Liver transplantation due to fulminant hepatic failure.

OBJECTIVES: To analyze the epidemiology, causes, complications, and mortality of liver transplants following fulminant hepatic failure over the last 16 years. MATERIALS AND METHODS: We completed a descriptive analysis of 21 patients with fulminant hepatic failure and a liver transplant. In almost half of the cases, the origin of liver failure was unknown. RESULTS: The mean age was 36 years; the study group was 47.61% female (n = 10) and 52.39% male (n = 11). The most common early complication was transplant rejection, which occurred in 33.3% of all patients (n = 7) and was confirmed by liver biopsy; the most frequent long-term complication was autoimmune hepatitis. Two retransplantations were necessary. The total mortality rate was 38.1% (n = 8) with late mortality in three patients (14.3%). CONCLUSIONS: Orthotopic liver transplantation as a treatment for fulminant hepatitis has a higher mortality rate than orthotopic liver transplantation due to other causes. It does, however, enable the survival of 62% of the patients who otherwise would have died due to liver failure. The etiology of most of the cases was unknown. We should point out the high incidence rates for transplant rejection and late autoimmune hepatitis, in addition to the possibility of hemorrhagic colonic diseases that may be associated with the condition causing liver failure. Multidisciplinary control over the patient is useful for deciding at which time a liver transplant would become the only treatment option.

Implantación de catéteres de diálisis peritoneal: Nuestra experiencia a corto y largo plazo / No disponible

Introducción: Experiencia a corto y a largo plazo en la implantación de catéteres de diálisis peritoneal y objetivos establecidos para instaurar la técnica en régimen de cirugía mayor ambulatoria(CMA).Material y métodos: Estudio retrospectivo durante ocho años. Dos grupos: catéteres tipo Tenckhoff con dos cuff y catéteres tipo Tenckhoff con dos cuff y un lastre final. Peculiaridad quirúrgica: introducción del catéter en una solución antibiótica. Las complicaciones se han dividido en corto y largo plazo en función de que aparecieran o no en la primera semana de implantación. Resultados: Causa más frecuente conocida de insuficiencia renal crónica: diabetes mellitus (9,8%). En el 33,1% (41 catéteres)no hubo ninguna complicación, y destacan el dolor a corto plazo(8,9%) y la peritonitis a largo plazo (8,1%). El 78,4% de los inicialmente implantados no precisaron ser recambiados. Conclusiones: La colocación del catéter peritoneal debe ser realizada en quirófano. La diálisis peritoneal es una técnica segura, eficaz y simple tanto para el cirujano como para el paciente. Presenta escasas complicaciones, fundamentalmente dolor y peritonitis. El catéter se recambia cuando funciona mal o fuga. No existen en la literatura estudios que reflejen la introducción del catéter en una solución antibiótica previo a su colocación. Puede implantarse en régimen de CMA (AU)

Introduction: Our short and long term experience in the implantation of peritoneal catheters is exposed in this study and whether the aims established for ambulatory surgery are fulfilled. Material and methods: An eight year retrospective study. Two groups: catheters type Tenckhoff with two cuffs and catheters type Tenckhoff with two cuffs and a ballast on the end. Surgical peculiarity: the introduction of the catheter in an antibiotic solution. The complications were divided in short and long term depending on when they appeared during the first week of implantation or not. Results: The most frequent reason for chronic renal insufficiency was: diabetes mellitus (9.8%). In 33.1% of cases (41catheters) there were no complications, and only pain on the short-term (8.9%) and peritonitis on the long-term (8.1%).78.43% of the initially implanted catheters did not need to be replaced. Conclusions: The placement of the peritoneal catheter must be done in the operating room.Peritoneal dialysis is a sure, effective and simple technique for the surgeon and for the patient. It presents few complications,mainly pain and peritonitis. The catheter is replaced when it works badly or leaks. There are no studies in the literature that reflectthe introduction of the catheter in an antibiotic solution before its placement. It can be implanted as an AS procedure (AU)

Diagnóstico y tratamiento de complicaciones biliares tras traumatismo hepático / No disponible

No disponible