Rapid correction of prothrombin time after low-dose recombinant factor VIIA in patients undergoing orthotopic liver transplantation.

Orthotopic liver transplantation (OLTx) is associated with a major risk of blood loss resulting from portal hypertension, collateral circulation, and clotting disturbances. Application of a recombinant factor VIIa (rFVIIa) has been reported to promptly correct clotting abnormalities reducing the risk of intraoperative bleeding. This study included 8 patients who underwent OLTx for end-stage liver cirrhosis, with protrombin times (PT) exceeding the upper limit of normal by more than 4 seconds before surgery. All subjects were administered a small single intravenous dose of rFVIIa [mean 68.37 microg/kg body mass (range, 32.88-71.64)] 10 minutes prior to the skin incision. The PT was then measured 15 minutes later, following graft reperfusion, and 12 hours since drug application. All patients showed rapid correction of PT within 15 minutes after injection (median PT before injection 20.25 seconds vs 11.5 seconds after injection, P <.0001). Following the reperfusion PT was found to be prolonged again. These values are not significantly differ from those before surgery and are comparable to PT values after reperfusion in patients who did not receive rFVIIa. None of the patients developed thromboembolic complications. In conclusion, lower than recommended dose of rFVIIa caused rapid improvement in the PT shortly after injection. After reperfusion PT became prolonged again, which may account for the lack of thromboembolic complications observed in this group of patients.

Influence of ureterovesical anastomosis technique on the incidence of vesicoureteral reflux in renal transplant recipients.

Urological complications of allogenic kidney transplantation include vesicoureteral reflux which can result in graft threatening urinary tract infection. To prevent this complication several ureterovesical anastomosis techniques have been developed. Authors present a comparison of three different techniques: extravesical without antireflux mechanism, extravesical Witzel-Lich with antireflux mechanism and intravesical Laedbetter-Politano with antireflux mechanism. 39 patients were selected randomly from a cohort of 420 allogenic kidney recipients (follow up time 10-147 months). All patients had voiding cystography and urine culture performed. The incidence of vesicoureteral reflux varied from 13.3% to 50%, depending on the anastomosis technique. No correlation between type of anastomosis and urinary tract infection was found.

Parasitic cysts of the liver - practical approach to diagnosis and differentiation.

BACKGROUND: The aim of the study was to determine the incidence of parasitic liver cysts. MATERIAL AND METHODS: In 1996-2000 at the Department of Infectious Diseases parasitic liver cysts were diagnosed in 31 patients. The diagnosis was based on imaging examinations (ultrasound, computerised tomography), serological reactions (ELISA, IHA) and histopathological investigation of the specimens obtained through fine-needle aspiration biopsy. RESULTS AND CONCLUSION: The latter followed the pre-treatment with antiparasitic drug and no significant complications were observed. On the basis of the criteria developed by our team (evident, highly probable and probable diagnosis), hydatid disease of the liver was diagnosed in 8 patients (25.8%). The remaining subjects, excluding one patient who underwent surgical treatment, received repeated treatment with imidazole derivatives (Zentel or Vermox).