Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. In the absence of consensus definitions and treatment guidelines the diagnosis and management of IAH and ACS remains variable from institution to institution. An international consensus group of multidisciplinary critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to develop practice guidelines for the diagnosis, management, and prevention of IAH and ACS. Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference. The present article is the second installment of the final report from the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of the Abdominal Compartment Syndrome. The prevalence and etiological factors for IAH and ACS are reviewed. Evidence-based medicine treatment guidelines are presented to facilitate the diagnosis and management of IAH and ACS. Recommendations to guide future studies are proposed. These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.

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Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840220145

The treatment of portal hypertension: A meta-analytic review

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.22772

Vascular disorders of the liver.

Although liver transplantation is a widely accepted treatment for hepatocellular carcinoma (HCC), much controversy remains and there is no generally accepted set of guidelines. An international consensus conference was held on Dec 2-4, 2010, in Zurich, Switzerland, with the aim of reviewing current practice regarding liver transplantation in patients with HCC and to develop internationally accepted statements and guidelines. The format of the conference was based on the Danish model. 19 working groups of experts prepared evidence-based reviews according to the Oxford classification, and drafted recommendations answering 19 specific questions. An independent jury of nine members was appointed to review these submissions and make final recommendations, after debates with the experts and audience at the conference. This report presents the final 37 statements and recommendations, covering assessment of candidates for liver transplantation, criteria for listing in cirrhotic and non-cirrhotic patients, role of tumour downstaging, management of patients on the waiting list, role of living donation, and post-transplant management.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(11)70175-9.pdf

Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report

Background Transjugular placement of an intrahepatic stent is a new technique to establish a portosystemic shunt for treatment of portal hypertension. A puncture needle is advanced in a catheter through the inferior vena cava into a hepatic vein; then an intrahepatic branch of the portal vein is punctured and an expandable stent of metallic mesh is implanted to establish the shunt. Methods We attempted the stent-shunt procedure in 100 of 112 consecutive patients with variceal bleeding due to cirrhosis, who were then followed for a mean (±SD) of 12 ±6 months. Of the 100 patients, 22 had Child-Pugh class C cirrhosis, 10 were treated on an emergency basis, and 68 had alcoholic cirrhosis. The shunt was established with use of Palmaz stents expanded to 8 to 12 mm in diameter. Results Technical success was achieved in 93 percent of the patients. The mean (±SD) time for the procedure was 1.2 ±0.3 hours. The shunt reduced the portal venous pressure gradient by 57 percent. Major complications were hemorrhage (intr...

https://www.nejm.org/doi/pdf/10.1056/NEJM199401203300303

The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding

FAILURE OF REPEATED INJECTION SCLEROTHERAPY TO IMPROVE LONG-TERM SURVIVAL AFTER OESOPHAGEAL VARICEAL BLEEDING: A Five-year Prospective Controlled Clinical Trial

BACKGROUND The outcome of kidney transplantation in human immunodeficiency virus (HIV)– positive patients who receive organs from HIV-negative donors has been reported to be similar to the outcome in HIV-negative recipients. We report the outcomes at 3 to 5 years in HIV-positive patients who received kidneys from HIV-positive deceased donors. METHODS We conducted a prospective, nonrandomized study of kidney transplantation in HIV-infected patients who had a CD4 T-cell count of 200 per cubic millimeter or higher and an undetectable plasma HIV RNA level. All the patients were receiving antiretroviral therapy (ART). The patients received kidneys from deceased donors who tested positive for HIV with the use of fourth-generation enzyme-linked immunosorbent assay at the time of referral. All the donors either had received no ART previously or had received only first-line ART. RESULTS From September 2008 through February 2014, a total of 27 HIV-positive patients underwent kidney transplantation. Survivors were followed for a median of 2.4 years. The rate of survival among the patients was 84% at 1 year, 84% at 3 years, and 74% at 5 years. The corresponding rates of graft survival were 93%, 84%, and 84%. (If a patient died with a functioning graft, the calculation was performed as if the graft had survived.) Rejection rates were 8% at 1 year and 22% at 3 years. HIV infection remained well controlled, with undetectable virus in blood after the transplantation.

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HIV-positive-to-HIV-positive kidney transplantation--results at 3 to 5 years.

Background: A 5-year experience with the modified sandwich-vacuum pack technique, using an opened 3-litre urological irrigation bag and continuous high-pressure suction, for temporary abdominal wall closure is presented. Methods: The records of all patients who underwent temporary abdominal wall closure using this method from January 1996 to December 2000 were examined. Results: The modified sandwich-vacuum pack was used 139 times in 55 patients. Forty patients sustained penetrating trauma while 15 patients sustained blunt trauma. The mean Injury Severity Score was 19 (range 9-34). Intra-abdominal sepsis (51 per cent) was the commonest indication, followed by visceral oedema (18 per cent), abdominal compartment syndrome (16 per cent), intra-abdominal packing (11 per cent) and abdominal wall defects (4 per cent). The overall mortality rate was 45 per cent. Three patients (5 per cent) developed enterocutaneous fistula. Of the 30 survivors, 16 patients underwent primary fascial closure. Conclusion: The modified sandwich-vacuum pack technique of temporary abdominal wall closure is easy and rapid, cost effective and provides an effective means of containing abdominal wall contents.

Temporary closure of open abdominal wounds by the modified sandwich–vacuum pack technique

BACKGROUND A recent study demonstrated that negative-pressure wound therapy increases underlying tissue pressure. This finding is incongruous with studies using laser Doppler that show that perfusion is immediately increased on initiation of suction. This study investigated perfusion in negative-pressure wound therapy using two alternative modalities. METHODS Radioisotope perfusion imaging was used to determine perfusion beneath circumferential negative-pressure wound therapy dressings on 20 healthy hands (n = 20). Ten hands received suction pressures of -400 mmHg and 10 received -125 mmHg, with the contralateral hand used as a control without any suction. Transcutaneous partial pressure of oxygen was used to determine perfusion beneath noncircumferential negative-pressure wound therapy dressings on 12 healthy legs (n = 12), with each volunteer being sequentially randomized to receive suction pressures of -400 and -125 mmHg, respectively. RESULTS Tissues undergoing circumferential negative-pressure wound therapy demonstrated a mean reduction in perfusion of 40 +/- 11.5 percent (p < 0.0005) and 17 +/- 8.9 percent (p < 0.0005) at suction pressures of -400 mmHg and -125 mmHg, respectively. Perfusion reduction at -400 mmHg was significantly greater than at -125 mmHg (p < 0.015). In the noncircumferential negative-pressure wound therapy group, there was a mean reduction in transcutaneous partial pressure of oxygen of 7.35 +/- 7.4 mmHg (p < 0.0005) and 5.10 +/- 7.4 mmHg (p < 0.0005) at suction pressures of -400 mmHg and -125 mmHg, respectively. There was a tendency for greater reductions in the -400 mmHg group, but this was not significantly different from the -125 mmHg group (p = 0.07). CONCLUSIONS These findings demonstrate that perfusion beneath negative-pressure wound therapy decreases for increasing suction pressure. Thus, it is suggested that negative-pressure wound therapy should be used with caution on tissues with compromised vascularity, particularly when used circumferentially.

Negative-pressure wound therapy II: negative-pressure wound therapy and increased perfusion. Just an illusion?

Investigators in South Africa undertook four renal transplantations involving HIV-positive donors and HIV-positive recipients with end-stage renal disease. At 12 months after transplantation, all recipients had good renal function and had not needed dialysis since the procedure.

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Delawir Kahn

Papers

FAILURE OF REPEATED INJECTION SCLEROTHERAPY TO IMPROVE LONG-TERM SURVIVAL AFTER OESOPHAGEAL VARICEAL BLEEDING: A Five-year Prospective Controlled Clinical Trial

HIV-positive-to-HIV-positive kidney transplantation--results at 3 to 5 years.

Temporary closure of open abdominal wounds by the modified sandwich–vacuum pack technique

Negative-pressure wound therapy II: negative-pressure wound therapy and increased perfusion. Just an illusion?

Renal transplantation between HIV-positive donors and recipients.