Anesthetic management during the first combined heart-liver transplant performed in Korea: a case report / 대한마취과학회지

Herein, we describe the anesthetic management during the first combined heart-liver transplant (CHLT) performed in Korea. Though CHLT is a rare procedure, accumulating evidence suggests that it is a feasible option for patients with coexisting heart and liver failure. A 45-year-old female patient presented with severe cardiac dysfunction requiring extracorporeal membrane oxygenation (ECMO) support and secondary congestive hepatopathy. The patient underwent consecutive heart and liver transplantation using extracorporeal circulatory devices—heart transplant with cardiopulmonary bypass, and liver transplant with peripheral ECMO. In this case report, we focus on the specific anesthetic considerations for CHLT pertaining to the challenges associated with dual pathophysiology.

Effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma patients

BACKGROUNDS/AIMS: To evaluate the effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma (HCC) patients on postoperative gastrointestinal motility recovery and admission days, liver function and nutrition recovery, and postoperative complication. METHODS: From August 2010 to July 2011, 102 patients with primary HCC underwent hepatectomy. Forty two patients took a sip of water (SOW) at postoperative day (POD)#1, soft blended diet (SBD) at POD#2 (early diet group, ED group), otherwise 60 patients took a SOW at POD#3, SBD at POD#4 (conventional diet group, CD group). Postoperative flatus-pass day, stool-pass day, nausea, vomiting, admission days, immediate postoperative (POD#0) and POD#1, 3, 5, 7 profiles of albumin, prothrombin time (PT) INR, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), white blood cell (WBC), and POD#1, 3, 5, 7 profiles of C-reactive protein (CRP), and postoperative complications cases were compared between ED group and CD group. All clinical data were compared retrospectively. RESULTS: Flatus-pass days (p<0.01), stool-pass days (p<0.01) and postoperative admission days (p=0.012) were shorter in ED group. Total bilirubin levels were higher at POD#0, 1, 3 but lower or similar at POD#5, 7 in ED group. AST, ALT levels were higher at POD#0 but lower at POD#1, 3, 5. There were no significant differences in albumin, PT INR, WBC, CRP and postoperative complication rates. CONCLUSIONS: ED group had no difference in nutritional recovery and postoperative complication rates compared to CD group but it has better gastrointestinal motility recovery, liver function recovery, and shorter postoperative admission days.

Rhabdomyolysis and Mild Kidney Injury in a Patient with Acute Hepatitis A / 영남의대학술지

A 48-year-old male visited the emergency room of the authors' hospital due to nausea, vomiting, and myalgia for four days. Acute hepatitis A was identified from the serologic marker of the hepatitis A virus. Mild elevation of the serum creatinine and creatinine phosphokinase (CPK) suggested rhabomyolysis, which was confirmed with the serum aldolase, myoglobin, and urine myoglobin. With supportive care, both the liver and renal functions were recovered gradually and fully. This case shows that rhabdomyolysis can be one of the mechanisms of renal complication in cases of acute symptomatic hepatitis A.

Effects of kainic Acid-induced seizures on GABA and GABA transporter in the cerebellum of the rat / 대한해부학회지

The effects of kainic acid-induced seizures on GABA and GABA transporter in the rat cerebellum were examined by means of immunohistochemical and Western blot methods. Immunocytochemical analysis showed that kainic acid-induced seizures led to a decreased immunoreactivity for GABA to 3 weeks after seizures with an slight increase in the immunoreactivity of cerebellum 24 h after treatment. Immunoreactivities of GABA transporters, GAT-1 and GAT-3 which are localized neurons and astrocytes, were increased at 24 and 48h and after that weak immunoreactivites for GABA transporters were shown in the cerebellar tissues. Our results indicate that kainic acid-induced seizures exerts specific effects on GABA contents and the GABA transporters in the cerebellum and a decrease of GABA contents might not always associated with the decrease in the number of GABA transporters in the rat cerebellum.

c-kit Receptor and Ligand Expression in Developing Nervous System Blocked c-kit Function by ACK2 / 대한해부학회지

The objective of the present study was to investigate the expression of KL ligand and synaptophysin during postnatal development of the cerebellum blocked c-kit function by ACK2 to determine whether the c-kit receptor and KL ligand interacting system could play a role during the migration of cerebellar neuronal cells and during establishment of functional synapses of all cerebellar neurons. In this study, we used in situ hybridization technique in order to examine the expression of KL mRNA in the cerebellar tissue following intraperitoneal injections of ACK2 and to study the localization of synaptophysin and protein products of KL ligand (SCF: Stem Cell Factor) during postnatal development we used immunohistochemical methods. Our findings are that the intensity of immunoreaction to SCF (protein product of KL ligand) antibody is increased while an immunoreactivity to anti-synaptophysin is decreased in the Purkinje cell bodies in the cerebellum of the mouse given ACK2 from the postnatal day 3 (P3) to Pl4. The overexpression of KL mRNA is detected in the Purkinje cell bodies at Pl4 in the cerebellum blocked c-kit function. At postnatal day 21, the period of which establishment of functional connections of all cerebellar neurons is complete, immunoreactivities of SCF and synaptophysin in the ACK2 treated cerebellum is recovered to the same level being observed in the control. With above results, we suggest a role for the c-kit receptor in the synaptogenesis and migration of developing cerebellar neurons with interaction of ckit receptor/KL ligand system. And the overexpression of KL ligand mRNA and protein product in the Purkinje cells is supposed to be one of mechanisms compensate for the lack of c-kit function in the cerebellum induced by ACK2 during postnatal development.