Results of liver transplantation in fulminant hepatic failure.

Liver transplantation has dramatically changed the management of patients with fulminant hepatic failure and subacute hepatic failure. A wide range of survival rates (55% to 90%) reported from different centers performing liver transplantation for fulminant hepatic failure reflects variations in patient selection and the centers' experience. Results of transplantation appear to be improving, with survival rates approaching 80% at 1 year in some series. The improved results are attributed to vigorous perioperative management, using intracranial pressure monitoring and continuous arteriovenous hemofiltration when required, early listing of patients with organ-sharing network, and exclusion of patients who are unlikely to recover neurologically after successful transplantation. Use of piggyback hepatectomy to minimize hemodynamic alterations during surgery has also contributed to better results in critically ill patients. Patients with acetaminophen toxicity have a more favorable outcome than those with viral hepatitis or non-acetaminophen drug hepatotoxicity. Because of limited availability of cadaveric organs, emergency living-related liver transplantation, use of ABO incompatible and marginal livers need consideration. Auxiliary liver transplantation is desirable for those who have a chance of spontaneous recovery, thus obviating life-long immunosuppression after recovery of the native liver.

Need for bringing in a change in biochemistry curriculum to make it clinically oriented?

OBJECTIVES: This study was conducted to (a) assess the views of medical students and doctors regarding relevance of biochemistry training, (b) explore if they have any suggestion to bring in any improvement in contents of biochemistry curriculum and mode of teaching. METHODS: In 1997-98, a structured questionnaire was filled up by 114 medical students and 118 doctors. RESULTS: As many as 62/114 (55%) medical students and 40/118 (34%) doctors believed that it is not important to remember minute details of biochemical reactions (p value < 0.0001). Among medical students, 108/110 (98.2%) agree that a clinician should be invited to seminars for developing skills of interpretation of laboratory investigations; whilst 110/118 (93.2%) doctors expressed similar view, p value ns. Approximately 92% responders favored that departments biochemistry and physiology should co-ordinate on the topics of common interest in order to save time and effort. What is the most informative and effective way of teaching biochemistry?' in response to this question only 0.9% responders opted lecture as the best option. Seminars with active participation of medical students was preferred by 93.2% responders. About 6.9% responders reckoned that symposium prepared by a more than one teacher. In response to the question whether it is possible to cover pre-clinical subjects in 12 months so as to allow spiral mode of curriculum, 73% of all the responders agreed that it would be good idea, there was no difference of opinion among the doctors and medical students. On the other hand, 27% were strongly opposed to this suggestion. CONCLUSIONS: We suggest that there is a need to modify the contents, methods of teaching, and curriculum organization of training in clinical biochemistry. How best the curriculum can be made problem oriented needs to be debated among medical educationists.