Risk of development of the metabolic syndrome after orthotopic liver transplantation.

Longer survival for orthotopic liver transplantation (OLT) patients over the last decade has focused emphasis on the metabolic complications that contribute to patient morbidity and mortality. The aim of our study was to analyze the prevalence of the metabolic syndrome (MS) and other risk factors after OLT among our patients at 1 year follow-up. From 2001 to 2008, we performed OLT in 210 patients with 62 exclusions leaving 148 patients for the study. We recorded age, gender, liver disease, smoking status, pre- and post-OLT body mass index, pre- and post-OLT arterial blood pressure, pre- and post-OLT fasting blood glucose, pre- and post-OLT high-density lipoproteins and triglycerides, family history of diabetes, hepatitis B and C virus status, immunosuppressive therapy, and corticosteroid bolus for rejection episodes. The MS was defined according to modified ATP III criteria. At month 12 after OLT, 29/148 patients (19.6%) developed the MS. The associated factors were obesity and hyperlipidemia pre-OLT, familial and personal history of diabetes as well as alcoholic cirrhosis. By multivariate analysis, pre-OLT body mass index (odds ratio, 3.7 [1.3-10.5]) and pre-OLT diabetes (odds ratio, 2.9 [1.1-7.9]) were independent risk factors.

Milan criteria versus San Francisco criteria in hepatocellular carcinoma: our center's experience.

BACKGROUND AND AIM: Liver transplantation (OLT) represents the best treatment for hepatocellular carcinoma (HCC) in advanced cirrhosis showing a 70% 5-year survival rate. Our study sought to compare overall survivals among patients who underwent OLT under Milan Criteria (MC) or San Francisco Criteria (UCSFC). METHODS: We retrospectively analyzed patients who underwent liver transplantation for HCC in our institution from November 2001 to December 2007. We analyzed age, gender, OLT indication, maximal tumor size, histology, and survival. We compared survival among patients who met MC versus UCSFC. RESULTS: From November 2001 to December 2007, 48/177 (27%) liver transplantations performed in our hospital were indicated due to HCC. The two patients who did not show any tumor in the explanted liver (false-positive ratio 4.2%) were excluded from the analysis. Another two patients were included who showed incidental HCC lesions (false-negative ratio 1.7%), yielding 48 analyzed patients. The mean diameter of the HCC nodules were 3.1 cm before OLT and 3.8 cm in the pathologic examination, a statistically significant difference. Two patients exceeded MC before OLT, and six patients showed this feature in the explanted liver. There was a significant difference in the degree of vascular invasion between the two groups. Overall mortality was 25.9% at 4 years; the MC group show an 11.9% versus UCSFC group, a 66.6% rate. CONCLUSIONS: HCC is a common indication for OLT. Hepatitis C virus is the most common etiology. Survival among the MC group was significantly better than that of subjects beyond the MC, a difference that supports the use of MC for HCC.

Resultados a medio largo plazo de la técnica de han en tratamiento de pacientes con varices y trombosis porto-espleno-mesentérica / HAN technique in the treatment of patients with varieces and thrombosis of portal, mesenteric and splenic veins. Results a long term

INTRODUCCIÓN. Una de las complicaciones más graves de la hipertensión portal es el sangrado digestivo por varices. Cuando la terapia endoscópica fracasa es preciso recurrir a la cirugía, con técnicas como las derivaciones o las devascularizaciones. CASO CLINICO 1: varón de 49 años con cirrosis enólica y episodios repetidos de sangrado por varices esofágicas y fúndicas. Trombosis de las venas porta, mesentérica superior y esplénica asociado a cavernomatosis portal. Se realizó devascularización esofagogástrica, fundectomía y esplenectomía. CASO CLINICO 2: mujer de 57 años con hipertensión portal por fibrosis hepática congénita. Presenta episodios repetidos de hemorragia digestiva por varices esofágicas, subcardiales y fúndicas. El tratamiento con betabloqueantes y endoscópico había fracasado. Shunt porto-cava y el TIPS (Shunt portosistémico intrahepático transyugular) no fueron capaces de controlar el sangrado por varices. Posteriormente presenta trombosis del eje espleno-portal. Finalmente se realiza devascularización esofagogástrica, fundectomía y esplenectomía. DISCUSIÓN. La endoscopia es la primera opción del tratamiento de las varices esofagogástricas. La devascularización esofagogástrica (procedimiento de Sugiura) surgió como una alternativa a las derivaciones quirúrgicas, pero tiene importantes complicaciones que aumentan la mortalidad. La fundectomía asociada a la devascularización constituye una buena alternativa,en pacientes con varices del fundus (AU)

INTRODUCTION. The digest variceal bleeding is one of the most serious complications of portal hypertension. If endoscopic therapy fails come be necessary to surgical treatment with portosystemical shunt or esophagogastric devascularization. CLINIC CASE 1. We present the case of a 49-year-old man with alcoholic cirrhosis. He had continuous episodes by oesophageal and fundal variceal bleeding. He had splenomesoportal thrombosis associated with development caverns in the portal system. We performed a periesophagogastric devascularization, fundectomy and splenectomy. CLINIC CASE 2. A 57-year-old with portal hypertension by congenital hepatic fibrosis. She had episodes of recurrent bleeding by oesophageal, subcardial and fundal variceal. Beta-blockade and endoscopy therapy had failed. The potacaval shunt and TIPS could not achieve definitive control of variceal bleeding. She had splenomesoportal thrombosis later. Finally we performed a periesophagogastric devascularization, fundectomy and splenectomy. DISCUSSION. The endoscopic therapy is the first option by treatment of esophagogastric varices. The periesophagogastric devascularization (Sugiura procedure) came up as another option to the surgical shunt, but has important complications that increase the mortality rate. The fundectomy related to devascularization is a good alternative especially for patients with fundal variceal (AU)

[Symptomatic hepatic arterioportal shunt resolved through conservative treatment]. / Fístula arterioportal sintomática resuelta mediante tratamiento conservador.

Arterioportal shunt in the liver is a rare vascular disorder that may be due to congenital vascular malformation (hereditary hemorrhagic telangiectasia), trauma, iatrogenic causes (after a hepatic biopsy) or neoplasm. Initial treatment consists of transcatheter arterial embolization with different kinds of materials. We present the case of a 64-year-old woman with signs of portal hypertension and severe diarrhea. Doppler ultrasonography, computed tomography and angiography revealed arterioportal fistulae between the hepatic artery and right portal vein. Transcatheter arterial embolization with n-butyl-2-cyanoacrylate surgical glue (Glubran) was successfully performed. After 2 years of follow-up, the patient remains asymptomatic. Transcatheter arterial embolization with Glubran should be considered as a therapeutic option in arterioportal shunts and could be a definitive therapy.

Fístula arterioportal sintomática resuelta mediante tratamiento conservador / Symptomatic hepatic arterioportal shunt resolved through conservative treatment

La fístula arterioportal hepática es un hallazgo vascular excepcional, que puede deberse a una malformación vascular congénita o a un traumatismo, u originarse por iatrogenia (biopsia hepática) o por la presencia de tumores hepáticos. El tratamiento inicial es la embolización transarterial con diversos materiales mediante arteriografía hepática. Se presenta el caso de una fístula arterioportal hepática con signos de hipertensión portal y diarrea grave. La ecografía Doppler, la tomografía computarizada y la arteriografía hepática demostraron la presencia de una fístula arterioportal entre la arteria hepática y la vena porta derecha. La fístula se resolvió mediante tratamiento percutáneo intravascular con embolización con cola quirúrgica compuesta por 3 monómeros ­etil-2-cianoacrilato, butilacrilato y metacrilosisolfolano (Glubran®)­, con lo que desaparecieron la clínica y las alteraciones analíticas. Después de 2 años de seguimiento la paciente permanece asintomática. El tratamiento percutáneo intravascular con Glubran® puede considerarse una opción terapéutica de las fístulas arterioportales e incluso ser definitivo

Arterioportal shunt in the liver is a rare vascular disorder that may be due to congenital vascular malformation (hereditary hemorrhagic telangiectasia), trauma, iatrogenic causes (after a hepatic biopsy) or neoplasm. Initial treatment consists of transcatheter arterial embolization with different kinds of materials. We present the case of a 64-year-old woman with signs of portal hypertension and severe diarrhea. Doppler ultrasonography, computed tomography and angiography revealed arterioportal fistulae between the hepatic artery and right portal vein. Transcatheter arterial embolization with n-butyl-2-cyanoacrylate surgical glue (Glubran®) was successfully performed. After 2 years of follow-up, the patient remains asymptomatic. Transcatheter arterial embolization with Glubran® should be considered as a therapeutic option in arterioportal shunts and could be a definitive therapy

[Familial hepatic hemangiomas]. / Hemangiomas hepáticos familiares.

Cavernous hemangioma is the most frequent benign hepatic tumor. These tumors are usually small, solitary or multiple, and asymptomatic but they can be large. In the majority of cases, these tumors are sporadic. We describe a family in which six members from three successive generations presented cavernous hepatic hemangiomas. One of the women, who was taking oral contraceptives, presented a giant cavernous hemangioma causing pain in the right hypochondriac region and biochemical abnormalities while the remaining cases were asymptomatic. We found only one study in the literature that reports familial cavernous hepatic hemangioma; a further two studies describe hepatic hemangiomas in members of families with angiomas in other sites. We believe that description of a new family with this disease is of interest. The findings could support autosomal dominant inheritance as the mode of transmission of these tumors, as well as the existence of proliferative factors in these tumors.

[The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon]. / Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al tratamiento con interferón.

BACKGROUND: Although many studies have been implemented in order to determine the pre-treatment factors that can predict patients' response to interferon (IFN) therapy, it is not yet clear whether characteristic histologic abnormalities in chronic hepatitis C can predict such response. AIMS: The aim of this study were to evaluate, in patients with chronic hepatitis C, (i) the predictive value of histologic lesions for the sustained response to IFN therapy (ii) other pre-treatment (epidemiological and analytical) factors known to be predictive of response. PATIENTS AND METHODS: Sustained response was retrospectively evaluated in two hundred one patients who had been treated with IFN for at least 3 months in four different hospitals from Castilla y León. The following histological parameters were studied as predictors of response: histological diagnosis, Knodell index, grading and stage, characteristic histologic lesions of HCV infection. Epidemiological and analytical parameters were also evaluated. RESULTS: The rate of patient's sustained response to IFN treatment was 16%. None of the histological parameters was useful to predict this response. By univariate analysis, age, disease evolution time, mode of viral transmission, GGT, ferritin and viral genotype were associated with a sustained response. The most powerful, and only independent predictive factor, however, was the genotype (the response odds ratio was 8.6). CONCLUSIONS: Histological parameters do not predict the response to IFN treatment. Other factors (mainly the viral genotype) are associated with a higher response percentage, although no one is useful to decide which patients are going to respond.

Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al trata miento con interferón / The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon

Introducción: Aunque se han realizado múltiples estudios para conocer los factores pre-tratamiento que pueden predecir la respuesta al tratamiento con interferón (IFN), se desconoce si las lesiones histológicas características de la hepatitis crónica C (HCC) sirven para predecir dicha respuesta. Objetivos: Valorar si los parámetros histológicos pueden predecir la respuesta mantenida al tratamiento con IFN en los pacientes con HCC, y estudiar otros parámetros (epidemiológicos y analíticos) ya descritos como factores predictivos de respuesta. Métodos: Se estudiaron de forma retrospectiva 201 pacientes, tratados con IFN durante al menos 3 meses en cuatro hospitales de Castilla y León. La variable dependiente analizada fue la respuesta mantenida al tratamiento. Como factores predictivos de respuesta se estudiaron las siguientes variables histológicas: diagnóstico histológico, índice de Knodell total y por apartados, grado y estadio, y lesiones características de la HCC. Además, se analizaron parámetros epidemiológicos y analíticos. Resultados: El 16 por ciento de los pacientes presentó una respuesta mantenida. Ninguno de los parámetros histológicos sirvió para predecir dicha respuesta. Demostraron ser factores predictivos en el análisis bivariante la edad, el tiempo de evolución de la HCC, la vía de transmisión, la GGT, la ferritina y el genotipo viral. El factor predictivo más importante fue el genotipo viral, y el único asociado independientemente a la respuesta mantenida ("odds ratio" de respuesta al tratamiento de 8,6). Conclusiones: Los parámetros histológicos no predicen la respuesta al tratamiento con IFN. Otros factores, fundamentalmente el genotipo viral, se asocian a un mayor porcentaje de respuestas, aunque ninguno sirve para decidir con exactitud qué pacientes responderán. (AU)

Amnesia global tras paracentesis evacuadora en paciente con derivación ventrículo-peritoneal / global amnesia after paracentesis in a patient with ventriculo peritoneal shunt

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[Eosinophilic enteritis causing intestinal obstruction]. / Enteritis eosinofílica como causa de obstrucción intestinal.

Eosinophilic enteritis is an uncommon disorder of unknown etiology in which the digestive symptoms are associated with eosinophilic infiltration of the different layers of the intestinal wall. Clinical symptoms depend on the layers involved and are usually characterized by peripheral eosinophilia. Radiological findings depend on the layers involved. Definitive diagnosis is based on clinical and histopathological findings. Treatment of choice is currently with corticoids and prognosis is benign with relapses. The pathogenesis remains unclear. We report a patient who presented with intestinal obstruction and describe the follow-up.

Eosinophilic gastroenteritis: a description of a new case with serous affectation.

We discuss a case of a 51 year old female who presented periodic episodes of abdominal pain, nausea and vomitus consisting of food elements and in addition in the last crisis presented ascites and increased abdominal circumference. The laboratory studies performed included the remarkable increase in eosinophils found in peripheral blood and ascitic fluid with the rest of the laboratory findings within the normal limits (biochemical, proteinogram, Igs, urine and stool examination, and negative food provocation test). Radiography demonstrated swelling of the gastric wall at antral level and the small intestinal wall. A gastric sample was taken via endoscopy which established the diagnosis of EG. EG is a disease of still disputable etiopathogenesis. Some think it is mediated by type I hypersensitivity mechanism and others (like our case) mediated by immunologic mechanism different from atopy which on occasions form part of a systemic feature. Regarding the role of eosinophil, it seems to be important as latest studies have found a relation between the degree of cell degranulation and the degree of histologic lesion. From the distinct form of EG (muscular, mucosa, serosa), EG with involvement of the serosa layer is the less frequent. It is usually associated to some other layer (generally muscular) and presenting ascites. Some authors denominate mixed-type EG to these forms whereby important involvement of more than one layer of the digestive tract is demonstrated.