ABSTRACT
Objective To discuss the surgical procedures and treatment after combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends in one case.Methods A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.With the techniques of en bloc,the liver and intestinal grafts were harvested from cadaveric donor.The intestinal graft,200 cm long,was implanted with portal venous drainage and aortic inflow,and enterostomy of both ends was performed instead of intestinal anastomosis.The liver graft was placed in a piggyback fashion with end to end anastomosis of the bile ducts without T tube. Inmunosuppression protocol was administrated with campath-1H and tacrolimus.Endoscopic biopsy of intestinal graft was performed regularly,and clinical observation was done to monitor the acute rejection.Results In the first month after operation,abdominal infection was controlled by intraperitoneal drainage with open surgery.One suspect acute rejection was treated with methylprednisolone.Until sixth month,the functions of liver and intestine were progressively restored.However,the patient lost weight and could not be free from intravenous nutrition because of diarrhea.Conclusion Combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends is a simple surgical procedure with lower risk of surgical complications.This method is propitious to monitoring rejection and function improvement of the grafts.Diarrhea and loss of digestive juice are the main reasons of low body weight and malnutrition.
ABSTRACT
In this study antigen-independent factor in the pathogenesis of chronic rejection of organ transplants was examined. Kidney isografts and allografts were transplanted orthotopically into bilaterally nephroectomized rat recipients and studied functionally, morphologically and immunohistologically, at serial intervals up to 52 weeks after transplantation. Allograft recipients developed progressive proteinuria after 12 weeks, with gradual renal failure ultimately leading to death. At the same time, morphological changes, including progressive arteriosclerosis and glomerulosclerosis, tubular atrophy and interstitial fibrosis, developed. Immunohistologically, macrophages infiltrated glomeruli during this period and cytokines became unregulated. Our results showed that antigen-independent functional and morphological changes occurred in long-term kidney isografts and mimicked those appearing much earlier in allografts that reject chronically. Initial injury and extent of functioning renal mass is suggested to be important factor for such late changes.
Subject(s)
Animals , Rats , Graft Rejection , Allergy and Immunology , Pathology , Graft Survival , Physiology , Kidney , Allergy and Immunology , Pathology , Kidney Transplantation , Allergy and Immunology , Methods , Pathology , Proteinuria , Rats, Inbred Strains , Time Factors , Transplantation, Homologous , Transplantation, IsogeneicABSTRACT
Objective To study and summarize the cause and reoperative method of massive hemorrhage of upper gastrointestinal tract after gastrectomy. Methods The clinical data of 11 cases patients with massive hemorrhage of the upper gastrointestinal tract after gastrectomy from August 1986 to June 2000 were analyzed retrospectively. Results 5 cases were anastomotic bleeding,3 cases injured gastric remnant mucosa bleeding,2 cases ulcer bleeding after bancroft gastrectomy, 1 case overlooked leiomyoma bleeding.All patients were cured with reoperation.Conclusions To prevent post operative bleeding is the key. The evaluation of the condition of patients with massive hemorrhage of the upper gastrointestinal tract,timing of reoperative intervention,and the selection of proper operative method are also very important.
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Objective TO compare the effect of early postoperative intraperitoneal chemotherapy (EPIC) with that of intravenous chemotherapy (IVC)on the immunity of patients with gastrointestinal carcinoma (GC).Methods 36 patients were divided into two groups each with 18 cases, one group received EPIC and the other IVC, then determined the serum T-lymphocyte subsets (T LS) and sIL-2R before and after the chemotherapy.Results Serum CD3, CD4 and sIL 2R in GC patients after the chemotherapy decreased more significantly than those of before the chemotherapy (P0.1),but mean sIL 2R level in EPIC group was lower than that in IVC (0.05