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BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS: We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (nâ¯=â¯18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, pâ¯=â¯.043), tumor size ≥8â¯mm (OR: 5.913; 95% CI: 1.795-19.481; pâ¯=â¯.003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; pâ¯=â¯.018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; pâ¯=â¯.001). Over the mean follow-up period of 119.8⯱â¯65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; pâ¯=â¯.112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9⯱â¯5.6 vs. 97.4⯱â¯10.3 months; pâ¯=â¯.034). CONCLUSIONS: The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.
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Carcinoma Papilar , Neoplasias de la Tiroides , Carcinoma Papilar/epidemiología , Humanos , Metástasis Linfática , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Neoplasias de la Tiroides/epidemiologíaRESUMEN
BACKGROUND: The study aim is to analyze the evolution over the last 25 years of the results reported after abdominal oncological surgery in patients aged 80 years of age and older. The primary endpoint was morbidity and mortality in this group of patients; the secondary endpoint was overall survival. METHODS: A systematic search strategy was used to browse through Medline/PubMed, EMBASE, Scopus, ClinicalTrials.gov, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials using a combination of standardized index terms. Studies published between 1997 and 2017 were selected. Only those studies that showed morbidity and mortality after digestive and hepatobiliary tract oncological surgery in individuals aged 80 years and older were included. The PROSPERO registration number is CRD42018087921. PRISMA and MOOSE guidelines were applied. RESULTS: A total of 79 studies were included, categorized by origin of malignancy: esophageal (7), stomach (26), liver (4), pancreas (19), and colorectal (23). Compared with the non-elderly group, the elderly group had similar esophageal morbidity with higher mortality (RR 2.51, 1.50 to 4.21; P = 0.0005); higher gastric morbidity (RR 1.25, 1.09 to 1.43; P = 0.001), and mortality (RR 2.51, 1.81 to 3.49; P = 0.0001); similar liver morbidity and mortality; higher pancreatic morbidity (RR 1.17, 1.03 to 1.33; P = 0.02) and mortality (RR 2.37, 1.86 to 3.03; P < 0.00001); and similar colorectal morbidity with higher mortality (RR 4.44, 1.91 to 10.32; P = 0.005). CONCLUSION: Oncological surgery of most abdominal visceral tumors is associated with increased morbidity and mortality in patients older than 80 years.
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Neoplasias del Sistema Digestivo/cirugía , Complicaciones Posoperatorias/epidemiología , Anciano de 80 o más Años , Neoplasias Colorrectales/cirugía , Neoplasias Esofágicas/cirugía , Humanos , Neoplasias Hepáticas/cirugía , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias/mortalidad , Neoplasias Gástricas/cirugía , Oncología QuirúrgicaRESUMEN
BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyse the factors associated with PTMC and mETE and the long-term prognosis of PTMC. MATERIAL AND METHODS: We conducted a retrospective study with a population consisting of patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) versus group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n=18) of the patients. In the multivariate analysis, mETE was associated with an age ≥45 years (OR, 4.383; 95% CI 1.051-18.283, p=.043), a tumour size ≥8mm (OR, 5.913; 95% CI 1.795-19.481; p=.003), bilaterality (OR, 4.430; 95% CI 1.294-15.173; p=.018) and metastatic lymph nodes (OR, 12.588; 95% CI 2.919-54.280; p=.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p=.112), but none of the patients died due to the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p=.034). CONCLUSIONS: The mETE of MCPT is a factor of worse prognosis, associated with the presence of metastatic lymph nodes and lower disease-free survival.
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BACKGROUND: Acetaminophen poisoning continues to be a major cause of liver failure that can lead to liver transplantation. N-acetylcysteine (NAC) is the cornerstone of treatment. Some authors use a Molecular Adsorbent Recirculating System (MARS) system in acetaminophen poisoning. It is reported that the MARS system eliminates acetaminophen more efficiently than conventional dialysis. It is theoretically possible that treatment with MARS administered after NAC will increase the effectiveness of treatment. CASE REPORTS: The first patient, a woman of 14 years old, presented blood levels of 112 mg/dL 12 hours after ingestion of 15 g of acetaminophen. Treatment with NAC was initiated. At 17 and 23 hours after ingestion, blood levels were 23.5 µg/mL and 5.9 µg/mL, respectively. The second patient, a woman of 28 years old, presented blood levels of 115 mg/dL 4 hours after ingestion of 40 g of acetaminophen. Treatment with NAC was initiated. At 14 and 23 hours after ingestion, blood levels were 15.8 µg/mL and <2 µg/mL, respectively. In both patients, we performed MARS after completing treatment with NAC, and after the first session, blood levels were below the lower limit of detection (≤2 µg/mL). DISCUSSION: The correct timing of MARS to avoid interactions with the administered dose of NAC in acetaminophen overdose is essential so as to not impair the effectiveness of this treatment. These considerations in the management of this entity help in the resolution of liver failure, thus avoiding the need for a liver transplant.
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Acetaminofén/envenenamiento , Acetilcisteína/uso terapéutico , Analgésicos no Narcóticos/envenenamiento , Sobredosis de Droga/terapia , Desintoxicación por Sorción/métodos , Acetilcisteína/sangre , Adolescente , Adulto , Femenino , Depuradores de Radicales Libres/sangre , Depuradores de Radicales Libres/uso terapéutico , Humanos , Masculino , Desintoxicación por Sorción/efectos adversosRESUMEN
BACKGROUND: Nowadays, neoadjuvant chemotherapy (nCT) in breast cancer is more and more standardized, not only in advanced tumours but also in those for which there is an attempt to achieve breast-conserving surgery. In literature, we can find evidences of the relationship between several types of tumours and systemic inflammatory response. Our objective is to analyse the prognostic value of blood parameters (lymphocytes, neutrophils, monocytes, lymphocyte-to-monocyte ratio (LMR), neutrophil-to-monocyte ratio (NMR) and neutrophil-to-lymphocyte ratio (NLR) in breast cancer (BC) patients treated with nCT. METHODS: A retrospective cohort of 150 breast cancer patients treated with nCT and subsequently with surgery was analysed. Data about the patients, histology, response to chemotherapy and peripheral blood values of lymphocytes, monocytes and neutrophils was collected, and used to calculate the LMR, NMR and NLR. Univariate and multivariate analyses were performed for the variables to see the relationship of the ratios to disease-free survival (DFS) and overall survival (OS). RESULTS: Patients with high LMR (≥5.46) and low NLR (<3.33) were associated with a lower percentage of relapse (P = 0.048 and P = 0.015, respectively) and, above all, NLR was associated with a better survival (P = 0.024), being those factors that predict a good progress. CONCLUSION: High LMR and low NLR can be considered as favourable prognostic factors in BC patients treated with nCT.
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Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Terapia Neoadyuvante , Adulto , Anciano , Biomarcadores de Tumor/inmunología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/mortalidad , Quimioterapia Adyuvante , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Recuento de Leucocitos , Persona de Mediana Edad , Monocitos , Neutrófilos , Pronóstico , Modelos de Riesgos Proporcionales , Estudios RetrospectivosRESUMEN
INTRODUCTION: The aim of the present study was to describe the incidence and microbiological profiles of positive cultures obtained from preservation solution (PS) and correlate these findings with infectious complications detected in the liver transplant (LT) recipient. PATIENTS: We conducted a single-center, retrospective study between December 2010 and August 2014 among 178 LT. In all grafts, a PS culture was carried out. All the infections in the receipt until hospital discharge were collected. In patients with >1, infection was considered the most severe according to Clavien-Dindo classification. RESULTS: PS culture was positive for bacterial or fungal agents in 79 of 178 LT recipients (44%). The most commonly cultured organisms were coagulase-negative staphylococci (64%), Enterobacteriaceae (17%), and Staphylococcus aureus (4.7%). In the 79 patients with positive PS, 49 blood cultures were requested in the period after LT. Twenty-five postoperative infections (31.7%) were diagnosed. Only 4 of 79 patients (5%) with PS contamination had a postoperative infections related with isolated microorganism. CONCLUSIONS: Contamination of PS appears in a high percentage of liver grafts before LT, although there is a poor correlation with postoperative infections in LT recipient. In these patients, a standardized process including fungal and bacterial cultures could be useful.
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Contaminación de Medicamentos , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Trasplante de Hígado/efectos adversos , Soluciones Preservantes de Órganos , Enterobacteriaceae/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Staphylococcus/aislamiento & purificaciónRESUMEN
INTRODUCTION: Diffuse peritoneal dissemination in advanced ovarian cancer can be treated using optimal effort surgery involving peritonectomy procedures and the administration of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC). OBJECTIVE: To report on our experience in the treatment of advanced ovarian cancer using peritonectomy procedures and HIPEC through the fast track program. PATIENTS AND METHOD: From September 2008 until May 2010, forty-six patients with primary advanced (stage III-C) or recurrent ovarian cancer have been included in the fast track protocol if they had optimal cytoreduction CC-0 or CC-1 accompanied by HIPEC and there had no more than one digestive anastomosis. RESULTS: The mean peritoneal cancer index (PCI) was 12.35 (3-21). The median operation time was 380 min (200-540). Optimal surgery CC-0 was achieved in 38 of the 46 patients and CC-1 in the remaining 8. Mean postoperative hospital stay was 6.94 ± 1.56 days (3-11). Major morbidity rates were 15.3%. Paralytic ileus was the most frequent of these. There was no mortality related to the procedure. CONCLUSION: Surgery with peritonectomy procedures and HIPEC in advanced ovarian carcinoma is possible under fast track surgery programs in patients with low volume peritoneal carcinomatosis. Prospective and randomized studies are needed.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/terapia , Hipertermia Inducida , Neoplasias Ováricas/terapia , Neoplasias Peritoneales/terapia , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carcinoma/tratamiento farmacológico , Carcinoma/secundario , Carcinoma/cirugía , Quimioterapia Adyuvante , Femenino , Humanos , Intestinos/cirugía , Periodo Intraoperatorio , Escisión del Ganglio Linfático , Persona de Mediana Edad , Morbilidad , Estadificación de Neoplasias , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Ovariectomía/métodos , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Esplenectomía , Resultado del TratamientoAsunto(s)
Neoplasias Abdominales/etiología , Hemofilia A/complicaciones , Neoplasias Abdominales/diagnóstico por imagen , Neoplasias Abdominales/patología , Adulto , Quistes/diagnóstico por imagen , Factor VIII/uso terapéutico , Hemofilia A/diagnóstico por imagen , Hemofilia A/patología , Humanos , Masculino , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The best treatment for hepatocellular carcinoma (HCC) associated with liver cirrhosis is liver transplantation and the best results are obtained when the tumors fulfill the Milan criteria. However, although the number of transplants is increasing, the organ deficit is growing, which lengthens time on the waiting list, increasing the risk of tumor progression of and exclusion from the list. The use of elderly donors is a valid option for patients on the transplant waiting list with HCC, reducing time on the waiting list. We report our experience with patients transplanted for HCC associated with hepatic cirrhosis using livers from donors >75 years of age. Our preliminary results supported the use of elderly suboptimal donors making it possible to give priority to these patients. All patients in the series achieved good graft function after a follow-up of 2 years with a 100% disease-free survival rate. More extensive long-term studies are needed to confirm these findings.
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Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Listas de Espera , Factores de Edad , Anciano , Anciano de 80 o más Años , Muerte Encefálica , Carcinoma Hepatocelular/complicaciones , Femenino , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/complicaciones , Masculino , Persona de Mediana Edad , Selección de Paciente , Donantes de TejidosAsunto(s)
Tolerancia Inmunológica , Trasplante de Hígado/inmunología , Traslado Adoptivo , Antígenos CD/inmunología , Citocinas/fisiología , Células Dendríticas/inmunología , Supervivencia de Injerto , Humanos , Hígado/citología , Hígado/inmunología , Subgrupos de Linfocitos T/inmunología , Subgrupos de Linfocitos T/trasplante , Linfocitos T Reguladores/inmunología , Timo/inmunología , Quimera por Trasplante , Trasplante Homólogo/inmunologíaRESUMEN
Hepatitis C virus (HCV) infection is a global problem in our health systems. The prevalence of infected patients in general population is about 2%. In the subgroup of pregnant woman the percentage of infected patients ranges from 1-3%. Several studies have described the relationship between pregnancy and chronic HCV infection, and in most cases serum transaminases levels return to normal values while HCV-RNA levels increase during the second and third trimester. The influence of maternal hormones after delivery in the natural history of HCV infection has not been sufficiently studied and consequently remains controversial. This case report shows the peculiar clinical course of a patient with chronic HCV infection in the puerperium.
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Hepatitis C Crónica/complicaciones , Fallo Hepático/etiología , Trastornos Puerperales/etiología , Enfermedad Aguda , Adulto , Progresión de la Enfermedad , Femenino , Hormonas Esteroides Gonadales/fisiología , Humanos , Cirrosis Hepática/etiología , Fallo Hepático/cirugía , Trasplante de Hígado , EmbarazoRESUMEN
Thrombosis of the portal-mesenteric axis is an infrequent cause of intestinal ischemia or infarction. In addition to the multiple acquired factors that contribute to the development of this entity, hereditary risk factors, especially the factor V Leiden mutation and the G20210A mutation of the prothrombin gene, have been implicated. The G20210A mutation of the prothrombin gene is found in up to 40% of patients with splenic-portal-mesenteric thrombosis. The present case illustrates the unusual and nonspecific presentation of this mutation in the form of diarrhea and images of thrombosis of the superior mesenteric-portal vein and cavernous transformation of the portal vein. Delayed diagnosis is highly frequent since the clinical signs, laboratory investigations and radiological tests do not suggest the diagnosis. The patient received anticoagulant treatment and showed clinical improvement with complete portal-mesenteric recanalization. Currently the diagnostic technique of choice is magnetic resonance angiography or computerized tomography angiography and treatment consists of indefinite anticoagulation. This case illustrates that an unusual or atypical localization of venous thrombosis may be a manifestation of thrombophilia, emphasizing the importance of genetic screening in these cases.
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Regiones no Traducidas 3'/genética , Venas Mesentéricas , Mutación , Vena Porta , Protrombina/genética , Vena Esplénica , Trombofilia/genética , Trombosis de la Vena/etiología , Acenocumarol/uso terapéutico , Angiografía , Anticoagulantes/uso terapéutico , Colonoscopía , Diarrea/etiología , Heparina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
INTRODUCTION: In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years. PATIENTS AND METHOD: 231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, chi2 test, Student's t test and a logistic regression test are applied. RESULTS: After a mean postoperative follow-up of 152 +/- 71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 +/- 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred. CONCLUSIONS: The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients.
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Bocio Nodular/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Recurrencia , Reoperación , Factores de Riesgo , TiroidectomíaRESUMEN
Phosphorylated FTY720 is an analog of Sphingosine 1 Phosphate (S1P) with immunosuppressive activity that negatively regulates the expression of S1P-Receptor 1. It also inhibits the migration of CD4 and CD8 single-positive T cells from the thymus to the periphery, sequesters peripheral blood lymphocytes in lymph nodes and Peyer's patches, and delays the exit of effector T cells toward the graft. The aim of our work was to study the effect of FTY720 on the kinetics of skin allograft rejection in a fully mismatched model; euthymic (Euthy) versus thymectomized (ATX) C57BL/6 mice (haplotype H-2(b)) recipients of BALB/c mice (haplotype H-2(d)) donor cells. The animals were injected daily with FTY720 (1 mg/kg) intraperitoneally for 2 weeks. To monitor the humoral immune response, serum samples collected at day 0 (pre-immune) and at day 23 after skin graft rejection were examined using BALB/c thymocytes as antigens in flow cytometry. To confirm the effect of FTY720 on peripheral lymphocytes, peripheral blood was analyzed by flow cytometry. Euthy and ATX FTY720-treated mice showed prolongation of skin allograft survival when compared with nontreated Euthy and ATX controls (P < .005). Unexpectedly, FTY720-treated Euthy mice showed significantly delayed graft rejection when compared to similarly treated ATX mice (P < .005). The delayed graft rejection in FTY720-treated Euthy mice correlated with a reduced content of Th1-mediated IgG(2a) and IgG(2b) antibodies when compared with FTY720-treated ATX mice (P < .05). In conclusion, FTY720 delays the kinetics of allograft rejection in a fully mismatched model by inhibiting Th1-mediated humoral immune responses. The presence of the host thymus appears to be required for this phenomenon.
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Formación de Anticuerpos/efectos de los fármacos , Inmunosupresores/farmacología , Glicoles de Propileno/farmacología , Trasplante de Piel/inmunología , Trasplante Homólogo/inmunología , Animales , Femenino , Clorhidrato de Fingolimod , Rechazo de Injerto/prevención & control , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Modelos Animales , Esfingosina/análogos & derivados , Timectomía , Factores de TiempoRESUMEN
AIM: To determine the influence of the information on donation generated from primary health-care on the attitude towards organ donation. DESIGN: Descriptive transversal study. SETTING: 45 municipalities of Murcia Region, Spain. PARTICIPANTS: The population in this study was randomly selected and stratified according to age, sex, and geographic localization among people over > or =15 years of age (n=1887). INTERVENTIONS AND MEASURES: The attitude was evaluated according to a questionnaire psychosocial aspects of donation. There is valued the information transmitted on donation to the population from primary care (group A) or other informative sources (group B), and if this information was to favour or in opposition to the same one. STATISTICS: chi2 test, t Student, and logistic regression analysis. RESULTS: Of 1887 surveys, 129 cases (group A) (7%) had received information from primary care. In this group, the 89% is in favour of the donation. In 120 cases the received information was favourable, presenting an attitude in favour of the donation of 93%, whereas in all 9 remaining cases the information was in against, decreasing the attitude to favour up to 44% (P<.05). In the group B (n=1758) the attitude in favour of the donation was of 65% (P<.05, with regard to the group A). The 62% (n=1083) received favourable information, improving in them the favourable attitude towards the donation up to 74%. The rest (38%; n=675) had received also unfavourable information, decreasing his attitude to favour up to 51% (P<.05). CONCLUSIONS: Little information about organ donation is transmitted from primary care, but when it is realized a very positive impact has if it is favourable and very negative if it is unfavourable.
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Actitud , Educación en Salud , Atención Primaria de Salud , Obtención de Tejidos y Órganos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Obtención de Tejidos y Órganos/métodosAsunto(s)
Antitiroideos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Metimazol/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/sangre , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Femenino , Humanos , Pruebas de Función Hepática , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Small bowel bleeding is infrequent and presents a challenge to the clinician. Approximately 30-40% of gastrointestinal bleeding localized in the small bowel is due to angiodysplasia, a vascular malformation. We present the case of a patient with multiple angiodysplasia of the small bowel who required push enteroscopy and capsule endoscopy to establish the diagnosis. Treatment with subcutaneous octreotide was successful. In conclusion, in doubtful cases or in patients with persistent hemorrhage, capsule endoscopy can improve the diagnostic yield of enteroscopy in bleeding gastrointestinal vascular lesions such as angiodysplasia. Endoscopic treatment (laser coagulation) and drug therapy (somatostatin or analogs) are valid alternatives in inoperable or non-resectable cases.
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Angiodisplasia , Intestino Delgado , Anciano , Angiodisplasia/diagnóstico , Angiodisplasia/tratamiento farmacológico , Fármacos Gastrointestinales/uso terapéutico , Humanos , Enfermedades Intestinales/diagnóstico , Enfermedades Intestinales/tratamiento farmacológico , Masculino , Octreótido/uso terapéuticoRESUMEN
INTRODUCTION: Medical treatment for fulminat hepatic failure seeks spontaneous recovery of the liver function, but the results are very discouraging (50-80% mortality). Liver transplantation is an option in patients with a poor evolution despite medical treatment, with survival rates of > 50%. The ideal moment for performing the transplant is controversial, as it should not be done too soon, when the liver disease is still reversible, or tool late, when the patient is in an irreversible clinical situation. PATIENTS AND METHOD: A retrospective review was made of the clinical histories of 34 patients admitted to our hospital with a diagnosis of fulminant hepatic failure, of whom 26 underwent transplantation. The most frequent cause was viral, with 10 cases (38%); no aetiology at all could be established in 11 cases (42%). Thirteen patients had preoperative complications, the most frequent being renal insufficiency. As for degree of ABO/DR compatibility, 13 cases were identical (40%), 17 compatible (51%) and the other 3 incompatible (9%). RESULTS: Thirty-three transplants were performed in 26 patients: 4 were retransplants due to chronic rejection, 2 for primary graft failure and 1 for hyperacute rejection. The overall mortality rate was 46% (12 patients), the most frequent cause of death being infection (50%). The overall actuarial survival rate was 68% at 1 year, 63% at 3 years and 59% at 5 years. The factors of poor prognosis were renal and respiratory insufficiency, a grade D electroencephalogram, and encephalopathy grades III and IV, the latter being the only prognostic factor identified in the multivariate analysis. The prognostic factors for mortality were a grade D electroencephalogram, encephalopathy grades III and IV and respiratory insufficiency, the latter being the only prognostic factor identified in the multivariate analysis. CONCLUSIONS: The achievement of good results with the use of transplantation in the management of fulminant hepatic failure depends on an optimum selection of transplant candidates, which means identifying them early, i.e. early indication for transplant, reduction in mean waiting time and exclusion of factors of poor prognosis.