ABSTRACT
Objective To explore nursing of the patients with acute myelogenous leukemia after upper abdominal cluster transplantation.Methods From March 2009 to August 2012,eight cases of upper abdominal organ cluster transplantation were performed in our center,among whom one suffered from acute myelogenous leukemia after operation.We summarized the clinical data and nursing methods of this case.Results The leukocytes,erythrocytes and platetets decreased 22 days after transplantation and the decreasing continued for more than four months.Four bone marrow biopsies were performed.During the first two biopsies,no definite cause of the blood cells decreasing was found,while the outcome of the third time showed that it was type M3 acute myeloid leukemia and genetic testing at the fourth time showed AML1/E-TO was positive.After diagnosis,the patient was shifted to the Department of Hematology and underwent further treatment.Conclusions Close observation,timely diagnosis and treatment,prevention of infection,bleeding and psychological nursing are the keys to promote patients recovery.
ABSTRACT
Objective Modified upper abdominal cluster transplantation (MCT), which was inspired by the classical cluster transplant technique, has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin-dependent diabetes mellitus (DM) than orthotopic liver transplantation (OLT) alone. In this study, we summarized our experience with MCT in 5 consecutive patients suffering from end stage liver diseases associated with insulin-dependent type 2 DM in our single center.Methods Five patients with hepatitis B-related chronic liver cirrhosis and insulin dependent type 2 DM received MCT in our single center. The biliary and exocrine pancreatic drainage reconstructions were achieved by a Roux-en-Y duodenojejunostomy or a side-to-side duodenojejunostomy. A quadruple immunosuppressive regimen based on tacrolimus including Basiliximab induction, mycophenolate mofetil (MMF) and steroids was used in the early stage post-transplant, and then converted to tacrolimus monotherapy.Results All of the patients experienced an uneventful post-operative recovery. They were rendered independent from insulin therapy shortly after transplantation. The fasting glucose and glycosylated hemoglobin levels were within normal range. In addition, the fasting C-peptide value was increased from much lower than the normal range pre-transplant to within normal range post-transplant and maintained stable since then. However, the third patient suffered from graft verse host disease (GVHD) 20 days post-operatively and died from severe infection on the post-operative 47 days. The other 4 patients had returned to work and a normal lifestyle over 22, 15, 5 and 4 months of follow-up.Conclusion MCT is an effective method in treating patients suffering from end stage liver diseases combined with insulin-dependent type 2 DM. Whether a cluster graft would increase the risk of GVHD needs further investigation.
ABSTRACT
Abdominal multivisceral transplantation is a new and proved effective therapeutic methods for two or more terminal abdominal organs. Upper abdominal exenteration(resection of the liver,stomach,spleen,pancreaticoduodenal complex,and part of the colon) for the treatment of otherwise unresectable tumors is one of the more radical operations in oncology.Some new surgical methods such as liver-intestinal,liver-kidney,pancreas-kidney and multivisceral cluster transplantation have emerged recently.These new advance surgical approache improve the curative effect of abdominal organ transplantation.
ABSTRACT
Objective To explore the monitoring methods for pancreatic graft function after upper abdominal cluster transplantation.Methods Analysis of the clinical data of 5 cases of successful upper abdominal(cluster) transplantation in our center.Results The patients recovered well after the operation.Endocrine and exocrine functions of all the pancreas graft returned to normal without any rejection.Conclusions Dynamic monitoring of blood glucose,C-peptide,blood insulin,blood amylase,urine amylase,amylase in abdominal drainage and duodenal tube decompression drainage,in addition to Doppler color ultrasound examination,can effectively detect the endocrine and exocrine function of the pancreas graft.