Surgical rescue for failures of cirrhotic sclerotherapy

Article Abstract:

The most serious complication of portal hypertension (increased pressure in the portal vein of the liver) is bleeding esophageal varices (enlarged, swollen and tortuous veins at the lower end of the esophagus). Liver cirrhosis (degenerative disease of the liver in which the lobes are covered with fibrous tissue) obstructs the flow of blood through the liver, causing portal hypertension. The best initial treatment for bleeding esophageal varices is endoscopic sclerotherapy. With this procedure surgery is avoided and survival may be improved. The failure rate for sclerotherapy is still about 30 percent. There are two surgical techniques that can help these patients following failed sclerotherapy: shunt surgery and liver transplantation. The current approach to sclerotherapeutic failure takes into account the underlying cause of the variceal bleeding. In the nonalcoholic cirrhosis conditions, such as cryptogenic cirrhosis and chronic hepatitis, shunt surgery should be successful if the liver function and size are preserved. In primary biliary cirrhosis, the patient can remain stable for many years; however, when levels of bilirubin, a pigment in the bile, begin to rise, liver deterioration is progressive; if the bilirubin is below 3 and albumin is normal, shunt surgery should be performed; otherwise transplantation should be considered. In sclerosing cholangitis, once jaundice and cirrhosis have been proven, transplantation should be used. Alcoholic cirrhosis may present an ethical dilemma for centers that have historically been reluctant to perform transplants because alcoholism was considered a self-induced disease and poor postoperative cooperation was assumed. This probably will change in the light of two recent court cases, and widening acceptance of alcoholism as a treatable disease. It has been shown that stable alcoholic cirrhotic patients who have preservation of functional liver cells can do well with shunt surgery. End-stage alcoholic liver disease requires transplantation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Usage, Injuries, Complications and side effects, Liver, Liver transplantation, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Esophageal varices, Portal hypertension, Sclerotherapy, Splenorenal shunt, Surgical, Surgical splenorenal shunt

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Fifty-three reoperations for hyperparathyroidism

Article Abstract:

The condition of hyperparathyroidism, the excessive activity of the parathyroid glands, is successfully treated during initial surgery 95 percent of the time. In cases in which the neck must later be reopened, the success rate is significantly lower. It has been shown that undiscovered or newly developed parathyroid adenomas (tumors) account for the majority of reoperations. This report describes a conclusive method for localizing parathyroid adenomas. Abnormalities of the parathyroid gland were imaged by subtraction angiography using the radioactive tracer, thallium-210-iodine 123, in 53 patients who had neck surgery previously. Forty-two patients had residual hyperparathyroidism and 11 had thyroidectomies (removal of the thyroid gland) before hyperparathyroidism was detected. The authors conclude that careful neck exploration and resection of the thymus during the initial surgery could identify parathyroid adenomas and prevent unnecessary reoperations. In addition, abnormal calcium and phosphorus levels in the blood might expose a concealed case of hyperparathyroidism. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Prevention, Surgery, Neck, Hyperparathyroidism, Reoperation

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