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Patients with splenectomy or splenic dysfunction are likely to suffer from severe infections and sepsis. This syndrome is called overwhelming postsplenectomy infection (OPSI). We present an adult case of OPSI syndrome secondary to Streptococcus pneumoniae, seven years after having performed splenectomy for mesenteric thrombosis with splenic venous involvement and antecedent of orthotopic liver transplantation. OPSI syndrome is associated with a high mortality. The course is rapid, the clinical symptoms are serious and the prognosis is poor. It is important for splenectomized patients to receive immunizations, antibiotic prophylaxis and seek medical attention at the earliest sign of minor infection. Public health politics should improve the implementation of guidelines related to the monitoring of splenectomized patients and prophylaxis, diagnosis and treatment of OPSI syndrome and give better information to patients and physicians in relation to this disease. [ABSTRACT FROM AUTHOR]

Background: Biliary complications after liver transplantation are a serious cause of morbidity and mortality. Direct invasive cholangiography techniques, endoscopic retrograde cholangiography (ERCP) and percutaneous transhepatic cholangiography (PTC) all have procedure-related complications. Ultrasonography and magnetic resonance cholangiopancreatography (MRCP) are non-invasive, safe, and accurate. Objective: The aim of this study was to evaluate the use of US and MRCP for detecting biliary complications following liver transplantation and compare these findings with those from the gold standard, ERCP. Methods: Between march 2006 and January 2009, twenty-seven consecutive liver transplant recipients at the Hospital Pablo Tobón Uribe in Medellín-Colombia who presented clinical and biochemical evidence of biliary complications were evaluated with US, MRCP and ERCP. Results: The presence of a biliary anastomotic complications was confirmed in 26 patients (92.6%), anastomotic biliary strictures in 24 (88.9%), ischemic or diffuse intrahepatic biliary strictures in two (7.4%), and choledocholithiasis in one (3.7%). All patients underwent ERCP, 25 underwent US (92, 5%) and 13 underwent MRCP (48, 1%). There was a statistically significant correlation for MRCP and ERCP findings, but not for US findings. The sensitivity of MRCP was 80% and its specificity was 50%. The sensitivity of US was 55.6% with 50% specificity. Positive and negative predictive values for MRCP were 92.3% and 25%, but for US were 93.7% and 7.8% respectively. Conclusions: MRCP is an accurate imaging tool for assessment of biliary complications after liver transplantation. We recommend that MRCP be the diagnostic imaging modality of choice in this setting, reserving direct cholangiography for therapeutic procedures. [ABSTRACT FROM AUTHOR]

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The case of a 54 year-old man, who received and orthotopic liver transplantation because of hepatic-cirrhosis by hepatitis B virus infection Before transplantation the patient received 150 mg/d of lamivudine for 19 months, and negative results for hepatitis B- DNA were achieved after one month of this treatment. The patient underwent an orthotopic liver transplantation on 30th of May 2001. He was extubated at 24 hrs post surgery and remained in the intensive care unit for five more days. Complications arising from the event were pneumonia at 72 hrs post surgery and Staphylococcus aureus sepsis and candidemia at day eleven, both showing good response to antibiotic treatment. A total amount of 78.029 IU of hepatitis B hyperimmune globulin were administrated intramuscularly starting in the anhepatic phase of transplantation and up to the 29m day after it. He received 10.000 IU of hepatitis B hyperimmune globulin every 4 to 8 weeks, which kept protective levels of anti-HBsAg. (>150 mlU/ml) The daily doses of 150 mg of lamivudine has continued without interruption so far. After reaching protection levels of anti-HBsAg, the polimerase chain reaction for hepatitis 8 virus was negative. The immunosuppressive therapy consisted of steroids and ciclosponne A. He left the hospital 21 days after the transplantation. This is the first reported case in Mexico regarding the used of lamivudine and hepatitis B hyperimmune globulin in liver transplantation of patients with cirrhosis by hepatitis B virus. [ABSTRACT FROM AUTHOR]