Hemodynamic assessment during auxiliary heterotopic liver transplantation with portal vein arterialization in a Swine model: preliminary report of 10 transplants.

UNLABELLED: Portal vein arterialization (PVA) is a technical variation of auxiliary heterotopic liver transplantation (AHLT) that is rarely studied but that simplifies the AHLT surgical technique because it does not act on the portal area. The objective of this study was to analyze the hemodynamic consequences of this auxiliary transplant in an experimental model. MATERIALS AND METHODS: Ten AHLT-PVA were analyzed in a pig model. A PiCCO (Pulsion) monitor was used for the hemodynamic study of the recipient. The following were measured: cardiac index, (CI), systemic vascular resistance index, (SVRI), mean arterial pressure (MAP), global end-diastolic volume, central venous pressure, and intrathoracic blood volume. The measurements were taken at four times during transplant: at baseline, after inferior vena cava clamping, after graft reperfusion, and at closure. RESULTS: After graft reperfusion there was a reduction in SVRI (968 +/- 168.03 vs 1686.25 +/- 290.66; P < .05) and in MAP, and there was an increase in CI. At the end of the transplant MAP and SVRI recovered (1254.2 +/- 225.79 vs 968 +/- 168.03; P < .05) but CI remained slightly high. The end-diastolic volume showed greater variation than central venous pressure, although this was only statistically significant at the inferior vena cava clamping phase (244.75 +/- 52.05 vs 333.37 +/- 170.13; P < .05). DISCUSSION: Heterotopic liver transplantation with portal arterialization is well-tolerated hemodynamically. Graft reperfusion decreases SVRI and increases CI to compensate for this. This behavior, which in healthy recipients like ours is not a problem, could imply a contraindication in patients with a prior hyperdynamic state.

Trasplante hepático pediátrico: indicaciones, técnicas quirúrgicas, complicaciones y tratamiento / Pediatric liver transplantation. Indications, surgical techniques, complications and treatment

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[A clinical analysis of internal or external diversion in biliary atresia]. / Análisis clínico de la derivación interna o externa en la atresia biliar.

Cholangitis has been the most common postoperative complication of Kasai's operation for biliary atresia. A host of ingenious surgical procedures have been used to prevent this complication, some including exteriorization of the bilioenteric conduit. The purpose of this report was to investigate the role of the derivation on the incidence of cholangitis, liver function and the survival of patients with biliary atresia treated with Kasai's operation. We have analyzed the clinical data of thirty-six patients with biliary atresia treated with Kasai's portoenterostomy during a seven year period (1987-1993). The patients were divided into two groups: Group I, patients treated with portoenterostomy and exteriorization of the bilioenteric conduit (n = 18) and Group II, patients treated with portoenterostomy without enterostomy. Our results suggest that the use of the exteriorization of the bilioenteric conduit was not shown to be effective in the prevention of episodes of cholangitis. The survival for both groups was not statistically significant and there was no increase in morbidity after the postoperative period or during the liver transplant.

[Surgery of lung metastasis in childhood]. / Cirugía de las metástasis pulmonares en la infancia.

From 1975 to 1987, we have operated 20 cases with lung metastases. They were 12 females and 8 males with ages between 1,6 and 12 years old (average of 5 years). The histology of the primary neoplasia was: 13 cases with Wilms' Tumors, 3 cases with Ewing's Sarcoma and 1 case with Neuroblastoma, Rhabdomiosarcoma, Hepatoblastoma and Neuroectodermic Tumor of Askin. We found 38 metastases and there were performed through a Thoracotomy 28 wedge resection, 7 pulmonary lobectomies and 3 biopsies. The operative mortality was 0%. The most frequent location of the lesion were on medium and lower lobule of the right lung. The survival was 70% (14 cases) after 4 years of average of the follow up. The survival for Wilms Tumors was 61% (8 cases) and all patients with Ewing's Sarcoma, Rhabdomiosarcoma, Neuroblastoma and Neuroectodermic Tumor of Askin were alive. The Thoracotomy is a useful method for therapy of tumors in children with lung metastases associated to chemotherapy and radiotherapy.

[Low ano-rectal malformations (author's transl)]. / Malformaciones anorrectales bajas. Tratamiento mediante técnica de "cutback". Estudio de 61 casos.

This work includes 61 cases of low anal atresias, 42 were female and 19 male. All of them were treated with "cutback" technique with a follow up longer than two years. Results are classified in good, regular and poor, depending on the continence, stenosis, mega-rectum and enchopresis, and were 90 per cent of good results, 8 per cent regular and 2 per cent poor. Authors recommend this technique as a choice proceding in this kind of low atresias.

[Hemihypertrophy and functioning adrenal tumor (author's transl)]. / Hemihipertrofia y tumor suprarrenal funcionante.

The case of a secreting adrenal tumor in a seven month old hemihypertrophic girl is described. Some features of hemihypertrophy and its relationships with the E.M.G. Syndrome and abdominal tumors are commented upon. The reported case is a typical association of malformation with tumor and recalls the close relationship between teratogenesis and oncogenesis.