Paraparesis caused by transarterial chemoembolization: A case report

Transarterial chemoembolization (TACE) is an effective modality for the treatment of Hepatocellular Carcinoma. It is used to treat small tumors and to downstage large tumors to meet liver transplant criteria. TACE can be associated with multiple side effects, including fever, right upper quadrant pain, nausea, vomiting, hepatic failure, hepatic encephalopathy, cholecystitis and pancreatitis. Neurological complications after TACE are rare, usually caused by cerebral embolism, and confirmed by means of imaging studies. Spinal cord ischemia secondary to TACE is extremely rare and can lead to significant morbidity. We report a case of paraparesis caused by TACE with normal imaging and nerve conduction studies, suggestive of localized vasculitis

Infrahepatic Vena Cavocavostomy, a Modification of the Piggyback Technique for Liver Transplantation

We describe our experience with a modification of the piggyback (PB) technique for orthotopic liver transplantation in which the donor infrahepatic vena cava is used as the venous outflow tract. From May 1997 to January 2006, a total of 109 cases using this technique were performed in 101 patients. Collected data included recipient demographics and diagnosis, warm ischernia time, use of venovenous bypass or temporary portacaval shunt and complications related to the venous outflow and graft, and patient survival. Data were compared with the patients undergoing standard PB technique during the same period. The reasons for using the technique were grouped according to whether there was a problem with the recipient hepatic veins or a concern about the length or diameter of the donor suprahepatic vena cava. These included the presence of a trans-jugular intrahepatic portosystemic shunt (eight cases), retransplantation (22 cases), thin-walled, friable hepatic veins (32 cases), Budd-Chiari syndrome (two cases), domino liver procurement (six cases), reduced or split liver grafts (five cases), and graft inferior vena cava to recipient hepatic veins size discrepancy (34 cases). There was no graft loss. The warm ischemia time was 39.65 minutes compared with 37 minutes in the standard PB group. The long-term graft and patient survival rates were similar in the two groups. Infrahepatic vena cavocavostomy is a useful variation of the standard PB technique