Trasplante de hepatocitos / No disponible

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Fístula arterioportal: causa infrecuente de hemorragia digestiva alta en pacientes con hipertensión portal / Arterioportal fistula: An unusual cause of gastrointestinal bleeding in patients with portal hypertension

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Presentación clínica infrecuente de cistoadenoma biliar / Unusual clinical presentation of biliary cystadenoma

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[Prosthetic infection after hernioplasty. Five years experience]. / Infección de la prótesis en la reparación herniaria. Nuestra experiencia en 5 años.

INTRODUCTION: Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply. MATERIAL AND METHOD: Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation. RESULTS: The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery >180 min (p<0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem. CONCLUSIONS: Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process.

Infección de la prótesis en la reparación herniaria. Nuestra experiencia en 5 años / Prosthetic infection after hernioplasty. Five years experience

Introducción: la infección de la prótesis es una complicación infrecuente pero importante en la cirugía de la pared abdominal. El objetivo de este estudio es valorar la incidencia y los factores de riesgo influyentes en la infección de la prótesis tras la reparación herniaria, así como el tratamiento a aplicar. Material y método: entre enero de 2002 y diciembre de 2006, se realizaron en total 1.055 reparaciones protésicas herniarias: 761 hernias inguinocrurales (72,1%), 74 hernias umbilicales (7%) y 220 eventroplastias (20,9%). Se analizaron de forma prospectiva variables preoperatorias, intraoperatorias y postoperatorias, así como la incidencia de infección de herida quirúrgica y de prótesis. Se utilizó la clasificación ASA para la valoración preoperatoria anestésica. Resultados: el porcentaje de infección del biomaterial en general fue del 1,3%. Observamos infección en 11 reparaciones con prótesis de polipropileno (PPL), en 4 con PTFE-e y 1 caso en prótesis combinada. Fueron factores de riesgo en la infección del biomaterial: la obesidad (p=0,002), la diabetes mellitus (p=0,020), el tipo de reparación (p=0,047), la intervención de urgencia (p=0,001), el tipo y el tamaño de la prótesis (p=0,003 y p=0,007) y el tiempo quirúrgico >180min (p<0,001). De 11 pacientes con infección de prótesis de PPL, 7 respondieron al tratamiento con curas, mientras que todos los casos con infección de PTFE-e o prótesis mixta necesitaron de su extirpación para resolver el problema. Conclusiones: existen numerosos factores de riesgo influyentes en la tasa de infección del biomaterial. Mientras que la terapia antibiótica adecuada y el drenaje quirúrgico de la infección pueden ser suficientes en la mayoría de las infecciones de prótesis de PPL, las de PTFE-e requieren extirpación precoz para acabar con el proceso infectivo (AU)

Introduction: Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply. Material and method: Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation. Results: The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery >180min (p<0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem. Conclusions: Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process (AU)

[Liver transplant in patients with hepatocellular carcinoma]. / Trasplante hepático en pacientes con carcinoma hepatocelular.

Liver transplant in patients with cirrhosis and hepatocellular carcinoma is indicated in the early stages of the disease, which can be achieved with early detection programs using liver ultrasound. Dynamic imaging techniques (ultrasound with contrast, magnetic resonance and tomography) are essential in the diagnosis of this tumour, being able to type the lesion clearly, and, in the majority of cases, lead to the therapy to follow. Surgery is the treatment of choice in these patients, and liver transplant, from a theoretical point of view, is the best. Currently, the size and number of nodes play an important role in the indication of a transplant. The best liver transplant results are obtained in these patients using the Milan criteria, with survivals that exceed 70% and recurrence indices of 15%, at 5 years. Nowadays we have the possibility of using neo-adjuvant treatments to transplant, such as arterial chemoembolisation, percutaneous ablation techniques, and even liver resection as a bridging technique. The survival of patients transplanted due to liver cancer is similar to that obtained for other non-tumour diseases. In Spain it is 1, 3 and 5 years and 82%, 70% and 60%, respectively. The recurrence is between 6.4% and 16%, micro- and macrovascular invasion being its highest risk variable.

Trasplante hepático en pacientes con carcinoma hepatocelular / Liver transplant in patients with hepatocellular carcinoma

El trasplante hepático para sujetos con cirrosis y carcinoma hepatocelular está indicado en estadios precoces de la enfermedad, que se puede conseguir con programas de detección precoz con ecografías de hígado. Las técnicas dinámicas de imagen (ecografía con contraste, resonancia magnética y tomografía) son fundamentales en el diagnóstico de este tumor, ya que pueden tipificar claramente la lesión e inducir, en la mayor parte de los casos, el tratamiento a seguir. El tratamiento de elección en estos pacientes es la cirugía, y el trasplante hepático, desde el punto de vista teórico, es el mejor. Actualmente, el tamaño y el número de nódulos tienen un importante papel en la indicación del trasplante. Los mejores resultados del trasplante hepático en estos pacientes se obtienen siguiendo los criterios de Milán, con supervivencias que exceden el 70% e índices de recidiva del 15% a 5 años. Hoy día tenemos la posibilidad de tratamientos neoadyuvantes al trasplante, como la quimioembolización arterial, las técnicas ablativas percutáneas e incluso la resección hepática como técnica puente. La supervivencia de los pacientes trasplantados por el hepatocarcinoma es similar a la obtenida por otras enfermedades no tumorales, que en nuestro país a 1, 3 y 5 años es del 82, el 70 y el 60%, respectivamente. La recurrencia está entre el 6,4 y el 16%, y destacan las invasiones microvascular o macrovascular como variables de más alto riesgo (AU)

Liver transplant in patients with cirrhosis and hepatocellular carcinoma is indicated in the early stages of the disease, which can be achieved with early detection programs using liver ultrasound. Dynamic imaging techniques (ultrasound with contrast, magnetic resonance and tomography) are essential in the diagnosis of this tumour, being able to type the lesion clearly, and, in the majority of cases, lead to the therapy to follow. Surgery is the treatment of choice in these patients, and liver transplant, from a theoretical point of view, is the best. Currently, the size and number of nodes play an important role in the indication of a transplant. The best liver transplant results are obtained in these patients using the Milan criteria, with survivals that exceed 70% and recurrence indices of 15%, at 5 years. Nowadays we have the possibility of using neo-adjuvant treatments to transplant, such as arterial chemoembolisation, percutaneous ablation techniques, and even liver resection as a bridging technique. The survival of patients transplanted due to liver cancer is similar to that obtained for other non-tumour diseases. In Spain it is 1, 3 and 5 years and 82%, 70% and 60%, respectively. The recurrence is between 6.4% and 16%, micro- and macrovascular invasion being its highest risk variable (AU)

[Liver transplantation in patients with benign hepatic lesions]. / Trasplante hepático en pacientes con lesiones hepáticas benignas.

Benign hepatic lesions are rare and liver transplantation in these cases is exceptional. We present a review of the subject, commenting on the aspects that have been subsidiary to liver transplantation, of which are highlighted: adenomatosis, polycystosis and hepatic epithelioid haemangioendothelioma (although this process may be a low to intermediate malignant grade). We assessed specific epidemiological, aetiopathogenic, clinical, diagnostic, therapeutic and aspects of the lesions as well as indication for transplantation, and the experiences of different authors on these pathologies.

Trasplante hepático en pacientes con lesiones hepáticas benignas / Liver transplantation in patients with benign hepatic lesions

Las lesiones benignas hepáticas son enfermedades poco frecuentes y el trasplante hepático en ellas es excepcional. Presentamos una revisión del tema, con comentarios sobre las entidades subsidiarias de trasplante hepático, de las que destacan: la adenomatosis, la poliquistosis y el hemangioendotelioma epitelioide hepático (aunque este proceso sea de grados bajo a intermedio de malignidad). Valoramos aspectos específicos de estas lesiones, desde el punto de vista epidemiológico, etiopatogénico, clínico, diagnóstico, terapéutico, indicación del trasplante y experiencia de los diferentes autores en estas afecciones (AU)

Benign hepatic lesions are rare and liver transplantation in these cases is exceptional. We present a review of the subject, commenting on the aspects that have been subsidiary to liver transplantation, of which are highlighted: adenomatosis, polycystosis and hepatic epithelioid haemangioendothelioma (although this process may be a low to intermediate malignant grade). We assessed specific epidemiological, aetiopathogenic, clinical, diagnostic, therapeutic and aspects of the lesions as well as indication for transplantation, and the experiences of different authors on these pathologies (AU)

Donantes de ayer y de hoy: ¿han cambiado las características de los donantes de hígado durante los últimos 15 años? / Donors yesterday and today: have the characteristics of liver donors changed over the last 15 years?

Introducción. Los cambios sociosanitarios y demográficos de nuestra población y el crecimiento de las listas de pacientes en espera de un trasplante han condicionado ciertas variaciones en los criterios de selección de los donantes de órganos. Material y método. Estudio retrospectivo, descriptivo y comparativo de las características de los donantes cadáver de hígado utilizados en la Unidad de Trasplante Hepático del Hospital Universitario La Fe de Valencia en 2 períodos diferentes. Distribuimos los casos en 2 grupos: grupo A, los primeros 200 donantes (entre enero de 1991 y junio de 1995) y grupo B, 200 donantes más recientes (desde febrero de 2004 hasta diciembre de 2005). Resultados. El número de donaciones se ha incrementado desde los 18 donantes durante 1991 a los 106 en 2006. En el grupo A la edad media fue de 32,4 años, frente a 52,3 años del grupo B. En la serie A, la principal causa de muerte fueron los traumatismos craneoencefálicos y en el grupo B, los accidentes cerebrovasculares. El tiempo en la unidad de cuidados intensivos fue mayor en el segundo grupo, con una media de 67,2 h. En el grupo B el 17% presentaba aterosclerosis considerable de la aorta y el 29,5%, esteatosis hepática macroscópica, frente al 5 y el 12%, respectivamente, en el grupo A. Conclusiones. Actualmente, los donantes de hígado son de mayor edad, presentan más enfermedades crónicas, mueren por enfermedades cerebrovasculares, permanecen más tiempo en cuidados intensivos y sus hígados son macroscópicamente peores que los de donantes de años anteriores (AU)

Introduction. The social, medical and demographic changes of our population and the increase in the number of patients on waiting lists have led to some changes in the selection criteria of organ donors. Material and method. A retrospective, descriptive and comparative study of the liver cadaveric donors features accepted in the Liver Transplant Unit in La Fe University Hospital of Valencia (Spain) in 2 different periods. We distributed the cases into 2 groups, including in group A the first 200 first donors (from January 1991 to June 1995) and in group B the last 200 donors (from February 2004 to December 2005). Results. The number of donors increased from 18 during 1991 to 106 in 2006. In group A the mean age was 32.4 years, compared to 52.3 years in group B. In group A, the main cause of death was craneoencephalic traumatism and in group B cerebrovascular accidents. The mean time in the intensive care unit was longer in the second group with 67.2 hours. In group B, considerable atherosclerosis was reported in 17% of cadaveric donors and macroscopic liver steatosis in 29.5%, compared to 5 and 12%, respectively, in group A. Conclusions. Nowadays, cadaveric liver donors are older, suffer more chronic diseases, die due to cerbrovascular diseases, remain longer in intensive care units and the livers are macroscopically worse compared to donors accepted 15 years ago (AU)

[Donors yesterday and today: have the characteristics of liver donors changed over the last 15 years?]. / Donantes de ayer y de hoy: han cambiado las características de los donantes de hígado durante los últimos 15 años?

INTRODUCTION: The social, medical and demographic changes of our population and the increase in the number of patients on waiting lists have led to some changes in the selection criteria of organ donors. MATERIAL AND METHOD: A retrospective, descriptive and comparative study of the liver cadaveric donors features accepted in the Liver Transplant Unit in La Fe University Hospital of Valencia (Spain) in 2 different periods. We distributed the cases into 2 groups, including in group A the first 200 first donors (from January 1991 to June 1995) and in group B the last 200 donors (from February 2004 to December 2005). RESULTS: The number of donors increased from 18 during 1991 to 106 in 2006. In group A the mean age was 32.4 years, compared to 52.3 years in group B. In group A, the main cause of death was craneoencephalic traumatism and in group B cerebrovascular accidents. The mean time in the intensive care unit was longer in the second group with 67.2 hours. In group B, considerable atherosclerosis was reported in 17% of cadaveric donors and macroscopic liver steatosis in 29.5%, compared to 5 and 12%, respectively, in group A. CONCLUSIONS: Nowadays, cadaveric liver donors are older, suffer more chronic diseases, die due to cerbrovascular diseases, remain longer in intensive care units and the livers are macroscopically worse compared to donors accepted 15 years ago.

[Hepatic undifferentiated (embryonal) sarcoma in an adult: a case report and literature review]. / Sarcoma indiferenciado (embrionario) de hígado del adulto: informe de un caso y revisión de la literatura médica.

Undifferentiated (embryonal) sarcoma of the liver (USL) is a rare malignant hepatic tumor in adults. We report the case of a 40-year-old man with USL who was successfully treated with surgical resection and chemotherapy using ifosfamide and adriamycin. To our knowledge, only 70 cases of USL in adults have been reported worldwide in the 40 years since this clinicopathological entity was defined. Although the prognosis of the disease remains generally poor, long term survival has been achieved in patients with a combination of surgery and chemotherapy.

Sarcoma indiferenciado (embrionario) de hígado del adulto: informe de un caso y revisión de la literatura médica / Hepatic undifferentiated (embryonal) sarcoma in an adult: a case report and literature review

El sarcoma indiferenciado (embrionario) de hígado (SIH) es un tumor hepático maligno que en raras ocasiones afecta al adulto. Presentamos el caso de un varón de 40 años de edad con SIH, tratado con cirugía y quimioterapia basada en iofosfamida y adriamicina con buenos resultados. Según nuestros datos, sólo hay 70 casos publicados en la literatura médica de pacientes adultos con SIH desde que se definió esta entidad clinicopatológica. En general, los pacientes tratados con cirugía asociada a quimioterapia obtuvieron mejores resultados que los sometidos únicamente a cirugía, si bien el pronóstico de este tipo de tumores sigue siendo poco esperanzador

Undifferentiated (embryonal) sarcoma of the liver (USL) is a rare malignant hepatic tumor in adults. We report the case of a 40-year-old man with USL who was successfully treated with surgical resection and chemotherapy using ifosfamide and adriamycin. To our knowledge, only 70 cases of USL in adults have been reported worldwide in the 40 years since this clinicopathological entity was defined. Although the prognosis of the disease remains generally poor, long term survival has been achieved in patients with a combination of surgery and chemotherapy

[Right hepatic lobe agenesis. Where is the gallbladder?]. / Agenesia del lóbulo hepático derecho. Dónde está la vesícula?

Anomalies of the liver are infrequent. Agenesis of the right hepatic lobe is an uncommon, usually asymptomatic, entity that is diagnosed through new imaging techniques or during surgery. We present the case of a 51-year-old woman with right hepatic lobe agenesis who underwent technically difficult cholecystectomy for symptomatic gallstones. We discuss the diagnosis and technical difficulties that can be encountered during cholecystectomy when there is right hepatic lobe agenesis.

Agenesia del lóbulo hepático derecho. ¿Dónde está la vesícula? / Right hepatic lobe agenesis. Where is the gallbladder?

Las anomalidades del hígado son raras. La agenesia del lóbulo hepático derecho es un hecho poco frecuente, generalmente asintomático, que se diagnostica mediante las nuevas técnicas de imagen o durante la cirugía. Presentamos el caso de una mujer de 51 años con agenesia del lóbulo hepático derecho sometida a colecistectomía dificultosa por colelitiasis sintomática. Discutimos el diagnóstico y las dificultades técnicas durante la colecistectomía cuando hay agenesia del lóbulo hepático derecho (AU)

Anomalies of the liver are infrequent. Agenesis of the right hepatic lobe is an uncommon, usually asymptomatic, entity that is diagnosed through new imaging techniques or during surgery. We present the case of a 51-year-old woman with right hepatic lobe agenesis who underwent technically difficult cholecystectomy for symptomatic gallstones. We discuss the diagnosis and technical difficulties that can be encountered during cholecystectomy when there is right hepatic lobe agenesis (AU)

El trasplante hepático

Contiene: indicaciones de trasplante en la cirrosis, coordinación y mantenimiento del donante de órganos, criterios de selección de los donantes hepáticos, técnica quirúrgica en el donante, líquidos de preservación y lesiones de preservación en el trasplante hepático, anestesia en el trasplante hepático, técnica quirúrgica en el receptor, trasplante hepático segmentario y de donante vivo, inmunosupresión en el trasplante hepático, complicaciones en el postoperatorio inmediato, complicaciones técnicas en el trasplante hepático, factores pronósticos en el trasplante hepático, resultados globales del trasplante hepático, trasplante en la cirrosis secundaria al virus de la hepatitis b, trasplante en la cirrosis secundaria al virus de la hepatitis c, cirrosis alcohólica y trasplante, trasplante en pacientes con hepatopatías colestásicas, trasplante en pacientes con tumores hepáticos, retrasplante hepático, anestesia en el trasplante hepático pediátrico, trasplante hepático pediátrico, calidad de vida de los pacientes trasplantados.