[Proximal vein by-pass in the treatment of venous stenosis in expanded polytetrafluoroethylene prosthesis for hemodialysis]. / By-pass a vena proximal para el tratamiento de estenosis venosas en prótesis de politetrafluoroetileno expandido para hemodiálisis.

OBJECTIVE: To show the long-term results of 97 politetraflouroethylene dialysis grafts submitted to a graft by-pass to treat graft-vein stenosis. MATERIALS AND METHODS: Venous stenoses were studied and diagnosed by means of fistulography in cases with fistula dysfunction or during surgery for graft thrombectomy. Both early and late complication rates were studied, as well as primary and secondary patency rates. RESULTS: Number of cases, 97. Mean age, 58 years (7-79). Diabetic nephropathy: 19.5%. Types of grafts in which stenoses developed: straight forearms 13; loop forearm 9; 6 mm upper arm 36; 6-8 mm upper arm 34; brachio-jugular 4; femoro-femoral 1. Overall follow-up time: 2,427 graft-months. Mean follow-up time: 21 +/- 5 months. Late complication rate: 0.30 episodes per graft-year of follow-up. Re-stenosis rate: 0.12 graft-year of follow-up. Primary cumulative patency rate: 70%, 62%, 51%, 45% at one, two, three and four years, respectively. Secondary cumulative patency rate: 87%, 79%, 74% and 71% at one, two, three and four years, respectively (p < 0.0016). No differences were observed between secondary patency observed after by-pass to treat dysfunction or thrombosis (p = 0.09259). DISCUSSION: In our experience, by-pass to proximal vein is associated with good results both at short and long term, probably because the intimal hyperplasia area is excluded and because by-pass is performed on an already dilated vein. The procedure can be performed under local anesthesia and in an outpatient basis between dialysis, with little discomfort for the patient.

[Splenectomy indications at a general hospital]. / Indicaciones de esplenectomía en un hospital general.

BACKGROUND: To analyse the evolution of indications for splenectomy for a 11-year period. METHODS: A review was made of cases of splenectomy from clinical records and the records of the Pathology Service at Hospital General Universitario Gregorio Marañón from 1986 to 1996. Both adult and pediatric cases were included. RESULTS: From 1986 to 1996 there was a total of 354 patients (273 males and 162 females) who underwent splenectomy. Mean age of patients was 44.6 years (SD +/- 20.5 years) and there was an average of 39.5 cases per year. The most common causes were trauma (32%), "incidental" splenectomy (14%), thrombopenia (12%) and non Hodgkin lymphoma (11%). Compared with the other causes, the mean age of patients with trauma was lower than that of the other groups (p < 0.0001), in contrast with patients with non Hodgkin lymphoma or extra-splenic tumors, where it was higher (p < 0.0001 for both groups). A decline was observed of cases due to trauma from the first to the last year of the study (p = 0.0009), as well as an increase in the group of splenectomy related to extrasplenic tumors (p = 0.01). In the group of the HIV infected patients (n = 30), thrombopenia was the most common indication for splenectomy (11 cases). CONCLUSIONS: Although the average of splenectomy cases remains relatively constant, a decrease in cases due to trauma was observed and an increase of splenectomies on account of abdominal oncologic resections.

[The liver transplant program of the Hospital General Universitario Gregorio Marañón: an analysis of the first 100 patients]. / Programa de trasplante hepático del Hospital General Universitario Gregorio Marañón: análisis de los 100 primeros pacientes.

During a 3-year period between 1990 and 1993, 100 patients received orthotopic liver transplantation at the "Gregorio Marañón" University General Hospital. The mean age of the patients was relatively high (46.9 +/- 10 years), with an important number of cirrhotic patients (91%). The rate of primary liver failure was relatively low (4.5% of transplantations) although 12 cases with more than 55 years were included in the present series. Eleven retransplantations were performed, 8 for early failure of the graft and 3 for chronic failure. Postoperative complications of the graft were vascular in 9 cases, biliary in 17 cases, and acute rejection (cellular) in 70 patients, although only 50 of these patients required treatment with steroid boluses. Infections were diagnosed in 60 cases with 80% of major infections, 6 of them caused by Aspergillus fumigatus that were lethal in all the cases. Postoperative survival was 82%, 72%, 69% and 69% at 1 month, 6 months, 1 year and 2 years respectively.

[A biliary fistula after T-tube removal in the transplant patient: its diagnosis by Tc-99m-HIDA]. / Fístula biliar tras la retirada del tubo en T, en el paciente trasplantado: diagnóstico mediante HIDA Tc-99m.

The Tc-99m HIDA scan is a valuable study after liver transplantation, associated with other image techniques. We have used this technique as a reliable and objective diagnostic method for biliary fistula after removal of the T-tube in 5 liver transplantation patients with pain after T-tube removal. All five patients who developed fistula not only were diagnosed immediately but, furthermore, the surgical technique was indicated by the gammagraphic study. After this experience, we propose to remove the T-tube during the Tc-99 HIDA scan.