New therapeutic options for obesity include restrictive bowel surgery and surgery that promotes malabsorption, such as the Fobi-Capella (gastric bypass) and Scopinaro (biliopancreatic diversion) techniques. Complications associated with these procedures, such as hepatocellular failure, have been observed with increasing frequency. Reported here are 3 patients who, 7 to 24 months after bariatric surgery, developed hepatocellular failure, for which liver transplantation was considered to be indicated. Liver transplantation was undertaken in 2 of the patients; the third patient died while waiting for this procedure. We discuss the possible causes of this uncommon and poorly understood complication of surgery for obesity. One possibility is that it might arise as a result of progression of steatohepatitis. An alternative concept is that this complication may be secondary to rapid, massive loss of body weight. Liver Transpl 14: 881-885, 2008.
These results indicate that videolaparoscopic cholecystectomy may be safely performed in public hospitals in Brazil, with low levels of complications, no associated mortality, and no need for blood derivatives.
The bile duct anatomic variations are frequent, and the magnetic resonance cholangiography showed moderate accuracy (70%) in reproducing the surgical findings; the computed tomography reproduced the intraoperative findings of the hepatic artery in 100% of donors, and of the portal vein in 89.4% of the cases, thus demonstrating high accuracy (89%).
EDITORIALRecebi um e-mail no dia 8 de janeiro de 2013, do meu irmão Ricardo Viebig, Editor Chefe dos Arquivos de Gastroenterologia, nossa revista que está completando 50 anos de idade neste ano. Era um fim de tarde e ele me pediu que escrevesse uma página, uma memória viva a ser publicada no número comemorativo dessa data. Representa esse um evento raro em nosso país. Confesso que a emoção tomou conta de mim, ele não viu, mas lágrimas vieram aos meus olhos. Encontrava-me junto a Denise, minha mulher que tem caminhado comigo nesse longo trajeto. Ela inquietou-se quando lhe comuniquei o conteúdo de e-mail recebido, no momento em que digitava um capítulo do meu novo livro a ser publicado "Carcinoma Hepatocelular no Cirrótico. Da Hepatocarcinogênese ao Transplante de Fígado". Imediatamente procurei me lembrar o que escrevera um dos nossos escritores maiores Raduan Nassar no seu livro lapidar "Lavoura Arcai ca": "Os homens que não se rebelam contra o curso da corrente do tempo, não recebeu suas iras, mas seus favores". A partir desse pensamento, mesmo reconhecendo que não seria merecedor dessa honraria, resolvi aceitá-la. Retornei, então, no tempo, voltando imediatamente ao Recife, ano de 1966, quando era estudante de Medicina na Universidade Federal de Pernambuco. Nessa época meu mentor era o Prof. Djalma Vasconcelos, referência na especialidade no Brasil. Consultei-o, indagando para onde deveria me dirigir visando especialização em gastroenterologia. Não titubeou e disse para me dirigir ao IBEPEGE (Instituto Brasileiro de Estudos e Pesquisas em Gastroenterologia), em São Paulo. Submeti-me ao Concurso de Admissão e fui aprovado. Passei, então, a conviver com os melhores especialistas nessa área da medicina. Figurava entre esses os Profs. José Fernandes Pontes, Luiz Caetano
-Background -An imprecise estimate of the tumor's aggressiveness of the hepatocellular carcinoma especially in transplanted patients beyond the Milan criteria has a poor outcome, although a more reliable criteria including microscopic vascular invasion is difficult to be established before transplantation. Aim -To examine a cohort of patients with hepatocellular carcinoma undergoing liver transplantation to evaluate the preoperative predicting factors for microscopic vascular invasion. Methods -A series of 46 consecutive cirrhotic patients with hepatocellular carcinoma undergoing transplantation based on Milan criteria or similar criteria in a single center were enrolled between 1993 and 2007. The survival was calculated using Kaplan-Meyer's method and a multivariate Cox regression was performed to evaluate survival and factors related to microscopic vascular invasion. Results -Multifocal tumors were present in 39%. Microvascular invasion, tumor relapses and hepatocellular carcinoma beyond the Milan criteria were identified in 33%, 13% and 33%, respectively. Overall 1-, 3-, and 5-year actuarial patient survival rates were 64%, 59% and 45% respectively. Patients who exceeded the Milan criteria had a higher incidence of microscopic vascular invasion and bilobar tumor compared to those who met the Milan criteria (53% vs. 23% and 80% vs. 19%; p<0.05, respectively). After multivariate analysis, the variable identified as independent risk factor for microscopic vascular invasion was the presence of bilobar tumor (hazard ratio, 3.67; 95% confidence interval, 1.01 to 13.34; p<0.05). Conclusions -The presence of a bilobar tumor is more frequent in hepatocellular carcinoma beyond the Milan criteria and it is an independent predictive factor of a high risk of microscopic vascular invasion. The presence of bilobar tumor in hepatocellular carcinoma beyond the Milan criteria could be used as selection criteria to estimate the risk of hepatocellular carcinoma recurrence, at least until large randomized studies becomes available.RESUMO -Racional -A recidiva tumoral após o transplante de fígado para o carcinoma hepatocelular tem grande impacto desfavorável na mortalidade e a presença de invasão microvascular desempenha papel importante na recidiva tumoral. Objetivo -Avaliar a sobrevida, o risco de recidiva tumoral pós-transplante e os fatores relacionados à invasão microvascular de uma série de transplantados por carcinoma hepatocelular. Métodos -No período entre 1993 e 2007 foi estudada uma série consecutiva de 46 cirróticos com carcinoma hepatocelular submetidos à transplante de fígado baseado nos critérios de Milão a partir de 1996 ou critérios semelhantes no período anterior a esta data. Inicialmente todas as variáveis foram analisadas descritivamente, e as quantitativas através da observação dos valores mínimos e máximos, e do cálculo de médias e desvios-padrão e medianas. Para as variáveis qualitativas calcularam-se frequências absolutas e relativas. Realizou-se a regressão logística com ajuste pelo modelo de Cox ...
The weight of the right liver lobe graft in a living-donor transplantation is less than that calculated by preoperative computed tomography, and the inclusion of the middle hepatic vein in the right liver lobe graft resulted in a statistically significant decrease in this difference.
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