction (PNF), and to describe a statistical predictive model for this complication. METHODS: to evaluate potential risk factors for the development of PDF (IPF and PNF), patients were classified into three groups on the basis of early postoperative graft function, and their medical charts were reviewed for donor, recipient and peroperative information. To evaluate the prognostic influence of potential risk factors, those that were statistically significant in the univariate analysis were subsequently studied by multivariate analysis using a Cox model. The study group comprised 214 liver transplants performed in 177 recipients. RESULTS: of the 214 liver transplants considered, 153 (71.5%) presented immediate graft function and 61 (28.5%) developed primary dysfunction. Initial poor function occurred in 43 (20.1%), while in 18 (8.4%) primary nonfunction of the liver was found. The severity of steatosis and preservation injury, recipient serum creatinine level, UNOS status, use of venovenous bypass, intraoperative coagulopathy and intraoperative bile output, reached statistical significance in the multivariate analysis and were predictors of PDF. CONCLUSIONS: the predictive model obtained is a useful tool to evaluate donors and recipients for liver transplantation, and for the early detection of primary dysfunction.

[Budd-Chiari syndrome: current medical-surgical management]. / Síndrome de Budd-Chiari: manejo médico-quirúrgico actual.

The Budd-Chiari syndrome or obstruction of the hepatic veins and/or suprahepatic inferior vena cava is a rare process, frequently associated with hypercoagulable states. There exist several clinical presentations, being most common the acute and subacute forms and rarely seen the fulminant and chronic forms (cirrhosis or fibrosis associated). We present here a female patient with Budd-Chiari syndrome produced by polycythemia, resolved by mesentericocaval interposition "H" shunt using internal jugular vein, after analyzing the current different modalities of medical-surgical treatment, specially portal system shunts and liver transplantation, related to presentation form.

Graft mass and volume calculation in living related donors for liver transplantation.

Living related liver transplantation is one of the strategies currently used to increase the donor pool. A preoperative and non-invasive estimate of the donor's liver volume is needed to ensure sufficient functional liver reserve for survival after resection, and to obtain a graft of adequate volume to suit the recipient's features. A method based on a preoperative abdominal computerised axial tomography of the donor, that enables the volume and mass of the whole liver, and the graft, to be calculated is herein described. The compatibility of the estimate with real graft mass after its removal has been proved, and the accuracy of the calculi has been compared with other published methods. Moreover, progressive growth of the recipient liver remnant has been demonstrated in subsequent explorations.