RESUMEN
Gastroenteropancreatic neuroendocrine tumors (NETs) often present as liver metastasis from a carcinoma of unknown primary. We recently showed that primary NETs from the pancreas, small intestine and stomach as well as their respective liver metastases differ from each other by the expression profile of the three genes CD302, PPWD1 and ABHB14B. The gene and protein expression of CD302, PPWD1, and ABHB14B was studied in abdominal NET metastases to identify the site of the respective primary tumors. Cryopreserved tissue from NET metastases collected in different institutions (group A: 29, group B: 50, group C: 132 specimens) were examined by comparative genomic hybridization (Agilent 105 K), gene expression analysis (Agilent 44 K) (groups A and B) and immunohistochemistry (group C). The data were blindly evaluated, i.e. without knowing the site of the primary. Gene expression analysis correctly revealed the primary in the ileum in 94 % of the cases of group A and in 58 % of group B. A pancreatic primary was predicted in 83 % (group A) and 20 % (group B), respectively. The combined sensitivity of group A and B was 75 % for ileal NETs and 38 % for pancreatic NETs. Immunohistochemical analysis of group C revealed an overall sensitivity of 80 %. Gene and protein expression analysis of CD302 and PPWD1 in NET metastases correctly identifies the primary in the pancreas or the ileum in 80 % of the cases, provided that the tissue is well preserved. Immunohistochemical profiling revealed CD302 as the best marker for ileal and PPWD1 for pancreatic detection.
Asunto(s)
Glándulas Endocrinas/patología , Metástasis de la Neoplasia , Neoplasias/patología , Femenino , Perfilación de la Expresión Génica , Humanos , Masculino , Neoplasias/genéticaRESUMEN
Neuroendocrine neoplasms (NEN) are rare malignancies with a wide spectrum of metastatic potential which originate from the endocrine cells of the body and express somatostatin receptors. The (68)gallium somatostatin receptor positron emission tomography-computed tomography (PET/CT) technique is the most sensitive method of assessment of well-differentiated NENs and for the detection of cancer of unknown primary (CUP syndrome) NENs. Imaging with 18F-fluorodeoxyglucose (18F-FDG PET/CT) is indicated in poorly differentiated neuroendocrine carcinomas. The receptor-dependent imaging of NENs has a decisive impact on further management.
Asunto(s)
Imagen Molecular/métodos , Imagen Multimodal/métodos , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/cirugía , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Fluorodesoxiglucosa F18 , Radioisótopos de Galio , Regulación Neoplásica de la Expresión Génica/genética , Humanos , Neoplasias Primarias Desconocidas/diagnóstico , Neoplasias Primarias Desconocidas/genética , Neoplasias Primarias Desconocidas/patología , Neoplasias Primarias Desconocidas/cirugía , Tumores Neuroendocrinos/genética , Tumores Neuroendocrinos/patología , Receptores de Somatostatina , Sensibilidad y Especificidad , SomatostatinaRESUMEN
Diffuse localised neuroendocrinal cells represent the largest population of endocrinally active cells and can degenerate to malignant neuroendocrine tumours (NET). In this review the most important hereditary syndromes that predispose for endocrine and neuroendocrine tumours are presented and discussed. NET occur mainly as sporadic tumours. Current investigations on the pathogenesis of sporadic neuroendocrine tumours have revealed a close relationship between hereditary and sporadic neuroendocrine tumours. In the course of hereditary syndromes, such as multiple endocrine neoplasia, endocrine and neuroendocrine tumours as well as non-endocrine neoplasias can occur. In order to recognise these syndromes in good time a knowledge of the predisposing syndromes and their cardinal symptoms is essential. In this way not only individualised diagnosis and therapy can be planned but also an appropriate early management of first degree relatives can be initiated.
Asunto(s)
Neoplasias Gastrointestinales/genética , Neoplasias Gastrointestinales/cirugía , Tumores Neuroendocrinos/genética , Tumores Neuroendocrinos/cirugía , Diagnóstico Diferencial , Neoplasias Gastrointestinales/diagnóstico , Humanos , Tumores Neuroendocrinos/diagnóstico , SíndromeRESUMEN
Pancreatic neuroendocrine tumors originate from the diffuse neuroendocrine system in the pancreatic region. These tumors exhibit a rising incidence despite their rareness and due to their benign behavior a considerable prevalence. Pathogenesis of pancreatic neuroendocrine tumors is characterized by common pathways of hereditary and sporadic tumors. Pancreatic neuroendocrine tumors may secrete peptide hormones or biogenic amines in an autonomous fashion as functional active tumors. Pathological grading and staging by TNM systems has been established in recent years classifying well and moderately differentiated pancreatice neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas. Chromogranin A and less so pancreatic polypeptide are suitable tumor markers for pancreatic neuroendocrine tumors. Expression of receptors for somatostatin is the basis of treatment of pancreatic neuroendocrine tumors with somatostatin analogues as antisecretive and antiproliferative agents. In addition, somatostatin scintigraphy or PET/CT allows comprehensive diagnosis of pancreatic neuroendocrine tumors, which should be supported by (endoscopic and contrast enhanced) ultrasound, CT and MRI. Therapy of pancreatic neuroendocrine tumors consists of somatostatin analogues, chemotherapy, targeted therapy and peptide receptor radionuclide therapy. Two molecular substances hav been registered for pancreatic neuroendocrine tumors recently, sunitinib (Sutent®) and everolimus (Afinitor®). Predominant tumor load in the liver may be treated by local ablative therapy or liver transplantation. These treatment options have been included in guidelines of several professional societies and weighted for sequential therapy of patients with pancreatic neuroendocrine tumors according to effects and side effects.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/tratamiento farmacológico , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/tratamiento farmacológico , Biomarcadores/sangre , Cromogranina A/sangre , Endosonografía , Everolimus , Alemania/epidemiología , Hepatectomía , Humanos , Incidencia , Indoles/administración & dosificación , Trasplante de Hígado , Imagen por Resonancia Magnética , Imagen Multimodal , Clasificación del Tumor , Estadificación de Neoplasias , Tumores Neuroendocrinos/sangre , Tumores Neuroendocrinos/epidemiología , Neoplasias Pancreáticas/sangre , Neoplasias Pancreáticas/epidemiología , Tomografía de Emisión de Positrones , Prevalencia , Pronóstico , Pirroles/administración & dosificación , Sirolimus/administración & dosificación , Sirolimus/análogos & derivados , Somatostatina/análogos & derivados , Sunitinib , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Osteopenia and osteoporosis are diseases frequently occurring after liver transplantation (OLT). PURPOSE: In a prospective study, we have investigated the effect of ibandronate, vitamin D(3), and calcium on the prevention and treatment of posttransplant osteopenia and osteoporosis. METHODS: The bone mineral density (BMD) of the lumbar spine (LS) and of the femoral neck (FN) were measured in 74 patients prospectively pre- and post-OLT. RESULTS: Postoperatively the study group showed a consistent percentage increase in BMD (g/cm(2)) and a significantly increased BMD after 12 and 24 months in the LS (12 months: 1.05 ± 0.21 g/cm(2); P < .001 24 months: 1.11 ± 0.19 g/cm(2); P < .001) and the FN (12 months: 0.88 ± 0.16 g/cm(2); P < .002 24 months: 0.90 ± 0.15 g/cm(2); P < .001) in comparison with baseline pre-OLT (LS pre-OLT 0.98 ± 0.19 g/cm(2), FN 0.86 ± 0.14 g/cm(2)). The overall bone fracture rate was 5.4% up to 24 months. CONCLUSION: Ibandronate once monthly per os significantly increased the BMD in the LS and FN after OLT at 12 and 24 months. The increased BMD limits the risk of fracture.
Asunto(s)
Conservadores de la Densidad Ósea/administración & dosificación , Enfermedades Óseas Metabólicas/prevención & control , Difosfonatos/administración & dosificación , Fracturas Óseas/prevención & control , Trasplante de Hígado/efectos adversos , Osteoporosis/prevención & control , Absorciometría de Fotón , Administración Oral , Fosfatasa Alcalina/sangre , Aminoácidos/orina , Biomarcadores/sangre , Biomarcadores/orina , Densidad Ósea/efectos de los fármacos , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Enfermedades Óseas Metabólicas/etiología , Enfermedades Óseas Metabólicas/metabolismo , Calcio/administración & dosificación , Distribución de Chi-Cuadrado , Colecalciferol/administración & dosificación , Creatinina/orina , Suplementos Dietéticos , Esquema de Medicación , Cuello Femoral/diagnóstico por imagen , Cuello Femoral/efectos de los fármacos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/etiología , Fracturas Óseas/metabolismo , Alemania , Humanos , Ácido Ibandrónico , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/efectos de los fármacos , Osteoporosis/diagnóstico por imagen , Osteoporosis/etiología , Osteoporosis/metabolismo , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Neuroendocrine tumors are heterogeneous in their clinical behavior and require therapies specially tailored according to staging and grading, origin and expression of peptide receptors. Somatostatin analogues act as antisecretory and antiproliferative agents. Chemotherapy is mandatory for poorly differentiated neuroendocrine carcinomas and is also effective in neuroendocrine tumors of the pancreas and of the bronchial system. For localized neuroendocrine tumors, surgery should be performed with curative intent and is also an option in advanced or metastasized neuroendocrine tumors with the goal to debulk tumor masses. Local ablative therapies may be applied to decrease tumor load in the liver; however, results are often of short duration. Peptide receptor radiotherapy is a new treatment method applying radionuclide-targeted somatostatin receptor agonists for internal cytotoxic radiotherapy in somatostatin receptor-expressing neuroendocrine tumors. Retrospective and prospective clinical studies indicate prolonged progression-free survival and overall survival of patients responding by stable disease or any kind of remission with this innovative treatment, which is, however, available only in a few specialized centers. Finally, small-molecule inhibitors of vascular endothelial growth factor and serine/threonine-protein kinase mTOR pathways have been shown to delay progression in patients with neuroendocrine tumors. In summary, treatment options for neuroendocrine tumors have expanded considerably in the last years leading to prolonged overall survival.
Asunto(s)
Tumores Neuroendocrinos/terapia , Humanos , Estadificación de Neoplasias , Tumores Neuroendocrinos/mortalidad , Tumores Neuroendocrinos/patología , Serina-Treonina Quinasas TOR/antagonistas & inhibidores , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
Benign symmetric lipomatosis, also known as Madelung's disease or Launois-Bensaude syndrome, is a rare disease, the etiology of which is still unknown. The presence of multiple, symmetric, nonencapsulated lipomatous masses in the face, neck, upper arms and upper trunk is typical. Until now many causes have been discussed among which liver dysfunctions are described frequently. In up to 90% of patients, alcoholism is observed. In our case the Launois-Bensaude syndrome developed after liver transplantation in a 49-year-old female patient suffering from decompensated cirrhosis (Child-Pugh C score: 12 points). Shortly after the transplantation a slow progress in tissue-building appeared on both upper arms, cervical areas as well as in the face. During postsurgical prednisolone therapy, a massive increase in fluid in the tissue developed, which led to a discontinuation of this therapy regimen. In the further course there was an increase in weight of 20 kg. As far as we know, this case is the first description of the induction of a Launois-Bensaude syndrome following liver transplantation.
Asunto(s)
Lipomatosis Simétrica Múltiple/etiología , Trasplante de Hígado/efectos adversos , Alcoholismo/complicaciones , Femenino , Glucocorticoides/efectos adversos , Glucocorticoides/uso terapéutico , Humanos , Lipomatosis Simétrica Múltiple/patología , Persona de Mediana Edad , Prednisolona/efectos adversos , Prednisolona/uso terapéuticoRESUMEN
Primary sarcoms of the liver are rare. Most often angiosarcomas have been reported. Primary liposarcoma of the liver is extremely rare. We report a case of primary liposarcoma of the liver in a 48-year-old woman and compare it with the 13 cases found in the literature. Histologic analysis showed a well differentiated liposarcoma. The treatment of choice is wide local tumor resection.
Asunto(s)
Liposarcoma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Núcleo Celular/patología , Diagnóstico Diferencial , Femenino , Hepatectomía , Humanos , Liposarcoma/patología , Liposarcoma/cirugía , Hígado/patología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Imagen por Resonancia Magnética , Persona de Mediana EdadRESUMEN
BACKGROUND: The aim of this study was to analyze the influence of cyclosporine A (CsA) taper in conjunction with mycophenolate mofetil (MMF) therapy on recurrent hepatitis C virus (HCV) in liver transplant patients. PATIENTS AND METHODS: Nineteen liver recipients with serologically and morphologically confirmed recurrent HCV were included in this study. After MMF introduction up to a maximum dose of 2000 mg/day, CsA dose was significantly tapered. In the control group immunosuppression remained unchanged. Allograft function and morphology, viral loads, and renal function were analyzed continuously. RESULTS: MMF treatment was well tolerated without risk of rejection. Allograft fibrosis progressed in 6 patients of the MMF group (66.6%) and none (0%) of the controls at 12-month biopsy (P=0.005). Moreover, aminotransferases and viral loads increased slightly in the MMF-treated patients. Renal function improved significantly (serum creatinine: 239.3+/-90.2 micromol/L vs. 175.8+/-46.0 micromol/L; P=0.008) in the treatment group, while deteriorating (serum creatinine: 156.8+/-44.6 micromol/L vs. 214.8+/-120.1 micromol/L; P=0.06) in the controls. CONCLUSION: MMF introduction allows a safe CsA taper in HCV-positive liver transplant patients and results in significant improvement of renal function. However, there seems to be a risk of marked progression of HCV-induced allograft injury.
Asunto(s)
Antiinflamatorios no Esteroideos , Hepacivirus/efectos de los fármacos , Hepatitis C/tratamiento farmacológico , Trasplante de Hígado/efectos adversos , Ácido Micofenólico/análogos & derivados , Adulto , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Ciclosporina/administración & dosificación , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Hepacivirus/fisiología , Hepatitis C/virología , Humanos , Inmunosupresores , Pruebas de Función Renal , Persona de Mediana Edad , Ácido Micofenólico/administración & dosificación , Ácido Micofenólico/uso terapéutico , Recurrencia , Resultado del TratamientoRESUMEN
INTRODUCTION: As a result of preexisting chronic liver disease and immunosuppression, the majority of liver transplant patients develop bone mineral density (BMD) loss in the first 3 to 6 months posttransplantation, leading to an increased fracture risk. Using basic prophylaxis and treatment by administration of vitamin D, calcium, and bisphosphonates, BMD loss may be controlled in the long term. In contrast, there is no established medical concept for prevention of early posttransplant BMD loss. MATERIAL AND METHODS: The aim of this trial was to evaluate the effect of prostaglandin E1 on BMD after liver transplantation. Between 1998 and 2004, 29 patients were enrolled in this study. BMD measurement was performed at lumbar spine and femoral neck using dual energy x-ray absorptometry pretransplant, and 3, 6, 12, and 24 months posttransplant. All patients received calcium and vitamin D as basic prophylaxis. In 13 patients, prostaglandin E1 (PGE) was additionally administered for 12 days posttransplant. RESULTS: BMD loss was significantly lower at 3 and 6 months posttransplant in the PGE group (lumbar spine, P < .03; femoral neck, P < .009). Development of BMD loss was comparable between both groups during further follow-up. In the PGE group there was a significantly lower fracture rate compared with the controls (P < .02). CONCLUSION: The application of PGE 1 proved to be beneficial in compensating the early posttransplant BMD loss and in subsequently reducing fracture rate. These positive effects of PGE 1 could be demonstrated in both the femoral neck and lumbar spine.
Asunto(s)
Alprostadil/uso terapéutico , Densidad Ósea/efectos de los fármacos , Trasplante de Hígado/fisiología , Osteoporosis/prevención & control , Inhibidores de Agregación Plaquetaria/uso terapéutico , Femenino , Fémur , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & controlRESUMEN
The aim of this study was to evaluate the impact of mycophenolate mofetil (MMF) on incidence, delay, severity and clinical course of early recurrent hepatitis C after liver transplantation (LT). A total of 21 hepatitis C virus (HCV)-positive patients after LT were prospectively enrolled in this study. All of them received a quadruple induction cyclosporine A (CsA)-based immunosuppression, augmented by MMF (n=12) or by azathioprine (n=9, AZA). MMF tended to delay recurrent disease (50+/-35 versus 35+/-35 weeks, P=0.5) with significantly lower levels of aminotransferases (P<0.05). Furthermore, patients under MMF revealed less severe allograft fibrosis at disease recurrence (stage of fibrosis: 1.5+/-0.5 versus 2.2+/-1.2; P=0.07). But stage of fibrosis significantly increased in the MMF-group (P<0.05) during 6 months of antiviral treatment. Three patients in the MMF-group and none of the controls suffered from severe fibrosing cholestatic recurrent hepatitis C. Initial post-LT administration of MMF tended to delay recurrent hepatitis C and to limit initial HCV-related biochemical and morphological graft dysfunction. But during clinical follow-up, its immunosuppressive capabilities exceeded possible antiviral properties, finally leading to significant progression of graft fibrosis. Thus, concomitant dose reduction of other basic immunosuppressants might be useful in this clinical setting.
Asunto(s)
Hepatitis C/prevención & control , Inmunosupresores/uso terapéutico , Trasplante de Hígado , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Adulto , Azatioprina/uso terapéutico , Ciclosporina/uso terapéutico , Femenino , Fibrosis/complicaciones , Rechazo de Injerto , Hepatitis C/complicaciones , Hepatitis C/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND/AIMS: In several clinical trials, the prophylactic application of prostaglandin E1 did not demonstrate a significant effect on incidence of primary graft nonfunction after liver transplantation. The aim of this study was to evaluate the effect of a selective prostaglandin E1 treatment in liver transplant patients with initially compromised perfusion and thereby depressed early posttransplant graft function. METHODOLOGY: A total of 142 patients were enrolled in this study. In all of them, duplexsonography was performed daily to generally assess patency of allograft vessels and to specifically calculate the resistive index of the hepatic artery. Intravenous therapy with a prostaglandin E1 analogue (Alprostadil, 0.5 microg/kg/h) was initiated in 67 patients after determination of a primarily elevated (>0.75) and posttransplant increasing resistive index of the hepatic artery that was associated with continuously elevating aminotransferases. RESULTS: After initiation of treatment, the arterial resistive index decreased significantly from 0.83+/-0.1 to 0.72+/-0.1 on the first day of application (P<0.05). Primarily elevated serum levels of aspartate aminotransferase (AST: Alprostadil: 890+/-180 IU/L: CONTROL: 375+/-98 IU/L) and alanine aminotransferase (ALT: Alprostadil: 850+/-178 IU/L, CONTROL: 310+/-79 IU/L) decreased significantly and reached values comparable to the control group after three days of therapy (AST: Alprostadil: 190+/-40 IU/L, CONTROL: 150+/-45 IU/L ALT: Alprostadil: 280+/-57 IU/L, CONTROL: 180+/-50 IU/L) (P<0.05). Only 2 grafts with initial compromised perfusion and function (3%) developed primary graft nonfunction. CONCLUSIONS: Prostaglandin E1 seems to be effective in ameliorating ischemia-reperfusion injury to the liver in patients with elevated arterial vascular resistance and early depressed graft function after liver transplantation. Duplexsonography in combination with graft function are useful tools for indicating and monitoring treatment.
Asunto(s)
Alprostadil/uso terapéutico , Trasplante de Hígado/fisiología , Daño por Reperfusión/prevención & control , Vasodilatadores/uso terapéutico , Adulto , Alanina Transaminasa/sangre , Femenino , Glutamato Deshidrogenasa/análisis , Arteria Hepática/fisiopatología , Humanos , Tiempo de Internación , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Daño por Reperfusión/fisiopatología , Ultrasonografía Doppler Dúplex , Resistencia VascularRESUMEN
We report on a 25-year old ASA physical status I patient, who developed within 20 minutes a full-blown malignant hyperthermia (MH) in the context of a living donor liver transplantation after 180 minutes of uneventful anaesthesia. The only trigger substance applied was Sevoflurane. The patient had already received a short, uneventful anaesthesia with Isoflurane a couple of years ago. In the context of the special constellation an initial dose of Dantrolene of 10 mg/kg body weight was administered. The patient was stabilised within 30 minutes, and the enzyme levels remained low compared with other case reports. The post-operative in vitro caffeine halothane contracture testing confirmed that son and mother were susceptible to MH, contracture testing in the father was negative. All known triggers may cause life-threatening MH crisis - even after hours and after inconspicuous multiple exposures to known trigger substances. Therefore all trigger substances must be avoided in all patients susceptible to MH.
Asunto(s)
Anestesia por Inhalación/efectos adversos , Anestésicos por Inhalación/efectos adversos , Trasplante de Hígado/efectos adversos , Donadores Vivos , Hipertermia Maligna/etiología , Éteres Metílicos/efectos adversos , Adulto , Análisis de los Gases de la Sangre , Cafeína , Estimulantes del Sistema Nervioso Central , Halotano , Humanos , Masculino , Hipertermia Maligna/fisiopatología , SevofluranoRESUMEN
INTRODUCTION: For surgeons the acute intestinal ischaemia is still a diagnostic and therapeutic challenge. If clinically suspected, the diagnostic procedures such as duplex sonography and arterial angiography should be carried out immediately. Although the diagnosis is often quickly clear, perioperative mortality rate remains high. We report the acute local thrombolytic therapy as an alternative treatment. CASE REPORT: A 80-year-old male patient was referred to our hospital with a complete occlusion of the superior mesenteric artery. Duplex sonography and the arterial angiogram confirmed the clinical diagnosis. Because the patient was assessed to be at high risk we decided to avoid an operation and local thrombolytic therapy using rt-PA and urokinase was carried out. RESULT: The local thrombolytic therapy was successful and led to a complete restoration of the arterial flow within the superior mesenteric artery. The clinical symptoms subsided and no complications were observed. CONCLUSION: Local thrombolytic therapy appears to be a suitable therapeutic option in patients suffering of mesenteric arterial occlusion. Although the duplex sonography often confirms the diagnosis with high accuracy the angiography remains the diagnostic gold standard.
Asunto(s)
Arteria Mesentérica Superior , Oclusión Vascular Mesentérica/tratamiento farmacológico , Terapia Trombolítica , Trombosis/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Angiografía , Humanos , Intestinos/irrigación sanguínea , Isquemia/diagnóstico , Isquemia/tratamiento farmacológico , Masculino , Oclusión Vascular Mesentérica/diagnóstico , Trombosis/diagnóstico , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéuticoAsunto(s)
Antivirales/uso terapéutico , Hepatitis C/tratamiento farmacológico , Hepatitis C/epidemiología , Interferón-alfa/uso terapéutico , Trasplante de Hígado/fisiología , Ribavirina/uso terapéutico , Alanina Transaminasa/sangre , Antivirales/efectos adversos , Aspartato Aminotransferasas/sangre , Quimioterapia Combinada , Estudios de Seguimiento , Hepatitis C/cirugía , Humanos , Interferón alfa-2 , Interferón-alfa/efectos adversos , Leucopenia/inducido químicamente , Pruebas de Función Hepática , Trasplante de Hígado/inmunología , Trasplante de Hígado/patología , Proteínas Recombinantes , Recurrencia , Ribavirina/efectos adversos , Factores de TiempoAsunto(s)
Antiprotozoarios/uso terapéutico , Trasplante de Riñón , Trasplante de Hígado , Trasplante de Páncreas , Complicaciones Posoperatorias/parasitología , Toxoplasmosis Cerebral/diagnóstico , Adulto , Anciano , Encéfalo/parasitología , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/parasitología , Toxoplasmosis Cerebral/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Densidad Ósea , Resorción Ósea/prevención & control , Difosfonatos/uso terapéutico , Trasplante de Hígado/efectos adversos , Osteoporosis/etiología , Calcio/uso terapéutico , Fémur/patología , Humanos , Ácido Ibandrónico , Vértebras Lumbares/patología , Osteoporosis/prevención & control , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Vitamina D/uso terapéuticoRESUMEN
Molecular Adsorbent Recirculating System (MARS) is a blood-filtering system designed to provide biological artificial liver support. We describe its use in a small child to illustrate its effectiveness and practicality in this age group. A 15-month-old male underwent split liver transplantation for acute liver failure following bone marrow transplantation. After development of graft dysfunction we instituted MARS-dialysis. MARS therapy led to a dramatic fall in serum bilirubin and transaminases. Liver synthetic function was not affected. This was accompanied by a stabilization of the patients clinical condition until repeat split liver transplantation was performed 2 weeks after the first graft. MARS-dialysis is practical in the small child. In this case, it did not provide definitive treatment but was an excellent bridging therapy before retransplantation.