ABSTRACT
INTRODUCTION: Variceal hemorrhage from sinistral portal hypertension has never been reported as a complication of live pancreas donation. CASE REPORT: We present a 68-year-old patient who underwent a simultaneous live-donor laparoscopic segmental pancreatectomy and nephrectomy for the purposes of donating to her daughter. Her postoperative course was significant for an episode of acute pancreatitis with a pseudocyst formation. More than a decade later, she presented with variceal hemorrhage from sinistral portal hypertension, which after a diagnostic work-up, prompted a laparoscopic splenectomy. DISCUSSION: Sinistral portal hypertension is a long-term complication of live-donor pancreas donation.
Subject(s)
Esophageal and Gastric Varices/etiology , Gastrointestinal Hemorrhage/etiology , Hypertension, Portal/etiology , Pancreas Transplantation , Pancreatectomy/adverse effects , Postoperative Complications/etiology , Tissue and Organ Harvesting/adverse effects , Aged , Esophageal and Gastric Varices/surgery , Female , Gastrointestinal Hemorrhage/surgery , Humans , Hypertension, Portal/surgery , Pancreas/surgery , Pancreatitis/etiology , Postoperative Complications/surgery , Splenectomy/methods , Tissue and Organ Harvesting/methodsABSTRACT
Orthotopic liver transplantation (OLT) is a life-saving procedure for patients with end-stage liver disease. Transfusion support is an important part of OLT. Intraoperative transfusion of large volumes of blood products is recognized to be a poor prognostic factor, probably due to the negative effects of blood transfusions, such as transfusion reactions, infectious contamination of blood products, or immune modulation of the transfused patient. The aim of this study was to evaluate the frequency of alloimmunization and its specificity to red blood cell (RBC) antigens among patients undergoing OLT. We identified 74 RBC alloantibodies in 70 (23%) patients when the indirect antiglobulin test (IAT) was performed. The most common RBC alloantibodies were against Rh system antigens. The majority (41.9%) were directed against the E antigen. Despite the ethnic heterogeneity of our population there were no cases of intravascular hemolysis. The incidence of alloimmunization (23%) was slightly higher among patients than in the literature, most probably as a consequence of our ethnic heterogeneity.
Subject(s)
Erythrocyte Transfusion , Isoantibodies/blood , Liver Transplantation/immunology , ABO Blood-Group System , Coombs Test , Erythrocyte Transfusion/adverse effects , Hemolysis , Histocompatibility Testing , Humans , Immunization/methods , Immunoglobulins/blood , Intraoperative Period , Isoantigens/immunology , Liver Failure/surgery , Liver Transplantation/mortality , Retrospective Studies , Survival Analysis , Time FactorsABSTRACT
The early demonstration of lung involvement in systemic lupus erythematosus (SLE) patients is a difficult but important task. In the present study we attempted to identify abnormalities in pulmonary clearance of 99mTc-DTPA in SLE, correlating their clearance data with clinical findings and disease activity. Forty-six consecutive SLE patients with and without active disease (LACC score) and 30 normal volunteers were studied. All subjects were submitted to pulmonary scintigraphy with 99mTc-DTPA to evaluate the pulmonary clearance, and to a chest X-ray, and SLE patients were submitted to tests of disease activity, spirometry, arterial blood gases and tests to assess acute-phase proteins. Pulmonary clearance was faster in SLE patients with active disease when compared to normal controls [half-life of 67.04 min (51.52-82.55 min) in active SLE versus 85.87 min (78.85-92.87 min) in controls, P<0.05] and there was a higher frequency of abnormal clearance rates in patients with active disease (11 of 26 patients, 42.3%) when compared with SLE patients without disease activity (2 of 20 patients, 10%) (P = 0.04). A significant correlation was observed between the clearance rates and cough (P<0.05), but not between the clearance rates and dyspnea symptoms or radiological findings, duration of SLE disease, antinuclear antibody titers and patterns, C-reactive protein or anti-double stranded DNA antibodies. We conclude that the pulmonary clearance of 99mTc-DTPA is increased in SLE patients with active disease.
Subject(s)
Lung/metabolism , Lupus Erythematosus, Systemic/metabolism , Technetium Tc 99m Pentetate/pharmacokinetics , Adolescent , Adult , Case-Control Studies , Female , Humans , Male , Metabolic Clearance Rate , Respiratory Function TestsABSTRACT
The early demonstration of lung involvement in systemic lupus erythematosus (SLE) patients is a difficult but important task. In the present study we attempted to identify abnormalities in pulmonary clearance of 99mTc-DTPA in SLE, correlating their clearance data with clinical findings and disease activity. Forty-six consecutive SLE patients with and without active disease (LACC score) and 30 normal volunteers were studied. All subjects were submitted to pulmonary scintigraphy with 99mTc-DTPA to evaluate the pulmonary clearance, and to a chest X-ray, and SLE patients were submitted to tests of disease activity, spirometry, arterial blood gases and tests to assess acute-phase proteins. Pulmonary clearance was faster in SLE patients with active disease when compared to normal controls [half-life of 67.04 min (51.52-82.55 min) in active SLE versus 85.87 min (78.85-92.87 min) in controls, P<0.05] and there was a higher frequency of abnormal clearance rates in patients with active disease (11 of 26 patients, 42.3 percent) when compared with SLE patients without disease activity (2 of 20 patients, 10 percent) (P = 0.04). A significant correlation was observed between the clearance rates and cough (P<0.05), but not between the clearance rates and dyspnea symptoms or radiological findings, duration of SLE disease, antinuclear antibody titers and patterns, C-reactive protein or anti-double stranded DNA antibodies. We conclude that the pulmonary clearance of 99mTc-DTPA is increased in SLE patients with active disease