Long Term Outcomes after Pediatric Liver Transplantation / 대한소아소화기영양학회지

Long term outcomes after liver transplantation are major determinants of quality of life and of the value of this heroic treatment. As short term outcomes are excellent, our community is turning to take a harder look at long term outcomes. The purpose of this paper is to review these outcomes, and highlight proposed treatments, as well as pressing topics needing to be studied. A systemic review of the English literature was carried in PubMed, covering all papers addressing long term outcomes in pediatric liver transplant from 2000-2013. Late outcomes after pediatric liver transplant affect the liver graft in the form of chronic liver dysfunction. The causes include rejection particularly humoral rejection, but also de novo autoimmune hepatitis, and recurrent disease. The metabolic syndrome is a major factor in long term cardiovascular complication risk. Secondary infections, kidney dysfunction and malignancy remain a reality of those patients. There is growing evidence of late cognitive and executive function delays affecting daily life productivity as well as likely adherence. Finally, despite a good health status, quality of life measures are comparable to those of children with chronic diseases. Long term outcomes are the new frontier in pediatric liver transplantation. Much is needed to improve graft survival, but also to avoid systemic morbidities from long term immunosuppression. Quality of life is a new inclusive measure that will require interventions and innovative approaches respectful not only on the patients but also of their social circle.

[Does nasal decontamination reduce the incidence of infections after cardiac surgery?]

Mupirocin applied to the anterior nares four times daily usually eliminates Staphylococcus aureus, including methicillin resistant, within 48 hours. Prophylactic intranasal mupirocin is safe, inexpensive and effective in reducing the overall sternal wound infection after open-heart surgery. This study was designed to determine whether decreasing nasal bacterial colonization by applying mupirocin intra nasally decreases mediastinal, sternal, pulmonary and cutaneous infections after open-heart surgery. After institutional approval and informed consent, 392 patients were included in a randomized, prospective study. Nasal cultures were taken for all patients before surgery. Patients were divided in two groups: Group I [n=190] receiving mupirocin in the anterior nares 4 times daily for 48 hours before surgery; Group II [n=202] was the control group. Patients were followed for a month after surgery. All mediastinal, sternal, pulmonary and cutaneous infections were documented and treated with appropriate antibiotics. A Student test for quantitative data and a X [2] test for qualitative data were used for statistical analysis. p

Combined coronary surgery and aortic valve replacement after previous right pneumonectomy

Cardiac surgery in patients with previous pneumonectomy is infrequently reported. We report a case of combined coronary artery bypass grafting and aortic valve replacement in a patient with left ventricular ejection fraction less then 35% and a previous right pneumonectomy. All steps in operative management of this rare condition are discussed

Mivacurium in an obese patient with myotonic dystrophy: a case report

Mivacurium is a short-acting non-depolarizing neuromuscular blocking agent. Its use in an obese patient with myotonic dystrophy undergoing laparoscopic cholecystectomy is reported. Mivacurium was used as a bolus dose of 0.07 mg. kg [-1], followed by a continuous infusion at the rate of 0.003 mg. kg [-1]. min [-1]. Muscle relaxation, monitored by a train of four count, was adequate throughout the surgery. Spontaneous recovery of the neuromuscular function was obtained fifteen minutes after the end of mivacurium infusion. Neostigmine was not given. Postoperative mechanical ventilation and respiratory complications were avoided

Hemodynamic effects of pressure support ventilation following cardiac surgery

Hemodynamic effects of pressure support ventilation [PSV] were assessed in 33 patients, after cardiac surgery. The patients, selected for their stable left ventricular and respiratory functions, underwent uncomplicated coronary artery bypass grafting. They all underwent the same anesthetic protocol, and an invasive hemodynamic monitoring. Eight to ten hours postoperatively, while all patients were fully awake, normothermic and hemodynamically stable, controlled ventilation [CV] was replaced by 3 levels of PSV [20, 10, 5 cm H20]. These levels were applied consecutively for 20 minutes each, before extubation. Hemodynamic and gas exchange data were recorded on CV, on each level of PSV, and on spontaneous breathing. The results were analyzed using ANOVA and Bonfferoni methods. No statistical significance could be noted between the five modes of ventilation as to hemodynamic parameters, arterial and mixed venous blood gases, and oxygen consumption [VO2]. The only 2 parameters that reached statistical significance were central venous pressure and respiratory rate. Our study demonstrates that patients with stable cardiovascular and respiratory function can adapt to different levels of PSV without hemodynamic modifications or an increase in their VO2