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Objectives. To evaluate the efficacy, safety, and quality of life by using 2.5 and mifepristone 5 mg daily doses to treat uterine fibroids over 3 months with a 9-month followup period. Design. Randomized clinical trial. Place. “Eusebio Hernández” Hospital, Havana, Cuba. Subjects. 220 women with symptomatic uterine fibroids. Treatment. One-half (2.5 mg) or one-whole 5 mg mifepristone tablet. Variables to Evaluate Efficacy. Changes in fibroid and uterine volumes, in symptomatic prevalence and intensity, and in quality of life. Results. After 3-month treatment, fibroid volume decreased by 27.9% (CI 95% 20–35) and 45.5% (CI 95% 37–62), in the 2.5 and 5 mg groups, respectively, P = 0.003. There was no difference in the prevalence of symptoms at the end of treatment, unlike after 6- and 9-month followup when there was a difference. Amenorrhea was significantly higher in the 5 mg group, P = 0.001. There were no significant differences in mifepristone side effects between the groups. Both groups displayed a similar improvement in quality of life. Conclusions. The 2.5 mg dosage resulted in a lesser reduction in fibroid size but a similar improvement in quality of life when compared to the 5 mg dose. This trial is registered with ClinicalTrials.gov NCT01786226.

We report a case of portopulmonary hypertension in which the pulmonary hypertension resolved after initial orthotopic liver transplantation. Portopulmonary hypertension recurred when the transplanted liver failed and again resolved after a second liver transplantation. Intravenous epoprostenol was administered perioperatively to control the pulmonary hypertension in both instances. (Liver Transpl 2001;7:645-648.) P ulmonary hypertension associated with chronic liver disease was first described in 1951. 1 Portopulmonary hypertension, a secondary form of pulmonary hypertension, 2 is defined as pulmonary arterial hypertension, a normal or low pulmonary artery occlusion pressure, and portal hypertension. Some investigators also require patients to have an elevated pulmonary vascular resistance. 3 Portopulmonary hypertension is classified as mild when the mean pulmonary artery pressure is between 25 and 35 mm Hg, moderate when mean pulmonary artery pressure is greater than 35 mm Hg but less than 50 mm Hg, and severe when mean pulmonary artery pressure exceeds 50 mm Hg. 3 The frequency of portopulmonary hypertension is unknown, but it is found in 2% to 8% of patients with portal hypertension who have pulmonary artery pressures measured. [4][5][6] Most patients awaiting liver transplantation found to have increased pulmonary artery pressures have only mild to moderate pulmonary hypertension. 3,5,6 Severe pulmonary hypertension defined as pulmonary artery systolic pressure greater than 60 mm Hg has been reported in less than 1% of patients scheduled to undergo liver transplantation. 6 Mild pulmonary hypertension does not appear to adversely influence outcomes in patients undergoing liver transplantation. 3,5,6 Moderate pulmonary hypertension has been associated with an increased risk for death, particularly if right ventricular function in decreased. 3,6 Severe pulmonary hypertension has been associated with perioperative mortality rates between 70% and 100%. 3,6 In the first report, follow-up examination of the 2 patients surviving transplantation showed moderate improvement in pulmonary hypertension in 1 patient and clinical resolution in the other patient. 6 Because of the high mortality, many liver transplantation centers consider patients with severe pulmonary hypertension to be high-risk surgical candidates. 7-10 Successful orthotopic liver transplantation has been reported in a patient with moderate to severe portopulmonary hypertension. 11 This patient showed a hyperdynamic circulatory state that improved with orthotopic liver transplantation. These investigators suggested that portopulmonary hypertension caused by a marked increase in cardiac index can be managed successfully with orthotopic liver transplantation.Portopulmonary hypertension is usually characterized by an elevated cardiac index, in contrast to the low cardiac index seen in primary pulmonary hypertension. 12 Despite this difference, the pathological state seen in portopulmonary hypertension, 13-15 pulmonary arteriopathy with plexiform lesions, is...

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Hepatic adenoma is a benign tumor characterized by its hypervascularity. Hepatic adenoma tends to occur more frequently in women and is related to the use of contraceptive hormones, androgenic/anabolic steroids, pregnancy, glycogen storage diseases and hemochromatosis. Hepatic venous obstruction, or Budd-Chiari syndrome, is a condition of hepatic vein occlusion that has many causes. A 35-year-old woman presented shortly after pregnancy with a huge cystic lesion in the liver. The lesion compressed the hepatic vein and created an early stage of Budd-Chiari syndrome. Tumor resection was carried out successfully. The final diagnosis of this case was multiple hepatic adenomas.