ГЕПАРИН-ИНДУЦИРОВАННАЯ ТРОМБОЦИТОПЕНИЯ У ПАЦИЕНТА ПОСЛЕ ТРАНСПЛАНТАЦИИ ПЕЧЕНИ

The widespread use of heparin as an anticoagulant has led to the formation of the problem of heparin-induced thrombocytopenia (HIT). At the present time, the number of different areas of surgical practice, in which we have to face this threat complication, is increasing. We present the clinical case of HIT in a young patient after liver transplantation. Diagnostics of HIT allowed in time to establish the cause of massive thrombus formation, perform liver transplantation, exclude the use of heparin and save the life of the patient.Широкое применение гепарина в качестве антикоагулянта привело к формированию проблемы гепарининдуцированной тромбоцитопении (ГИТ). На современном этапе число различных направлений хирургической практики, в которых приходится сталкиваться с этим грозным осложнением, увеличивается. Представлен собственный опыт диагностики ГИТ у молодого пациента после трансплантации печени в НИИ скорой помощи им. Н.В. Склифосовского, который позволил вовремя установить причину массивного тромбообразования, выполнить ретрансплантацию печени, исключив использование гепарина, и сохранить жизнь пациенту

Grain and seed protein functionality

Editado por Jiménez-López, José Carlos (CSIC

Baseline characteristics of patients in the reduction of events with darbepoetin alfa in heart failure trial (RED-HF)

<p>Aims: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes.</p> <p>Methods and results: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate <60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106–117) g/L.</p> <p>Conclusion: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.</p&gt

Echography in the evaluation of the severity of ischemia-reperfusion injuries of a liver transplant

Objective: to study the role of echographic techniques in the evaluation of hemodynamic and structural changes in a liver transplant (LT) in ischemia-reperfusion injuries (IRI).Materials and methods. The results of an echographic follow-up were analyzed in 122 patients who had undergone orthotopic liver transplantation in 2005 to 2010.Results. A high-resistance flow pattern was more frequently recorded in the arterial bed of LT within the first 24 postoperative hours. On day 3, there were negative changes as an increased resistance index at the level of the hepatic artery or its branches in 35% of the patients. Transient postischemic structural changes in the grafted organ were diagnosed in 42.3% of all the examinees; formation of large focal necroses was found in 28%. Mortality in patients with transient edema of the hepatic parenchyma was 4.5%. In the group of recipients who had been diagnosed as having large focal hepatic parenchymal necroses, mortality was 29.6%. Liver retransplantation was carried out in 10% of the patients because of graft dysfunction.Conclusion. According to the echographic findings, LT hemodynamic and structural changes as a sequel of prior IRI were revealed in the overwhelming majority of recipients. Ultrasound follow-up monitoring is a reliable tool for assessing the severity of LT injuries and risk factors for poor outcome

The role of sonography in early diagnosis of biliary complications in orthotopic liver transplantation

The results of multiple complex ultrasound examinations performed in 180 patients after the OLT in early and late postoperative period are analyzed. The presence of biliary anastomotic failure (BAF) after OLT was diagnosed in 6.1 % of recipients. Sensitivity, specificity and diagnostic accuracy of BAF by dynamic ultrasound observation in our study were 100, 98 and 99 % respectively. The emergence of biliary hypertension (BH) due to strictures of anastomotic and nonanastomotic localization was diagnosed by ultrasound in 12.2 % of operated patients. According to the study of dynamic ultrasound investigation previous ischemic damage to liver transplant or vascular complications were detected in 82.3 % of patients with the BAF and in 30.4 % patients with evidence of the presence of strictures of the biliary tree

HEPARIN-INDUCED THROMBOCYTOPENIA IN PATIENT POST LIVER TRANSPLANTATION

The widespread use of heparin as an anticoagulant has led to the formation of the problem of heparin-induced thrombocytopenia (HIT). At the present time, the number of different areas of surgical practice, in which we have to face this threat complication, is increasing. We present the clinical case of HIT in a young patient after liver transplantation. Diagnostics of HIT allowed in time to establish the cause of massive thrombus formation, perform liver transplantation, exclude the use of heparin and save the life of the patient

Prophylaxis end treatment of vascular complications after liver transplantation

The study analyzes the reasons for the development of vascular complications, prevention and treatment after liver transplantation. In a retrospective study enrolled 206 patients who had undergone 214 orthotopic liver transplantation (OLT). Vascular complications has diagnosed in 18 (8.4 %) patients in postoperative period. A relatively low incidence of hepatic artery thrombosis (HAT) had seen in our study. Low molecular weight heparin (LMWH) plays an important role in the prevention of thrombosis. Doppler ultrasonography is a convenient and efficient method for detecting posttransplant complications and plays an important role in guiding treatment. Early diagnosis of these complications allows to decide on the tactics of the patients and to determine indications for emergency surgical revascularization and save the graft

Therapy for sepsis caused by methicillin-resistant Staphylococcus aureus strain in a patient after orthotopic liver transplantation: a clinical observation

The paper gives a clinical example of successful therapy for severe sepsis, the cause of which was methicillin-resistant Staphylococcus aureus infection in a patient undergoing liver transplantation and splenectomy

Liver Transplantation in the Treatment of Unresectable Hepatocellular Carcinoma in the Absence of Liver Cirrhosis

Aim.  The aim of the study is to determine the effectiveness of liver transplantation (LT) in the treatment of unresectable hepatocellular carcinoma (HCC) occurred in normal liver.Material and methods.  6 patients with unresectable HCC underwent orthotopic liver transplantation (OLT). The long-term OLT results were compared with survival results of liver resection in patients with late stage HCC.Results.  Hepatocellular carcinoma is one of the most common types of cancer, which occurs mainly in patients with liver cirrhosis and chronic viral hepatitis. Only about 10 % of HCC develops in non-cirrhotic liver among young and somatically healthy patients. 1-, 3-, 5-year recurrence-free and overall survival in LT group was significantly better than in the control group.Conclusion.  LT is indicated for patients with unresectable HCC in non-cirrhotic liver and its extrahepatic localization. A large tumor size and macrovascular invasion should not be a contraindication for LT in such patients

Liver Transplantation in the Treatment of Unresectable Hepatocellular Carcinoma in the Absence of Liver Cirrhosis

Aim.  The aim of the study is to determine the effectiveness of liver transplantation (LT) in the treatment of unresectable hepatocellular carcinoma (HCC) occurred in normal liver.Material and methods.  6 patients with unresectable HCC underwent orthotopic liver transplantation (OLT). The long-term OLT results were compared with survival results of liver resection in patients with late stage HCC.Results.  Hepatocellular carcinoma is one of the most common types of cancer, which occurs mainly in patients with liver cirrhosis and chronic viral hepatitis. Only about 10 % of HCC develops in non-cirrhotic liver among young and somatically healthy patients. 1-, 3-, 5-year recurrence-free and overall survival in LT group was significantly better than in the control group.Conclusion.  LT is indicated for patients with unresectable HCC in non-cirrhotic liver and its extrahepatic localization. A large tumor size and macrovascular invasion should not be a contraindication for LT in such patients