sábado, 21 de diciembre de 2013

Más de hígado y pulmón/More on liver and lung

 El pulmón y el hígado: un viejo problema, nuevos conceptos
The lung in liver disease: old problem, new concepts.
Fallon MB, Zhang J.
Department of Internal Medicine, Division of Gastroenterology, Hepatology & Nutrition, The University of Texas Medical School at Houston, 6431 Fannin Street, MSB 4.234, Houston, Texas 77030, USA. Michael.B.Fallon@uth.tmc.edu
Trans Am Clin Climatol Assoc. 2013;124:250-62.
Liver dysfunction has been recognized to influence the lung in many different clinical situations, although the mechanisms for these effects are not well understood. One increasingly recognized interaction, the hepatopulmonary syndrome (HPS) occurs in the context of cirrhosis and results when alveolar microvascular dilation causes arterial gas exchange abnormalities and hypoxemia. HPS occurs in up to 30% of patients with cirrhosis and significantly increases mortality in affected patients. Currently, liver transplantation is the only curative therapy. Experimental biliary cirrhosis induced by common bile duct ligation (CBDL) in the rat reproduces the pulmonary vascular and gas exchange abnormalities of human HPS and has been contrasted with other experimental models of cirrhosis in which HPS does not develop. Microvascular dilation, intravascular monocyte infiltration, and angiogenesis in the lung have been identified as pathologic features that drive gas exchange abnormalities in experimental HPS. Our recent studies have identified biliary epithelium and activation and interaction between the endothelin-1 (ET-1)/endothelial endothelin B (ETB) receptor and CX3CL1/CX3CR1 pathways as important mechanisms for the observed pathologic events. These studies define novel interactions between the lung and liver in cirrhosis and may lead to effective medical therapies. 

Transplante de hígado: avances y cuidado perioperatorio 
Liver transplantation: Advances and perioperative care.
Nandhakumar A, McCluskey SA, Srinivas C, Chandy TT.
Department of Anaesthesia, Toronto General Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada.
Indian J Anaesth. 2012 Jul;56(4):326-35. doi: 10.4103/0019-5049.100812.
Liver transplantation is one of the treatments for many-life threatening liver diseases. Numerous advances in liver transplant surgery, anaesthesia and perioperative care have allowed for an increasing number of these procedures. The purpose of this review is to consider some of the important advances in perioperative care of liver transplant patients such as pre-operative evaluation, intraoperative monitoring and management and early extubation. A PubMed and EMBASE search of terms "Anaesthesia" and "Liver Transplantation" were performed with filters of articles in "English", "Adult" and relevant recent publications of randomised control trial, editorial, systemic review and non-systemic review were selected and synthesized according to the author's personal and professional perspective in the field of liver transplantation and anaesthesia. The article outlines strategies in organ preservation, training and transplant database for further research.
KEYWORDS:Adult liver transplantation, anaesthesia, hepatopulmonary syndrome, hepatorenal syndrome, liver transplantation, organ preservation, recent advances, reperfusion injury

Anestesiología y Medicina del Dolor
Publicar un comentario