RESUMEN
In the authors' experience, 0.24% of the patients submitted to liver imaging (ultrasound or computerized tomography) have hemangiomas. These are shown as solid nodular lesions, mostly found by chance. Sometimes they do not appear as typical solid vascular lesions. The authors' experience and the literature are discussed. A clear and concise approach to this benign neoplasm is suggested.
Asunto(s)
Hemangioma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Adulto , Niño , Femenino , Hemangioma/diagnóstico por imagen , Arteria Hepática/diagnóstico por imagen , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Studies were carried out on 16 alcoholic cirrhotics with clinically intractable ascites who underwent the implant of peritoneovenous (LeVeen) shunts. Our purpose was to find out how this group of patients responded to this kind of surgical treatment for ascites. Fifteen of these patients were male and one female, with a median age of 51.3 years. According to Child classification, 7 were Child B and 9 Child C. Thirty-three surgeries were conducted, in that 5 were performed for revision of the shunt positioning and 12 for the replacement of the valves. A total of 28 shunts were used. Postoperative immediate mortality occurred in 5 patients (4 Child C and one Child B). The median late postoperative follow-up of the 11 patients who survived was 25.8 months. We concluded that LeVeen shunt implantation is a valid palliative therapeutic resource for the treatment of ascites in alcoholic cirrhotics. The results obtained with this patient population are similar to those observed in cirrhotics who presented other etiologies. We also concluded that late mortality was not related to the implant of a LeVeen shunt but was due to the normal course of the disease.
Asunto(s)
Ascitis/cirugía , Cirrosis Hepática Alcohólica/cirugía , Derivación Peritoneovenosa , Ascitis/etiología , Endoscopía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Derivación Peritoneovenosa/efectos adversos , Complicaciones Posoperatorias/mortalidad , Cuidados PreoperatoriosRESUMEN
As a contribution to the study of ascites in patients with liver cirrhosis, congestive heart failure and peritoneal carcinomatosis evaluate in serum and ascites the concentrations of alphafetoprotein, carcinoembryonic antigen and fibronectin, they might suggest a diagnosis for the basic pathology. Forty-seven patients were studied, from whom 23 with cirrhosis, 17 peritoneal carcinomatosis and 7 with congestive heart failure. We conclude that: a) none of the tools usually employed in the analysis of ascitic fluid alone can make the base pathological process responsible for producing ascites; b) fibronectins were more useful for differential diagnosis between cirrhosis and carcinomatosis; c) alpha-fetoprotein and carcinoembryonic antigen were not useful for the definition for differential diagnosis.
Asunto(s)
Ascitis/diagnóstico , Carcinoma/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Cirrosis Hepática/diagnóstico , Neoplasias Peritoneales/diagnóstico , Líquido Ascítico/química , Antígeno Carcinoembrionario/análisis , Diagnóstico Diferencial , Femenino , Fibronectinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Factores Sexuales , alfa-Fetoproteínas/análisisRESUMEN
Serum levels of alkaline phosphatase, gamma-glutamyltranspeptidase, -1 fucosidase and glutathione-S-transferase are increased in 60, 90, 75 and 64% of patients with hepatocellular carcinoma. In these patients the mean plasma fibrinogen levels is 461.78 mg/dl, while mean serum copper is 200.50 mg/dl. Serum levels of desgamma-carboxiprothrombin is over 900 mg/dl in 67% of the patients (60% of them have HB virus, mostly anti HBe positive). Forty to 95% of them have increased levels of -fetoprotein (AFP). The authors suggest that cirrhotic patients, with or without HB virus, specially those with increased AFP, should have ultrasound examination of the liver every 6 months. This method of imaging has been shown to be more sensitive than AFP (72% versus 25%) in the detection of hepatocellular carcinoma smaller than 2 cm in diameter.
Asunto(s)
Biomarcadores de Tumor/sangre , Carcinoma Hepatocelular/diagnóstico , Fibrinógeno/análisis , Antígenos de Superficie de la Hepatitis B/análisis , Neoplasias Hepáticas/diagnóstico , alfa-Fetoproteínas/análisis , Carcinoma Hepatocelular/sangre , Humanos , Neoplasias Hepáticas/sangreRESUMEN
Minimally invasive percutaneous procedures has an important place in internal medicine. In this concept is included a transjugular intrahepatic portosystemic shunts (TIPS). In this pilot study we describe the indication of this therapeutic modality in three cirrhotic patients with hemorrhagic congestive gastropathy unresponsive to infusion of drugs that reduce the portal pressure. All of them were treated by TIPS and control of gastric bleeding occurred in all. One of these showed partial stenosis of the wallstent, treated by prosthesis dilatation. Another developed portosystemic encephalopathy controlled by usual therapeutic measures in the other we implanted two TIPS to obtain a low pressure level of the hepatic-portal gradient. They had no further necessity of blood transfusion, with better hemodynamic conditions and biochemical tests with reduction of the values of the GHP. We conclude that TIPS may be useful to treat hemorrhagic congestive gastropathy acting like a bridge for subsequent elective liver transplantation under good clinical and hemodynamic conditions.
Asunto(s)
Hemorragia Gastrointestinal/cirugía , Cirrosis Hepática/cirugía , Derivación Portosistémica Intrahepática Transyugular , Gastropatías/cirugía , Adulto , Femenino , Venas Hepáticas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Flebografía , Proyectos Piloto , Vena Porta/diagnóstico por imagen , PortografíaRESUMEN
Sixteen patients with jaundice after heart surgery with extracorporeal circulation, were studied. They were divided in 2 groups, according to the postoperative outcome; either death (group I) or hospital discharge (group II). Clinical, epidemiological, surgical and laboratorial aspects were compared in order to ascertain their role in the outcome. The results were analysed by the Student-t test. The main cause of death was low output syndrome, which occurred in 10 cases (62.5%), 5 of them died (31%). A statistically significant difference was observed in the postoperative values of serum GOT (p less than 0.01), GPT (p less than 0.01) and total bilirubin (p less than 0.01), which were then considered prognostic indicators in these patients.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Colestasis Intrahepática/etiología , Adulto , Anciano , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Circulación Extracorporea , Femenino , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Necrosis/etiología , Complicaciones Posoperatorias , PronósticoRESUMEN
Over the last few years, ultrasound became important in characterization of space -occupying solid lesions of the liver. Recently, Canadian authors using this method, described a 23% incidence of intrahepatic or subcapsular hematoma after liver biopsy. We prospectively evaluated the incidence of this complication after liver biopsy under laparoscopic guidance in 8 cirrhotic patients, 7 with steatosis, 7 chronic active hepatitis and 4 with intrahepatic cholestasis. Biopsy was performed under general anesthesia provided that prothrombin activity was over 50%, serum fibrinogen was over 100% and platelets over 50.000/mm3. In none of 26 consecutive patients, was an intrahepatic or subcapsular hematoma observed.
Asunto(s)
Hematoma/etiología , Hepatopatías/etiología , Ultrasonografía , Adolescente , Adulto , Anciano , Biopsia con Aguja/efectos adversos , Femenino , Hematoma/diagnóstico , Hematoma/patología , Humanos , Laparoscopía , Hepatopatías/diagnóstico , Hepatopatías/patología , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Hemangiomas are the most common benign vascular tumor found in the liver. In this study, 103 cases of hepatic hemangiomas were analysed in a retrospective manner. Image aspects such as those seen in ultrassonography, computed tomography, nuclear magnetic resonance and arteriography are discussed. The incidence was higher amongst the female sex, between individuals from 40 to 60 years old, which presented predominantly without symptoms (66%) and localized mainly in the right hepatic lobe (74%). The meaning of those aspects, when adopted, permits the clinicians to differentiate benign from malignant nodular lesions in the liver.
Asunto(s)
Hemangioma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Adulto , Factores de Edad , Femenino , Hemangioma/diagnóstico por imagen , Arteria Hepática/diagnóstico por imagen , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Espectroscopía de Resonancia Magnética , Masculino , Persona de Mediana Edad , Factores Sexuales , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Hepatorenal syndrome was observed in 25% of the patients with end stage liver disease. In this situation they stayed longer time in intensive unit treatment, hemodialysis. This evolution was observed in 67% of them with this complication after surgery. In this report we describe three patients with hepatorenal syndrome reversible after liver transplant. We define the form of management of these patients after surgery, regard treatment with cyclosporine A, only 72 h after surgery, without administration of aminoglycosides and amphoterycin. This good evaluation also depends of absence of arterial hypotension or infection episodes during and after surgery. It also depends of the good conditions of the implanted liver.
Asunto(s)
Ciclosporina/uso terapéutico , Síndrome Hepatorrenal/cirugía , Cirrosis Hepática/complicaciones , Trasplante de Hígado , Adulto , Femenino , Síndrome Hepatorrenal/sangre , Síndrome Hepatorrenal/etiología , Humanos , Masculino , Persona de Mediana Edad , Cuidados PosoperatoriosRESUMEN
Primary sclerosing cholangitis is a disease usually with a poor prognosis with a mean survival of 10-12 years, starting from the time of diagnosis. Among the different populations studied, males predominate in a ratio 2:1 with ages ranging from 20-78 (mean 42 years). This article describes four patients with this syndrome, a child of eight and three adolescents, thirteen and fourteen years old. It is possibly of autoimmune etiology, characterized by stenosis, dilatation and fibrosis involving the intrahepatic and extrahepatic biliary tree. We analyzed laboratory assays, clinical, immunological, laboratory assays, histological and cholangiographic aspects. In conclusion, in this age group perhaps of the small population sample there was no sex predominance, and 50% progressed without jaundice and without hepatomegaly. The serum levels of gamma glutamyltransferases and especially alkaline phosphatase were elevated compared to aminotransferases without increase of the serum auto antibodies. Only one patients displayed the typical histological appearance of primary sclerosing cholangitis. The diagnosis in al was confirmed by typical cholangiographic signs, restricted only to the intrahepatic biliary tree, identified in all those included in this study.
Asunto(s)
Colangitis Esclerosante/diagnóstico , Adolescente , Niño , Colangitis Esclerosante/inmunología , Colangitis Esclerosante/terapia , Femenino , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
During the past 20 years, several authors have reported increased prevalence of cholelithiasis in liver cirrhosis. This biliary disease has been implicated with the deterioration of liver function, liver disease of alcoholic origin or even the presence of hypersplenism in this patient population. This study analyzes the incidence and possible factors which are responsible for promoting cholelithiasis in cirrhosis. The study included 110 cirrhotic patients of a private center specialized in treating liver diseases. The incidence of cholelithiasis was 27.3% (25.3% in males and 33.3% in females). There was no correlation between liver function defined by Child's classification or through the laboratory examinations (AST, ALT, AP, GGT, PT, Alb, TB, DB, PA) and the presence of gallstones. No evidence was found that the etiology of cirrhosis or the presence/absence of hypersplenism affected the prevalence of cholelithiasis in this population. In conclusion, an increased prevalence of cholelithiasis was verified in this population of cirrhotics but the pathogenesis is still obscure.
Asunto(s)
Colelitiasis/complicaciones , Cirrosis Hepática/complicaciones , Adolescente , Adulto , Anciano , Brasil/epidemiología , Distribución de Chi-Cuadrado , Niño , Preescolar , Colelitiasis/epidemiología , Colelitiasis/cirugía , Interpretación Estadística de Datos , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
In the most of the cases, the diagnosis of focal solid hepatic lesions are performed by ultrasonography, computed tomography, magnetic resonance and hepatic angiography imagig. However, the distinction between benign and malignant neoplasias, sometimes is made after liver biopsy. This report is about 32 of these lesions, diagnosed after guided liver biopsy by ultrasonography. The efficacy of this propedeutic method, minimally invasive, is defined emphasizing that there are no mortality and low levels of morbidity.
Asunto(s)
Biopsia con Aguja/métodos , Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Ultrasonografía Intervencional/métodos , Adolescente , Adulto , Anciano , Humanos , Persona de Mediana EdadRESUMEN
Transjugular intrahepatic portosystemic shunts (TIPS) represents a new surgical technique minimally invasive utilized in the treatment of portal hypertension. Such technique avoid the risks of general anesthesia, and major surgery like portocava anastomosis, reducing the hepatic-portal gradient, and help bleeding esophagogastric varices, hemorrhagic congestive gastropathy and refractary ascites. Certainly diminishes the intensity of intraperitoneal colorectal circulation and the necessity of blood transfusion during surgery for liver transplantation. In this report we reported the first case in Brazil of the implant of TIPS like preparation for liver transplantation in cirrhotic alcoholic patient. We made consideration about techniques aspects and surgery evolution. This new interesting technique applied for this type of patients is indicated as a bridge for candidates for liver transplantation.
Asunto(s)
Cirrosis Hepática Alcohólica/cirugía , Trasplante de Hígado , Derivación Portosistémica Intrahepática Transyugular , Adulto , Humanos , Cuidados Intraoperatorios , Masculino , Periodo PosoperatorioRESUMEN
A 54-year-old man with Chagas cardiomyopathy that was submitted to a heart transplantation and five months later presented a progressive increase in liver enzymes. Diagnosis of chronic active hepatitis was confirmed by histopathologic studies. A transitory interruption of treatment with azathioprine and the posterior re-introduction of small doses, as well as the use of lesser amounts of cyclosporin-A improved the clinical and laboratory pictures. Despite several investigations the pathogenesis of hepatitis remained undetermined, although some type of drug injury was presumed to be involved. The eventual role of viruses as the primary inciting event could not be completely ruled out.
Asunto(s)
Cardiomiopatía Chagásica/cirugía , Enfermedad Hepática Crónica Inducida por Sustancias y Drogas , Trasplante de Corazón , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Pruebas de Función Cardíaca , Hepatitis Crónica/enzimología , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
Thirty-six patients with pyogenic liver abscess treated by percutaneous drainage plus antibiotic therapy were reviewed. The most frequent symptoms were fever (75%) and pain (72.2%), and the most common physical signs were liver enlargement (58.3%) and jaundice (33.3%). The mean time interval from admission to diagnosis was 16 days. CT scans and ultrasonography were diagnostic in 100% of the patients. The percutaneous drainage was effective in one attempt in 19 patients, two attempts in 8, three attempts in 8 patients and more than four attempts in only one patient. There were three patients with hemoperitoneum (8.7%) as a post-drainage complication, one of them needed to be treated surgically. Mean hospital stay was of 24.8 days and the mortality rate was 5.5%. Percutaneous drainage plus antibiotic therapy is then an efficient therapeutic approach to the treatment of pyogenic liver abscess.