The treatment of postsurgical chylothorax with fibrin glue is reported. Chylothorax developed in a 3 1/2-month-old infant 2 days after extrapleural ligation of a patent ductus arteriosus. At rethoracotomy the chyle leak could not be located. To stop chyle effusion, the region of the presumed leakage was sealed with fibrin glue and a pleural flap. It is suggested that early reoperation and closure of the chyle leak with fibrin adhesive should be considered in cases of postsurgical chylothorax in infants.

A case of retroperitoneal fibromatosis in a 28-year-old white male is presented. The soft tissue tumor, with a weight of 8000 g, was resected by laparotomy. Because of adhesions to the ascending colon and the right ureter, a hemicolectomy and partial resection of the right ureter had to be performed additionally. Intraabdominal fibromatoses are very infrequent tumorous lesions of the connective tissue, occurring retroperitoneally only in isolated cases. Their etiology is presumed to be a hereditary or gene-associated defect in the regulation of connective tissue growth. In addition, trauma and hormonal influences often appear as inductive cofactors.

The two main indications for liver grafting are primary malignancy and parenchymatous liver disease. In both cases orthotopic transplantation remains the preferred technique. Since graft rejection was considered not to be the main problem in clinical liver transplantation, recent improved survival rates were reported to be due to a more aggressive diagnostic management and consequent treatment of postoperative complications nonrelated to graft rejection. Because of the limited number of organs available for organ grafting sometimes technical modifications may become necessary. This was the case in a 40-year old male patient suffering from primary malignant hepatoma. The donor was a child, and during operation a great difference between organ size and length and diameter of the hepatic vessels became evident. Orthotopic transplantation was performed using an unusual method of caval vein anastomosis. Initially the patient did very well, but later on liver function deteriorated and the patient died in the eighth postoperative week because of hepatic artery thrombosis. The autopsy showed that all other vascular anastomosis were patent and no signs of portal hypertension were evident. The surgical technique used in this case is described in detail and some interesting aspects are discussed.

No abstract

No abstract