RESUMO
STUDY DESIGN: Between July 1993 and March 1997, 110 children were listed for primary elective liver transplantation with cadaveric (Cad: n = 68) or living-related (LR: n = 42) donors. Pregraft mortality, post-transplant survival, and surgical and immunologic complications were retrospectively compared in both groups. RESULTS: The pregraft mortality rate was 10 (15%) of 68 versus 1 (2%) of 42 in the Cad and LR groups, respectively (P =.049). Postliver transplantation 1-year patient and graft survival rates were 87% and 75% in the Cad group (n = 49) versus 92% and 90% in the LR group (n = 41), respectively (NS). The incidence of post-transplant complications was as follows: hepatic artery thrombosis (Cad: 16%; LR: 0%, P =.020), portal vein thrombosis (Cad: 8%; LR: 2%, NS), and biliary complications (Cad: 14%; LR: 34%, P =.044). The overall incidence of acute rejection was similar in both groups; however, a lower incidence of acute rejection occurred in LR graft recipients treated with tacrolimus. CONCLUSIONS: The introduction of an LR donor liver transplantation program allowed a significant decrease in the pretransplant mortality rate, with a consequent overall improvement in patient survival compared with the Cad series. The incidence of biliary complications was higher in the LR series, whereas better human leukocyte antigen matching in this subgroup did not result in a lower rejection incidence.
Assuntos
Transplante de Fígado , Doadores Vivos , Adolescente , Bélgica/epidemiologia , Cadáver , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Incidência , Lactente , Falência Hepática/mortalidade , Falência Hepática/cirurgia , Transplante de Fígado/mortalidade , Transplante de Fígado/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: This multicenter study compared the clinical and bacteriologic efficacy of two oral antibiotics, cefuroxime axetil and amoxicillin/clavulanate, in the treatment of acute bacterial maxillary sinusitis. PATIENTS AND METHODS: Three hundred seventeen patients with clinical and radiographic evidence of acute maxillary sinusitis were enrolled at nine centers and were randomly assigned to receive 10 days of treatment with cefuroxime axetil 250 mg twice daily (n = 157) or amoxicillin/clavulanate 500 mg three times daily (n = 160). Patients were assessed for both clinical and bacteriologic responses once during treatment (5 to 7 days) and twice after treatment (1 to 3 days and 4 weeks). Bacteriologic assessments were based on needle aspirates of the maxillary sinus obtained pretreatment and, when possible, at the first posttreatment visit. RESULTS: Organisms were isolated from the pretreatment sinus aspirates of 198 of 317 (62%) patients, with the primary isolates being Streptococcus pneumoniae (22%), Haemophilus spp. (17%), Staphylococcus aureus (13%), and Haemophilus influenzae (10%). A satisfactory clinical outcome (cure or improvement) was achieved in 85% (98 of 115) and 82% (102 of 124) of the clinically evaluable patients treated with cefuroxime axetil or amoxicillin/clavulanate, respectively (P = 0.446). With respect to the eradication of the bacterial pathogens, a satisfactory outcome (cure or presumed cure) was obtained in 84% (31 of 37) and 87% (34 of 39) of bacteriologically evaluable patients treated with cefuroxime axetil or amoxicillin/clavulanate, respectively (p = 0.567). Treatment with amoxicillin/clavulanate was associated with a significantly higher incidence of drug-related adverse events (13% versus 3%, p = 0.001), particularly diarrhea (8% versus 1%, p = 0.001). Two patients in the cefuroxime axetil group and three patients in the amoxicillin/clavulanate group withdrew from the study due to adverse events. CONCLUSIONS: Our results indicate that cefuroxime axetil twice a day is as effective as amoxicillin/clavulanate three times a day in the treatment of acute bacterial maxillary sinusitis but produces fewer adverse effects.
Assuntos
Amoxicilina/uso terapêutico , Cefuroxima/análogos & derivados , Ácidos Clavulânicos/uso terapêutico , Sinusite Maxilar/tratamento farmacológico , Pró-Fármacos/uso terapêutico , Doença Aguda , Adulto , Amoxicilina/efeitos adversos , Combinação Amoxicilina e Clavulanato de Potássio , Cefuroxima/efeitos adversos , Cefuroxima/uso terapêutico , Ácidos Clavulânicos/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/uso terapêutico , Humanos , Sinusite Maxilar/microbiologia , Pró-Fármacos/efeitos adversos , Método Simples-Cego , Resultado do TratamentoRESUMO
Two years after an orthotopic liver transplantation, a multifocal hepatic tumor with lymphonodular metastases, identified as a fibrosarcoma, developed in a 4-year-old girl being treated with cyclosporine. On a needle biopsy sample, genetic typing of the HLA-DR group revealed that tumoral cells were from the recipient.
Assuntos
Fibrossarcoma/etiologia , Neoplasias Hepáticas/etiologia , Transplante de Fígado/efeitos adversos , Pré-Escolar , DNA de Neoplasias/análise , Feminino , Fibrossarcoma/genética , Antígenos HLA-DR/genética , Humanos , Neoplasias Hepáticas/genética , Doadores de TecidosRESUMO
An acute or fulminant adenovirus hepatitis developed in 5 of 224 pediatric patients who were recipients of orthotopic liver transplants. All had received prednisolone, azathioprine, and cyclosporine as basal immunosuppression, and four received monoclonal (OKT3) or polyclonal (antithymocyte globulin) antibodies for steroid-resistant rejection episodes. These patients initially had high fever and a worsening condition for a mean of 73 days after transplantation (range 44 to 140 days). Results of biochemical tests showed very high serum levels of lactate dehydrogenase. Aspartate aminotransferase values were always markedly more elevated than those of alanine aminotransferase. Two patients had severe leukopenia. Results of histologic studies of the liver showed extensive areas of confluent necrosis and targetlike hepatocyte nuclei. Typical intranuclear viral inclusions were observed on electron microscopy. Adenovirus was cultured in all patients and in two relatives. Two patients died of liver failure; others recovered after cessation of immunosuppression. We conclude that adenovirus hepatitis can be fatal in liver transplant recipients. There is no specific treatment, and immunosuppression must be discontinued.
Assuntos
Infecções por Adenovirus Humanos/etiologia , Hepatite Viral Humana/etiologia , Transplante de Fígado/efeitos adversos , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/patologia , Adenovírus Humanos/classificação , Adenovírus Humanos/isolamento & purificação , Azatioprina/administração & dosagem , Azatioprina/uso terapêutico , Atresia Biliar/cirurgia , Pré-Escolar , Ciclosporina/administração & dosagem , Ciclosporina/uso terapêutico , Hepatite Viral Humana/diagnóstico , Hepatite Viral Humana/patologia , Humanos , Lactente , Hepatopatias/cirurgia , Transplante de Fígado/patologia , Necrose , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Fatores de TempoRESUMO
La sintomatología otoneurológica se aprecia frecuentemente en el síndrome postcontusional encefálico, predominando síntomas en forma de vértigo postural, desequilibrio corporal, tinnitus e hipoacusia. La actual experiencia clínica y experimental sugiere una clara relación entre la cuantía del traumatismo encéfalo craneal y el grado de secuela vestíbulo-coclear. El análisis de dos grupos de pacientes con síndrome vestíbulo-craneal post-traumatismo encéfalo craneal diferenciados por su perfil evolutivo temporal entrega indicios de que la persistencia de la lesión laberíntica no compensada a nivel de los núcleos vestibulares centrales participa en la génesis del síndrome post contusional mediante la distorsión de los reflejos vestíbulo-ocular y vestíbulo-espinal. El hallazgo de alteraciones concomitantes en dos reflejos de seguimiento ocular (interacción visual-vestibular-oculomotora) en forma de nistagmus optokinético y seguimiento visual pendular reafirman estos supuestos. Paralelamente se analizan la influencia del cerebelo, interacción visual-vestibular y retículo-espinal en el proceso de la compensación vestibular central
Assuntos
Humanos , Lesões Encefálicas/complicações , Vertigem/etiologia , Reflexo Vestíbulo-OcularRESUMO
Stenosis of the suprahepatic inferior vena caval anastomosis is a rare but serious vascular complication after liver transplantation. It may cause significant obstruction to venous drainage from the allograft liver and result in the Budd-Chiari syndrome with massive ascites and pleural effusion causing respiratory compromise. The authors report two such cases in which percutaneous transluminal angioplasty (PTA) of the stenotic anastomosis was performed. This nonsurgical approach resulted in resolution of ascites, pleural effusion, and respiratory distress in both patients. They conclude that PTA is a therapeutic alternative with minimal risk compared with surgical repair or retransplantation and should be considered the initial treatment of choice in selected patients.
Assuntos
Angioplastia com Balão , Síndrome de Budd-Chiari/terapia , Transplante de Fígado , Complicações Pós-Operatórias/terapia , Veia Cava Inferior/cirurgia , Derivação Arteriovenosa Cirúrgica , Constrição Patológica/terapia , Feminino , Humanos , LactenteRESUMO
Of 33 children admitted within 24 hours after accidental ingestion of a caustic substance, 14 (42.5%) had evidence of upper airway lesions on direct laryngoscopy. Three patients, 10 to 12 months old, needed endotracheal intubation for acute respiratory obstruction; four patients younger than 2 years had severe dyspnea without obstruction; seven patients had mild or no respiratory symptoms. All were discharged without respiratory sequelae, although esophageal stenosis developed in six patients. Nine of 13 patients younger than 2 years, compared to five of 20 patients older than 2 years, had upper airway lesions (P less than 0.01). The frequency of respiratory tract lesions was higher in patients with severe esophagitis. Eleven of 17 patients with severe esophagitis, compared to three of 16 with mild inflammation, had respiratory tract lesions (P less than 0.025). No specific caustic substance predisposed to upper airway lesions.