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Biliary tract reconstruction in liver transplantation
1206
INTERNATIONAL ABSTRACTS
autopsy, although the material in one case could not be adequately analyzed. The unexpected finding of meconium peritonitis in these cases addresses the importance of autopsy of all stillborn fetuses whose parents may benefit from genetic counseling based on autopsy findings.--Eugene S. Wiener Prognosis of Extrahepatic Biliary Atrasia. R.H.J. Houwen, R.P. Zwierstra, R.S. Severinjen, et al. Arch Dis Child 64:218, (March), 1989.
This retrospective study of 89 patients with extrahepatic biliary atresia born in The Netherlands over a 10-year period revealed that of 71 cases who had hepatic portoenterostomies, bile drainage was achieved in 65%. The development of cholangitis was the most important determinant of long-term survival with a 5-year survival rate of 54% in the 19 patients who had cholangitis and 91% in the 27 who did not. The authors support early surgical intervention without external bile drainage, recommend the use of ciprofloxacin as antibiotic prophylaxis against cholangitis, and discuss the use of choleretic drugs.--D.M. Burge Biliary Tract Reconstruction in Liver Transplantation.
ItF.J. Wall,
D.R. Grant, R.E. Mimeault, et al. Can J Surg 32:9%100, (March), 1989. The authors reviewed their first 161 orthotopic liver transplant patients, some of whom were as young as 8 months. Their method of biliary reconstruction differs from that of others in that it uses no stents or T-tubes and retains the donor gallbladder, allowing radiologic access in the posttransplant period. There were biliary complications in 13%. A Roux-en-Y reconstruction with anastomosis to the donor duct was associated with the lowest complication rate (2%). Previous upper abdominal surgery was a major risk factor for biliary complications. These complications must be diagnosed accurately and treated quickly. Death due primarily to such complications is now uncommon. To avoid leakage after the cholecystostomy tube is removed, the authors wait for at least 3 months when the daily steroid dose is low. The long-term frequency of ehololethiasis in the donor gall bladder remains to be determined.~igmund H. Ein Biliopancreatic Bypass in the Prader-Wil|i Syndrome. J.J.
Brossy.
Br J Surg 76:313, (March), 1989. The Prader-Willi syndrome (PWS) presents with mental retardation, hypotonia, hypogonadism, and obesity. Most survivors are grossly obese. The author describes the use of a jejunoileal shunt in successfully treating this problem in a 31-year-old man. He suggests that the operation be considered in all PWS patients who survive to their teens.--John D. Orr Congenital Splenic Cysts Presenting After Blunt Abdominal Trauma. S. Stylianos and T. V. Santulli. NYS J Med 89:289-291, (May),
1989. The authors report two children who were discovered to have congenital cysts of the spleen following blunt abdominal trauma. A 15-year-old girl presented with abdominal discomfort and a left upper quadrant mass 5 months following a fall from a bicycle, and a 17-year-old boy presented with similar symptoms 3 months following a skiing accident. Both underwent splenectomy for large epidermold cysts containing old blood. The authors reviewed the literature and found 125 reported cases of congenital splenic cysts. Thirty (24%) of these patients presented following an episode of blunt abdominal trauma, and most (63%) presented with abdominal discomfort or a mass within 6 months of injury. Treatment is discussed, and partial splenectomy with cystectomy for splenic cysts not involving the hilum is recommended.--John N. Schullinger
Distal Splenorenal Shunt for Portal Vein Thrombosis After Liver
Transplantation. LR. Marino, C.O. Esquivel, A.B. Zajko, et al. Am J Gastroenterol 84:67-70, (January), 1989. A 17-year-old female who received a liver transplantation for type I glycogen storage disease developed thrombosis of the portal vein with hepatopetal collateral flow 1 year following her transplant. The collaterals were sufficient to maintain good liver perfusion but were insufficient to decompress the portal hypertension. Since graft function remained excellent and its histologic architecture was normal, retransplantation was not performed. Instead, the patient was successfully treated with a distal splenorenal shunt.--Richard R. Ricketts Cytomagalovirus Gastroenteritis After Liver Transplantation. R. Proujansky, S.R. Orenstein, S.A. Kocoshis, et al. J Pediatr 113:700703, (October), 1988.
Orthotopic liver transplantation is being utilized with increasing frequency as a treatment for chronic progressive liver disease that has not responded to standard medical or surgical therapy. Cyclosporin A and steroids have been used postoperatively to control rejection episodes and to prolong graft survival but may put the patient at risk for acquiring life-threatening infectious diseases. The authors report four patients with cytomegalovirus infection in the posttransplant period whose initial symptoms were of serious gastrointestinal disease including nausea, vomiting, and rectal bleeding. The authors recommend prompt endoscopic evaluation of serious gastrointestinal symptoms in immunosuppressed patients after transplant procedures. This evaluation should include histologic examination and viral culture of mucosal biopsy specimens.--G. IV. Holcomb, Jr Adrenal Hemorrhage in the Newborn With Evidence of Bleeding in Utero. T. Gotoh, Y. Adachi, O. Nounaka, et al. J Urol 141:1145-
1147, (May), i989. The authors report adrenal hemorrhage in a male newborn with evidence of bleeding while in utero. The patient had a large cystic mass on ultrasound at 36-weeks gestation. Abdominal computerized tomography after birth also showed a cystic mass above the left kidney that became smaller with peripheral calcification at 5 months of age. On follow-up ultrasound 3 months later, the mass had disappeared. This case suggests that adrenal hemorrhage can occur before delivery.--G. W. Holcomb, Jr Out-Patient Operation of Inguinal Hernia in Children. S. Mejdahl, H.J. Gyrtrup, and E. Kvist. Br J Surg 76:406-407, (April), 1989.
The authors present a review of 527 hernia repairs performed on children as outpatients with a median age of 4 years. There were 15 (3.7%) recurrences with no wound infections observed, nor were there any anesthetic complications. The authors conclude that inguinal herniotomy should be performed on outpatients immediately after the diagnosis has been made, irrespective of the age of the child. Outpatient surgery resulted in a significant financial saving.-J.D. Orr
GENITOURINARY TRACT Aphallia: Its Classification and Management. S.J. Skoog and A.B.
Belman. J Urol 141:589-592, (March), 1989. Aphallia is an extremely rare disorder with profound urologic and psychological consequences. Approximately 60 patients have been reported on in the literature, and the authors report their experience with three additional patients. Fifty patients had sufficient information to classify the condition according to the site of the urethral
INTERNATIONAL ABSTRACTS
autopsy, although the material in one case could not be adequately analyzed. The unexpected finding of meconium peritonitis in these cases addresses the importance of autopsy of all stillborn fetuses whose parents may benefit from genetic counseling based on autopsy findings.--Eugene S. Wiener Prognosis of Extrahepatic Biliary Atrasia. R.H.J. Houwen, R.P. Zwierstra, R.S. Severinjen, et al. Arch Dis Child 64:218, (March), 1989.
This retrospective study of 89 patients with extrahepatic biliary atresia born in The Netherlands over a 10-year period revealed that of 71 cases who had hepatic portoenterostomies, bile drainage was achieved in 65%. The development of cholangitis was the most important determinant of long-term survival with a 5-year survival rate of 54% in the 19 patients who had cholangitis and 91% in the 27 who did not. The authors support early surgical intervention without external bile drainage, recommend the use of ciprofloxacin as antibiotic prophylaxis against cholangitis, and discuss the use of choleretic drugs.--D.M. Burge Biliary Tract Reconstruction in Liver Transplantation.
ItF.J. Wall,
D.R. Grant, R.E. Mimeault, et al. Can J Surg 32:9%100, (March), 1989. The authors reviewed their first 161 orthotopic liver transplant patients, some of whom were as young as 8 months. Their method of biliary reconstruction differs from that of others in that it uses no stents or T-tubes and retains the donor gallbladder, allowing radiologic access in the posttransplant period. There were biliary complications in 13%. A Roux-en-Y reconstruction with anastomosis to the donor duct was associated with the lowest complication rate (2%). Previous upper abdominal surgery was a major risk factor for biliary complications. These complications must be diagnosed accurately and treated quickly. Death due primarily to such complications is now uncommon. To avoid leakage after the cholecystostomy tube is removed, the authors wait for at least 3 months when the daily steroid dose is low. The long-term frequency of ehololethiasis in the donor gall bladder remains to be determined.~igmund H. Ein Biliopancreatic Bypass in the Prader-Wil|i Syndrome. J.J.
Brossy.
Br J Surg 76:313, (March), 1989. The Prader-Willi syndrome (PWS) presents with mental retardation, hypotonia, hypogonadism, and obesity. Most survivors are grossly obese. The author describes the use of a jejunoileal shunt in successfully treating this problem in a 31-year-old man. He suggests that the operation be considered in all PWS patients who survive to their teens.--John D. Orr Congenital Splenic Cysts Presenting After Blunt Abdominal Trauma. S. Stylianos and T. V. Santulli. NYS J Med 89:289-291, (May),
1989. The authors report two children who were discovered to have congenital cysts of the spleen following blunt abdominal trauma. A 15-year-old girl presented with abdominal discomfort and a left upper quadrant mass 5 months following a fall from a bicycle, and a 17-year-old boy presented with similar symptoms 3 months following a skiing accident. Both underwent splenectomy for large epidermold cysts containing old blood. The authors reviewed the literature and found 125 reported cases of congenital splenic cysts. Thirty (24%) of these patients presented following an episode of blunt abdominal trauma, and most (63%) presented with abdominal discomfort or a mass within 6 months of injury. Treatment is discussed, and partial splenectomy with cystectomy for splenic cysts not involving the hilum is recommended.--John N. Schullinger
Distal Splenorenal Shunt for Portal Vein Thrombosis After Liver
Transplantation. LR. Marino, C.O. Esquivel, A.B. Zajko, et al. Am J Gastroenterol 84:67-70, (January), 1989. A 17-year-old female who received a liver transplantation for type I glycogen storage disease developed thrombosis of the portal vein with hepatopetal collateral flow 1 year following her transplant. The collaterals were sufficient to maintain good liver perfusion but were insufficient to decompress the portal hypertension. Since graft function remained excellent and its histologic architecture was normal, retransplantation was not performed. Instead, the patient was successfully treated with a distal splenorenal shunt.--Richard R. Ricketts Cytomagalovirus Gastroenteritis After Liver Transplantation. R. Proujansky, S.R. Orenstein, S.A. Kocoshis, et al. J Pediatr 113:700703, (October), 1988.
Orthotopic liver transplantation is being utilized with increasing frequency as a treatment for chronic progressive liver disease that has not responded to standard medical or surgical therapy. Cyclosporin A and steroids have been used postoperatively to control rejection episodes and to prolong graft survival but may put the patient at risk for acquiring life-threatening infectious diseases. The authors report four patients with cytomegalovirus infection in the posttransplant period whose initial symptoms were of serious gastrointestinal disease including nausea, vomiting, and rectal bleeding. The authors recommend prompt endoscopic evaluation of serious gastrointestinal symptoms in immunosuppressed patients after transplant procedures. This evaluation should include histologic examination and viral culture of mucosal biopsy specimens.--G. IV. Holcomb, Jr Adrenal Hemorrhage in the Newborn With Evidence of Bleeding in Utero. T. Gotoh, Y. Adachi, O. Nounaka, et al. J Urol 141:1145-
1147, (May), i989. The authors report adrenal hemorrhage in a male newborn with evidence of bleeding while in utero. The patient had a large cystic mass on ultrasound at 36-weeks gestation. Abdominal computerized tomography after birth also showed a cystic mass above the left kidney that became smaller with peripheral calcification at 5 months of age. On follow-up ultrasound 3 months later, the mass had disappeared. This case suggests that adrenal hemorrhage can occur before delivery.--G. W. Holcomb, Jr Out-Patient Operation of Inguinal Hernia in Children. S. Mejdahl, H.J. Gyrtrup, and E. Kvist. Br J Surg 76:406-407, (April), 1989.
The authors present a review of 527 hernia repairs performed on children as outpatients with a median age of 4 years. There were 15 (3.7%) recurrences with no wound infections observed, nor were there any anesthetic complications. The authors conclude that inguinal herniotomy should be performed on outpatients immediately after the diagnosis has been made, irrespective of the age of the child. Outpatient surgery resulted in a significant financial saving.-J.D. Orr
GENITOURINARY TRACT Aphallia: Its Classification and Management. S.J. Skoog and A.B.
Belman. J Urol 141:589-592, (March), 1989. Aphallia is an extremely rare disorder with profound urologic and psychological consequences. Approximately 60 patients have been reported on in the literature, and the authors report their experience with three additional patients. Fifty patients had sufficient information to classify the condition according to the site of the urethral