RESUMO
eHAT is one of the most dreaded post-LT complication. Treatment approaches include retransplantation, revascularization, or observation. Systemic thrombolytic therapy is used in pediatric patients with thromboembolic events. However, there is no previous study reporting on the use of systemic r-tPA to treat eHAT. The treatment strategies used in patients with eHAT are described, focusing on two children who failed SR and were treated with systemic heparinization plus systemic r-tPA infusion. r-tPA-RP consists of intravenous systemic infusion at a dose of 0.3 mg/kg/h during 6 hours, for 5 days. First case (3-year) was transplanted with a whole liver, and second case (6-year) received a LLS from a living donor. HAT was diagnosed by doppler US and confirmed by angioCT scan in both patients in the first day after LT. They underwent SR and were clinically stable. Re-thrombosis occurred in both patients the day after, and r-TPA-RP was started-one patient required two r-TPA-RP for HAT recurrence. They presented minor bleeding, without repercussion. Hepatic artery recanalized after 10 and 3 days in the first and second patient, respectively. Retransplant was avoided, and one developed biliary strictures, successfully managed in the follow-up. r-TPA-RP avoided retransplantation after eHAT in these cases. To our knowledge, this is the first report of the use of systemic r-TPA to treat eHAT in children. This strategy may compose an algorithm to treat eHAT that failed SR in stable patients.
Assuntos
Fibrinolíticos/uso terapêutico , Fígado/irrigação sanguínea , Complicações Pós-Operatórias/tratamento farmacológico , Trombose/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Transplante de Fígado , Masculino , Procedimentos Cirúrgicos VascularesRESUMO
A infecção aguda do trato urinário é importante causa de morbidade na criança. a infecção crônica ou recorrente e suas seqüelas são causas evitáveis de hipertensão arterial e insuficiência renal crônica. estudos por imagem são de grande valia para definição diagnóstica, busca de alterações anatômicas e/ou funcionais, visando planejamento terapêutico a curto prazo. o objetivo deste artigo é apresentar uma revisão atualizada da investigação por imagem na infecção urinária em crianças.