Utility of Oral Anticoagulants as Prophylaxis of Recurrent Portal Thrombosis after Liver Transplantation.

INTRODUCTION: Portal vein thrombosis (PVT) is a relatively common finding in patients undergoing liver transplantation. Although the recommendation to prevent its recurrence is anticoagulation for a duration of 3 to 6 months, this is controversial. AIM: The aim of our study was to determine the efficacy of oral anticoagulants (OAC) as prophylaxis for recurrent PVT after liver transplantation. MATERIALS AND METHODS: Our study included 215 liver transplant patients who underwent surgery in our center from January 2012 to August 2017. We selected all patients diagnosed with PVT either pre-transplantation (using Doppler echography or Angio-CT) or during transplant surgery. All patients with PVT were initially anticoagulated with low-molecular-weight heparin in the postoperative period; at discharge they received OAC for a duration of six months. Control Doppler ultrasound was performed at 3, 6, and 12 months post-transplantation. RESULTS: PVT was identified in 37 out of 215 patients (17.2%). PVT was diagnosed with a pre-transplant vascular study in 17 out of 37 cases (45.9%). All patients were anticoagulated with OAC (warfarin) for at least 6 months. There were no cases of recurrent thrombosis and no complications associated with anticoagulant treatment throughout the follow-up period. CONCLUSIONS: The prevalence of portal thrombosis in liver transplant patients in our study was fairly high, at 17.2%. PVT was identified in nearly 50% of patients using high-quality vascular studies prior to transplant surgery. Anticoagulation with OAC for 6 months was effective in preventing a recurrence of thrombosis and there were no associated complications.

Repercusión de la resonancia magnética nuclear mamaria en el tratamiento final del cáncer de mama / Impact of breast magnetic resonance imaging on the final treatment of breast cancer

Objetivo: Conocer la capacidad de la resonancia magnética nuclear mamaria preoperatoria para valorar su influencia en el tratamiento final del cáncer de mama. Material y métodos: Incluimos a las pacientes diagnosticadas de carcinoma de mama infiltrante o carcinoma ductal in situ en el Hospital Nuestra Señora de Gracia de Zaragoza entre enero de 2010 y diciembre de 2013. Todas ellas tenían estudios con mamografía o ecografía y fueron operadas en el mismo centro del diagnóstico con el estudio anatomopatológico final como «prueba de oro». Resultados: En un 40% de las pacientes, la resonancia provocó un cambio del tratamiento final. En un 8% de las pacientes el cambio fue no relevante, ya que se aumentó el margen de la cirugía conservadora en 1cm como máximo. En el 32% del total de pacientes, en las que sí que consideramos que la resonancia influyó de una manera significativa en la modificación del tratamiento, el cambio más frecuentemente realizado fue de cirugía conservadora a mastectomía. Conclusiones: La resonancia nuclear magnética mamaria determina de una forma más correcta el tratamiento final del cáncer de mama con una tasa de 4,45% de falsos positivos

Objective: To determine the utility of preoperative breast magnetic resonance imaging (MRI) and its influence on the final treatment of breast cancer. Material y methods: We included patients with a diagnosis of breast cancer between January 2010 and December 2013 in Nuestra Señora de Gracia Hospital in Zaragoza (Spain). All patients had undergone mammography and/or ultrasound and underwent surgery in the centre where they received their diagnosis. The final pathological study was taken as the gold standard. Results: In 40% of patients, magnetic resonance imaging led to a change in the final treatment. In 8% of the patients, the change was not relevant, because the margin of conservative surgery was increased by 1cm or less. magnetic resonance imaging significantly influenced a change of treatment in 32% of the patients, the most frequent change being a switch from conservative surgery to a mastectomy. Conclusions: Breast magnetic resonance imaging was the most useful technique in selecting the final treatment of breast cancer with a false-positive rate of 4.45%

¿Qué prueba de imagen determina más correctamente el tamaño tumoral en el cáncer de mama? / Which imaging test determines more corectly tumor size in breast cáncer?

Objetivos: Determinar la capacidad de la RNM, la ecografía y la mamografía preoperatorias para evaluar la extensión de cáncer de mama, comparando el tamaño dado por la anatomía patológica definitiva con el tamaño estimado por la mamografía, la ecografía y la resonancia magnética. Material y Métodos: Incluimos a las pacientes con diagnóstico de carcinoma de mama infiltrante o carcinoma ductal in situ en el Hospital nuestra Señora de Gracia de Zaragoza entre enero 2010 y diciembre 2013. A todas ellas se les realizó estudios con mamografía y/o ecografía, así como RNM y fueron operadas en el mismo centro del diagnóstico con el estudio anatomopatológico final como "prueba de oro". Resultados: Utilizando el criterio de diferencias menor o igual a 5 mm con respecto al tamaño patológico final, la técnica de RNM tuvo mejor acuerdo con la anatomia patologica con un 90,90% de los tamaños correctamente estimado, en comparación con 54,30% de la mamografía y el 47,20% de la ecografía. Las infravaloraciones fueron más frecuentes en el caso de la mamografía y ecografía y las sobreestimaciones al usar la RNM mamaria. Conclusiones: La RNM de mama fue la técnica que mejor se correlacionó con el tamaño del tumor final dado por la histología. La mayor precisión de la resonancia magnética en comparación con la mamografía o ecografía en la evaluación del tamaño del tumor se produce independientemente de la densidad mamaria, la edad de las pacientes y con cualquier patrón histológico, pero existe una alta influencia en el caso de carcinoma in situ asociado

Objective: To determine the ability of preoperative breast MRI, mammography and ultrasound to evaluate the final tumor size of breast cancer, comparing the final pathological size withe the size estimated by mammography, ultrasound and MRI. Methods: We included patients diagnosed with carcinoma infiltrating breast or ductal carcinoma in situ in the Hospital "Nuestra Señora de Gracia" of Zaragoza, between January 2010 and December 2013. They all had studies with mammography and / or ultrasound and MRI and were operated on the center of diagnosis with the final pathological study as "gold standard". Results: Using the criterion of less than or equal to 5 mm difference with respect to pathologic size, the MRI technique was better agreement with the pathology with 90.90% of matched sizes, compared to 54.30% of matched sizes by mammography and ultrasound 47.20%. If no agreement, the undervaluation on mammography and ultrasound and MRI in breast overstatements were more frequent. Conclusions: The breast MRI was the technique that best correlated with final tumor size given by histology. The increased accuracy of MRI compared to mammography or ultrasound in the assessment of tumor size occurs in breasts of any kind (breast density) of patients with any age and with any histological pattern, but high in situ tumors associated

Papel de la RNM mamaria para la detencción del carcinoma ductal in situ / Role of Breast MRI to detect breast ductal carcinoma in situ

Objetivo: conocer la capacidad de la RNM mamaria preoperatoria para valorar componente in situ asociado al carcinoma infiltrante y el CDIS puro. Material y métodos: incluímos a las pacientes con diagnóstico de carcinoma de mama infiltrante o carcinoma ductal in situ en el Hospital nuestra Señora de Gracia de Zaragoza entre enero 2010 y diciembre 2013. Todas ellas tenían estudios con mamografía y/o ecografía y fueron operadas en el mismo centro del diagnóstico con el estudio anatomopatológico final como 'prueba de oro'. Resultados: la RNM determina correctamente todos los casos de carcinoma ductal in situ asociado al carcinoma infiltrante y el 93,54% de los CDIS puros Conclusiones: la RNM es la técnica de imagen que mejor determina el CDIS

Objective. To determine the ability of preoperative breast MRI to stevaluate in situ component associated to invasive carcinoma and pure CDIS. Material and methods: we included patients diagnosed with invasive breast carcinoma or ductal carcinoma in situ in the Hospital of Our Lady of Grace Zaragoza between January 2010 and December 2013. They all had studies with mammography and / or ultrasound and were operated on the center of diagnosis with the final pathological study as 'gold standard'. Results: MRI determined correctly all cases of CDIS associated to invasive carcinoma and the 93.54 % of pure DCIS Conclusions: MRI is the best imaging test to evaluate CDIS

Mastopatía diabética: lesión poco conocida que simula un cáncer de mama / Diabetic mastopathy: a little-known lesion mimicking breast carcinoma

La mastopatía diabética es una complicación poco frecuente y poco conocida de la diabetes mellitus, que puede simular un cáncer de mama. La forma más frecuente de presentación es un nódulo indoloro de consistencia pétrea y de márgenes irregulares. Los resultados de las pruebas diagnósticas de imagen son inespecíficos, siendo imprescindible para su diagnóstico el estudio anatomopatológico que pondrá de manifiesto fibrosis estromal asociada a ductitis, lobulitis y vasculitis linfocítica. Presentamos el caso de una paciente diabética tipo 1 de 33 años de evolución que consultó por un nódulo en la mama, el cual fue sometido a estudio mamográfico y ecográfico, con diagnóstico de lesión sospechosa de malignidad (BIRADS IV ). Se realizó una biopsia con aguja gruesa y el resultado anatomopatológico fue compatible con mastopatía diabética. (AU)

Diabetic mastopathy is an uncommon complication that usually occurs in patients with longstanding diabetes mellitus. This entity often presents as a palpable hard and irregular mass that mimics breast carcinoma. Imaging features are nonspecific and a histological diagnosisis required to exclude malignancy. The pathological features of diabetic mastopathy show densekeloid-like fibrosis associated with lymphocytic ductulitis, lobulitis and vasculitis. We report the case of a woman with a longstanding history of insulin-dependent diabetes mellitus and a hard, painless and irregular mass in her breast. Mammography and ultrasound examination showed a suspicious lesion (BIRADS IV). Sonographically-guided core biopsy of the mass was performed and pathological features revealed fibrosis compatible with diabetic mastopathy (AU)

Incidence of hepatic artery variations in liver transplantation: does it really influence short- and long-term results?

BACKGROUND: Some variations of hepatic artery, which show 30% incidence, must be taken into account to avoid damage to the liver transplant during harvesting, we analyzed the incidence of variations and their influence on postoperative results. PATIENTS AND METHODS: We performed a retrospective study of 325 liver transplantation between 2001 and December 2011. RESULTS: Variations in the hepatic artery were detected in 91 transplantations (32%) including 29 donors (8.9%), 57 recipients (17.5%), and 5 both (1.5%). The main variation among donors was a right hepatic artery originating from the mesenteric artery (38.2%), and a left hepatic artery from the left gastric artery (35.3%). Recipients showed the same distribution: RHA-UMA (right hepatic artery from upper mesenteric artery) (38.7%) and LHA-LGA (left hepatic artery from left gastric artery) (12.9%). 48.5% of donor hepatic variations did not need bench reconstruction, but all RHA-UMA required it mainly due to the donor gastroduodenal artery (7; 58%) We did not observe significant difference in cold or warm ischemia time, surgical time, red blood cell requirement, postoperative mortality, or overall survival when there was or was not an arterial anomaly. But arterial complications were more frequent in cases where there were recipient anomalies or both versus without anomalies or with donor anomalies (20%, 7,8%, 0%, 5,6%; P = .06). Donor RHA-UMA was associated with worse overall survival (69, 2%; P = .07) and longer cold ischemia time and red blood requirement. Bench reconstruction held to longer cold ischemia time and blood cell requirements (P = .01) and shorter overall survival (82.4%). RHA-UMA was associated (P = .08) with worse actuarial survival and a needed for bench reconstruction (P = .01). CONCLUSION: One must be careful during liver harvest to detect hepatic artery variations to avoid damage. Hepatic artery anomalies do not influence liver transplant results except for the presence of an RHA from the UMA with a need for bench reconstruction.

Transplantation for acute liver failure: report of results in the region of Castilla y Leon (Spain) after 10 years of activity.

Acute liver failure is an uncommon disease but its overall mortality rate is still high without liver transplantation, which is the treatment of choice for patients achieving certain criteria. We have reported herein the experience and retrospectively analyzed results of liver transplantation for acute liver failure since the beginning of activity of our group, which is the only one in the region of "Castilla y Leon" (Spain). In 10 years, 14 patients underwent emergency transplantation among an overall series of 325 subjects. The patients were generally young men and women; the average wait list time was 2.14 days. The most common etiology was toxic exposure (no cases were related to acetaminophen overdose), followed by viral infection (all because of acute hepatitis B). Our posttransplant outcomes were: perioperative mortality, 0%; posttransplant in-hospital mortality, 14%; and 1-y, 3-y, and 5-year survival rates of 77.1%, 64.3%, and 64.3% respectively. Retransplantation rate was 7%. A major morbidity occurred in four patients: one primary dysfunction, one hyperacute rejection due to ABO blood group-incompatibility requiring retransplantation, two arterial complications, and two biliary leakages. Our outcomes of emergency transplantation were similar to those reported by both the European and Spanish Liver Transplantation Registries, despite the small number of patients.

Eight years experience with liver transplantation in Rio Hortega hospital.

OBJECTIVES: We sought to evaluate our transplant series in light of the parameters outlined in the quality criteria established by the Spanish Hepatic Transplant Society (Sociedad Española de Trasplante Hepático [SETH]). METHODS: We retrospectively analyzed 240 hepatic transplantations performed in 223 patients from November 2001 to December 2009. RESULTS: Among the series, 57% were in Child class C, 50% had cirrhosis without hepatocellular carcinoma, and 32% had this neoplasm. The most common cause for the illness was alcohol, followed by a virus, namely hepatitis C virus in 76% of cases. The average waiting list time was 45.14 days. The total graft ischemia averaged 460 minutes (range, 265-937). The 4.1% (n = 10), incidence of an urgent retransplantation was mainly due to primary graft failure or arterial thrombosis. During the perioperative period the mortality rate was 2.5% (n = 6) and the 1-month mortality rate was 6.6% (n = 16). The raw survival rates at 1, 3, and 5 years after the operation are 85%, 78%, and 72%, respectively. CONCLUSION: Our perioperative as well as the long-term results fall within the quality standards established by SETH.

Incidence, management, and results of vascular complications after liver transplantation.

INTRODUCTION: Vascular complications show an 8%-15% incidence after liver transplantation and represent an important cause of mortality. An aggressive policy is necessary for an early diagnosis and treatment. PATIENTS AND METHODS: From 2001 to 2009, we performed 240 liver transplantations in 232 patients. We employed Doppler ultrasonography on days 1 and 4 as well as before hospital discharge and always try a radiological approach. RESULTS: The incidence of vascular complications was 7.2% (n = 18) including arterial (n = 12, 4.8%) of early thrombosis (n = 4), late thrombosis (n = 4), and stenosis (n = 4) or portal (n = 3; 1.2%) of thrombosis (n = 2) or stenosis (n = 1); or caval complications (n = 3, 1.2%). Radiologic therapy was effective in 1 patient with arterial stenosis, in the 3 patients with portal complications, and in 2 patients with caval complications. All patients with early thrombosis and 2/4 with late thrombosis required retransplantation. Surgical treatment was effective in 1 patient with late thrombosis, 3 with stenosis, and 2 with caval complications. The overall mortality rate was 16.6%; 2 patients with arterial complications and 1 with a caval complications. CONCLUSION: Vascular complications, mainly artery complications, represent serious problem after liver transplantation, which often requires retransplantation. With an aggressive policy of diagnosis and treatment, we can decrease the mortality rate from these adverse events.