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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The factors that can influence the outcome of orthotopic liver transplantation (OLT) are numerous. The purpose of this study was to determine the effects of recipient preoperative factors on patient mortality. Between April 1986 and April 1998 a total of 600 OLTs were performed in our institution. We retrospectively reviewed our first 203 consecutive primary adult OLTs with at least 4 years of follow-up. A case-control comparison was performed between survivors and nonsurvivors, and differences in recipient variables were studied for their correlation with patient mortality. A logistic regression analysis was also performed. Mortality was significantly increased among those with fulminant hepatic failure (FHF) (66.6%, p= 0.003), primary cancer (63.1%, p= 0.018), females (46.1%, p= 0.043), encephalopathy grade IV (72.7%, p= 0.012), recipients under respiratory support (69.2%, p= 0.031), and ABO-incompatible transplants (80%, p= 0.05). FHF, primary cancer, and female gender were the only variables that had a significant association with mortality in the logistic regression analysis. A higher incidence of prolonged respiratory support, bacterial and fungal infections, pneumonia, and chronic rejection contributed to the lower outcome observed in females. These results stress the need for continuous evaluation of the selection criteria of candidates for OLT suffering from primary cancer and FHF. The impact of recipient gender on mortality warrants further analysis but suggests that in the future more attention must be paid to the influence of this factor on the final outcome of OLT.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Nous avons étudié rétrospectivement 19 patients opérés pour une hydaditose hépatique s'étendant soit vers le diaphragme, soit vers le thorax par extension transdiaphragmatique (TD) dans une série de 444 patients ayant été opérés. Dans tous les cas de TD, le diagnostic a été confirmé par l'échographie, la tomodensitométrie ou la résonance magnétique nucléaire. Nous proposons une nouvelle classification (grades 1 à 5), basée sur le degré de TD. Avant 1984, une thoracophrénolaparotomie a été la voie d'abord préférée (9 cas) puis on a utilisé la voie souscostale droite. Seulement quatre patients ont nécessité une résection pulmonaire atypique. Chez 13 patients, on a réparé immédiatement le diaphragme et tous les kystes hydatiques hépatiques (n=24) ont été traités par une périkystectomie soit totale (16 cas) soit partielle (8 cas). Il n'y a eu aucun décès et la complication la plus grave observée a été une fistule biliaire et bilio-bronchique. Nous recommandons la périkystectomie totale ou presque totale par une incision sous-costale droite prolongée chez ces patients.
    Abstract: Resumen Hemos realizado un estudio retrospectivo de 19 pacientes operados por enfermedad hidatídica hepática con extensión diafragmática o transdiafragmática (E-TD) al toráx, dentro de un total de 44 pacientes sometidos a cirugía por enfermedad hidatídica del hígado. En la totalidad de los casos la extensión E-TD fue confirmada por ultrasonografía, TAC o resonancia magnética. Proponemos una nueva clasificación (grados 1 a 5) basada en el grado de desarrollo de la extensión E-TD. Con anterioridad a 1984, se hizo la exposición mediante toracofrenolaparotomía (9 casos) y más tarde por incisión subcostal derecha. Sólo 4 pacientes requirieron una resección pulmonar atípica. En 13 casos el diafragma fue reparado y todos los 24 quistes hepáticos fueron tratados mediante cistopericistectomía total (16 casos) o parcial (8 casos). No se registró mortalidad operatoria y la morbilidad más seria consistió en una fístula biliar y una broncobiliar. Para el tratamiento de este tipo de pacientes nosotros recomendamos una incisión subcostal derecha y una cistopericistectomía total o casi total como la técnica quirúrgica de primera escogencia.
    Notes: Abstract We performed a retrospective study of 19 patients who had been operated on for hepatic hydatid disease with diaphragmatic or transdiaphragmatic (D-TD) thoracic involvement chosen from a total of 444 patients who underwent operations for hepatic hydatid disease. In all cases D-TD involvement was confirmed by ultrasonography, CT, or MRI scan. We propose a new classification (grades 1–5) based on the degree of development of D-TD involvement. Before 1984 exposure was obtained by thoracophrenolaparotomy (nine cases) and later by right subcostal incision. Only four patients required atypical pulmonary resection. In 13 cases the diaphragm was repaired, and all 24 hepatic cysts were treated with total (16 cases) or partial (8 cases) cystopericystectomy. There was no operative mortality, and the most serious morbidity consisted of a biliary fistula and a biliobronchial fistula. For treatment of these patients we recommended right subcostal incision and total or near-total cystopericystectomy as a first choice of surgical technique.
    Type of Medium: Electronic Resource
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