Esteban Cugat

Prostacyclin, thromboxane and oxygen free radicals and postoperative liver function in human liver transplantation

The aim of this prospective study is to evaluate prostanoid (prostacyclin and thromboxane) and lipid peroxide levels at the portal and hepatic veins, and their relation to immediate postoperative liver function. Nineteen patients with liver cirrhosis undergoing orthotopic liver transplantation were prospectively studied. Blood samples were obtained within 5 min and 1 and 2 hr after reperfusion of the new liver, through a catheter placed at the portal vein in the recipient and another at the left hepatic vein in the donor liver. Plasma prostacyclin and thromboxane were analyzed by HPLC and RIA. The formation of lipid peroxides was determined and expressed in terms of thiobarbituric acid-reacting substances. Immediate postoperative liver function was evaluated using the transaminase levels within the first 48 hr and the early postoperative graft function score, as described previously. After reperfusion, only determinations at 5 min were related with liver function. Either prostacyclin (R = -0.61, P = 0.004) levels at the hepatic vein or prostacyclin production (subtraction between hepatic and portal vein levels) (R = -0.47, P = 0.04) correlated significantly with the early postoperative graft function score. Besides, there was a significant relationship between lipid peroxide production as measured by thiobarbituric acid-reacting substances and a worse early postoperative graft function score (R = 0.61, P = .005). These results suggest that prostacyclin released after liver grafting attenuates preservation and reperfusion damage of the liver, supporting the hypothesis that there is an imbalance of prostanoids within the microvasculature in patients with a compromised postoperative liver function. Our results agree with the involvement of some degree of lipid peroxidation products in the damage of hepatocytes during anoxia and reperfusion.

Hepaticothoracic transdiaphragmatic echinococcosis

Between 1970 and 1985, seven patients were referred to us for surgical treatment of simultaneous hydatid cysts in the liver and the chest. Their mean age was 45.4 years (age range, 23-73 years), and they represented 46% of patients with hydatid cysts in the liver and thorax. Three patients had hepaticopleural involvement, and 3 patients had symptoms of pulmonary origin. In a single patient, only the diaphragm was involved along with the liver. Liver scintigraphy and ultrasonography were equally helpful in delineating the extent of the disease, but computed tomographic scanning is now the method of choice. The operations were through a thoracolaparotomy in 3 patients and a thoracotomy alone in 3 patients. A single patient had a thoracotomy with a transdiaphragmatic laparotomy. Complete drainage or excision of hydatid cavities was accomplished in all patients. Hydrogen peroxide instilled into the cysts was satisfactory for control of spread potentially secondary to possible intraoperative spillage. There have been no postoperative deaths. Follow-up has ranged from 6 months to 8 years, and 2 patients had relapsing hydatid disease 3 years postoperatively. These results suggest that, when hydatid disease of the liver is complicated by transdiaphragmatic extension and simultaneous pleural or pulmonary cysts, early surgical repair is indicated. Complete drainage and cyst excision are recommended.

Análisis del Registro Nacional Español de la Cirugía Laparoscópica del Páncreas

Resumen Introduccion En el pasado, la experiencia de la cirugia laparoscopica del pancreas se mantenia limitada a experiencias individuales con un reducido nucleo de pacientes. El reciente estudio multicentrico europeo ha permitido conocer los limites y los resultados de la tecnica. En este trabajo se presenta el analisis de los resultados del Registro Nacional Espanol de la Cirugia Laparoscopica del Pancreas (RNEP). Material y metodos Se ha incluido a 132 pacientes con lesiones localizadas en el pancreas izquierdo: 42 tumores neuroendocrinos, 40 neoplasias quisticas, 24 quistes y seudoquistes, 8 tumores inflamatorios, 8 carcinomas ductales, 7 neoplasias papilares mucinosa, 1 carcinoma acinar, 2 tumores solidos seudopapilares. Resultados El indice de conversion fue del 9,7%. La tecnica de enucleacion se realizo tan solo en pacientes portadores de un insulinoma. La pancreatectomia distal con preservacion esplenica fue la utilizada con mas frecuencia. La mortalidad fue nula y, como morbilidad, la fistula pancreatica aparecio en el 16% de los casos. Conclusiones A pesar de que el numero de hospitales espanoles es limitado, los resultados obtenidos hacen esperar una mayor experiencia en un futuro proximo.