Effective hemostasis is critical in severe presacral hemorrhage because the bleeding may be fatal. We report our successful use of combined hemostatic sponge and cyanoacrylate glue in three patients with life-threatening presacral hemorrhage after abdominoperineal resection of the rectum for carcinoma.
In Brief Objective: To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients. Background: Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need for timely and size appropriate grafts for pediatric recipients. Methods: Analysis of data from the Studies of Pediatric Liver Transplantation (SPLIT) registry, a multicenter database of 44 North American pediatric liver transplant programs. The outcome (morbidity and mortality) of each of the technical variants were compared with that of whole organ recipients. Results: Data were available on 2192 transplant recipients (1183 whole, 261 split, 388 reduced, and 360 live donor). Recipients of all technical variant graft type were significantly younger than whole organ recipients, but on average spent 2.3 months less on the waiting list. Thirty-day post-transplant morbidity was increased for each type of technical variant relative to whole organ (45.1% whole, 66.7% split, 65.5% reduced, 51.9% live-donor). Biliary complications (30 day: 7.5% whole, 18.8% split, 16% reduced, 17.5% live-donor) and portal vein thrombosis (30 day: 3.6% whole, 8% split, 8% reduced, 7.5% live-donor) were more common in all technical variant types. Graft type was an independent predictor of graft loss (death or retransplantation) in a multivariate analysis. Split and reduced (relative risk = 1.74 and 1.77, respectively) grafts had a worse outcome when compared with whole organ recipients. Conclusions: Technical variant techniques expand the pediatric donor pool and reduce time from listing to transplant, but they are associated with increased morbidity and mortality. Technical variant liver transplantation comprising reduced, split, and live-donor grafts evolved to address the need for size appropriate organs for pediatric liver recipients. This study will examine the outcome and morbidity of the technical variant techniques relative to whole organ transplants in the Studies of Pediatric Liver Transplantation (SPLIT) database.
Abstract: Primary angiosarcoma of the breast is a rare and aggressive malignancy that is typically seen in premenopausal patients. The tumor's spread occurs predominantly through the bloodstream; involvement of the lymphatics is unusual. We present a case of breast angiosarcoma presenting with enlarged axillary lymph nodes treated with a modified mastectomy and axillary lymph node dissection. Pathology found no tumor in the lymph nodes. Based on this experience and data from the literature, we suggest evaluation of the sentinel nodes prior to potentially morbid standard level 1 and 2 axillary lymph node clearance.
Department of Surgery, University of Missouri-Columbia, Columbia, Missouri, USA Reprint requests and correspondence: James W Jones, MD, PhD, Professor and Chairman, Department of Surgery, University of Missouri-Columbia School of Medicine, M580 HSC, One Hospital Drive, Columbia, MO 65212, USA. Received 07 March 2002; accepted 25 March 2002
