Factors affecting metabolic and electrolyte changes after reperfusion in liver transplantation.

BACKGROUND: The metabolic and electrolyte changes were evaluated after various durations of cold and warm ischemia times to correlate ASA status with hemodynamic changes that may affect the severity of the reperfusion syndrome. PATIENTS AND METHODS: Sixty-one patients who underwent liver transplantation (OLT) were monitored by arterial pH, PaO2, PaCO2, HCO2, BE, K+, Ca2+, Na+, GL, and serial Ht at three specific times: after the skin incision (baseline), 10 minutes before reperfusion (T2), and 10 minutes after reperfusion (T3). Changes in metabolic parameters were correlated with ASA status, hemodynamic changes, time of OLT, as well as cold and warm ischemia times. RESULTS: The pH in ASA IV patients was significantly lower at T1 and T3, and PCO2 higher in ASA V at T1. A significant correlation was observed between pH, PaCO2, HCO3-, BE, Na+, Ca2+, and glucose with the phase of the procedure. The pH and HCO3- decreased significantly from T1 and T2, increasing during T3. Ca2+ fell from T1 to T2 increasing in T3. Mean glucose and sodium levels increase from T1 to T3. Mean BE dropped from T1 to T2 and increased at T3 without a significant correlation between the metabolic parameters in any phase of the study and the cold or warm ischemia times. Patients with a high ASA status showed an increased risk for cardiovascular collapse after reperfusion. CONCLUSIONS: Patients with advanced ASA status are more prone to metabolic and acid-base disturbances during reperfusion, without any relation to the cold or warm ischemia times. High ASA status shows an increased risk for cardiovascular collapse after reperfusion.

Surgical treatment of human echinococcosis.

Hydatid disease may affect several organs in the human body and thus represents a major challenge for the general surgeon. The aim of this study was to analyze the multiple clinical presentations of hydatid disease and the surgical options according to the involved organ. The medical records of 272 adult patients operated on for hydatid disease in our department during the period 1970-1996 were retrospectively reviewed. The most commonly involved organ was the liver (204 patients; 75%), followed by the lung (42 patients; 15.4%) and the spleen (14 patients; 5.1%). In 12 patients, the cysts were located in uncommon sites: in the pancreas (4 patients; 1.5%), the gallbladder (2 patients; 0.74%), the kidney, the thyroid gland, the breast, the pericardium, the supraclavicular region and the thigh (1 patient in each case; 0.37%). Clinical symptomatology varied according to anatomic location and pre-operative diagnosis was accomplished with plain abdominal films, ultrasound, computerized tomography and serological tests. The surgical procedures performed included simple closure with drainage, unroofing of the cyst with omentoplasty (for liver cysts), marsupialization, cyst excision, excision of the involved organ or combinations of procedures. Postoperative morbidity was mainly due to septic complications (n = 41), postoperative bleeding (n = 2), deep vein thrombosis (n = 2) and fistulae (n = 13). Four patients died in the early postoperative period (mortality rate, 1.5%) secondary to septic complications (n = 3) and pulmonary embolism (n = 1). During long-term follow-up, 14 patients developed recurrent disease. In conclusion, hydatid disease should be included in the differential diagnosis of cystic masses in solid organs or other anatomic sites, especially in endemic countries. Since there is not an effective medical treatment, surgery still remains the treatment of choice, offering a good clinical result and an acceptable recurrence rate.

Splenic artery aneurysm rupture.

This is the report of a case with an atherosclerotic splenic artery aneurysm ruptured into the peritoneal cavity which presented with hypovolaemic shock. The patient underwent successfully emergency laparotomy and splenectomy. A brief review of the the literature follows.