Gabexate combined with Xuebijing after local infusion in treatment of severe acute pancreatitis / 国际外科学杂志

ObjectiveTo observe the treatment effect of seveve acute pancreatitis (SAP) with gabexate combined with Xuebijing after local infusion. MethodsForty-four patients with SAP were randomly divided into receiving intravenous gabexate or Xuebijing alone (control group) group and receiving local infusion with gabexate combined with Xuebijing( experimental group) group. At 1,7,14 days of testing in diamine oxidase (DAO), lipopolysaccharide, IL-18, TNF-α, APACHE- Ⅱ score, T lymphocyte subpopulation and monocyte HLA-DR expression and single change in the number of nuclear cells were tested. ResultsBetween two patients groups at 1,7,14 days diamine oxidase, lipopolysaccharide, IL-18, TNF-α, APACHE-Ⅱ score showed a downward trend; T suppressor cells (Ts) reduced in their percentage; total T lymphocytes, T helper cell (Th), monocyte HLA-DR expression (percentage) and mononuclear cells showed an upward trend in the experimental group than control group, the differences being statistically significant (P ＜ 0.05). In the experimental group and control group, the pain relief time, intestinal function recovery time, the withdrawal of ventilator time, the incidence of sepsis, the rate of conversion to open surgery were statistically significant different (P ＜ 0.05 ). Conclusions Compared with intravenous drug use alone the implementation of gabexate combined with Xuebijing local infusion can reduce the early course of SAP patients intestinal permeability and reduce endotoxin translocation, protect intestinal barrier function of patients with SAP, improve the patients' immune function, symptoms, signs and reduce the rate of sepsis and transit operations.

Successful ABO Incompatible Adult Living Donor Liver Transplantation with New Simplified Protocol without Local Infusion Therapy and Splenectomy / 대한이식학회지

BACKGROUND: Since the time various strategies have been introduced to overcome the ABO-blood barrier including local infusion therapy (LIT), plasmapheresis and rituximab, the graft and patient survival outcome of ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) has remarkably improved. But, the need for LIT under rituximab prophylaxis should be reevaluated because of high incidence of the LIT-related complications. The aim of this study was to verify the safety and efficacy of the protocol without local infusion therapy in ABOi ALDLT. METHODS: From November 2008 to December 2010, 43 cases of ABO-incompatible adult living donor liver transplantation were performed. In all cases, the spleen was preserved. From the 1st to 20th case, LIT was employed (group I, n=20). From the 21th case onwards, LIT was eliminated from the protocol (group II, n=23). The 3-month and 1-year patient and graft survival rates were compared between the two groups. The clinical parameters including recipient, donor and graft-related factors were also compared. The graft function was assessed in each group based on the serial changes in serum AST/ALT, total bilirubin and prothrombin time. RESULTS: There was 1 case of in-hospital mortality (2.3%) among the 43 cases. Overall 3-month and 1-year patient and graft survival rate was 97.7% and 92.1% during a mean period of 11.4 +/- 0.4 (0.9~28.9) months. There was no significant difference in the 3-month and 1-year patient and graft survival rates (95.0 vs. 100% and 90.0 vs. 92.9%, P=0.60) between groups. LIT-related complications occurred in 4 patients (20.0%). One case of antibody-mediated rejection occurred in group II. Both groups showed no difference in graft function at postoperative 3rd month. CONCLUSIONS: ABOi ALDLT without splenectomy and LIT resulted in promising outcomes. Therefore, LIT can be safely eliminated from the protocol.

Superselective Local Infusion of Urokinase for Acute Ischemic Stroke in the Carotid Artery Territory

BACKGROUND: It has been known that superselective local infusion of urokinase (UK) for an acute ischemic stroke in the carotid artery territories (CAT) is associated with a high incidence of complete recanalization (RCN) of the occluded arteries and good clinical outcomes without excess risk of hemorrhagic transformation. We intended to evaluate the clinical outcomes of patients who had experienced an acute ischemic stroke in CAT who underwent superselective local infusions of UK and to find clinical variables affecting complete RCN or clinical outcomes. METHODS: Consecutively, 18 patients with acute ischemic strokes in CAT (12 in MCA occlusion and 6 in ICA) were enrolled in this study. All patients underwent superselective local infusion of UK and were assessed degree of to the RCN with angiographic findings and clinical outcomes using a modified Barthel index and a modified NIH stroke scale score prospectively. RESULTS: A complete RCN was achieved in 12 patients (67%), partial RCN in 3 patients (17%) and no RCN in 3 other patients (17%). A complete RCN seems to have been affected by the site of the occlusion (10 in MCA occlusion and 2 in ICA), and the type of ischemic stroke (10 in embolic and 2 in thrombotic). The degree of leptomeningeal collateral circulation(LCC) also affected the degree of the RCN; patients with thrombotic stroke (n=5 ; 2 in good LCC and 3 in poor), a complete RCN was achieved only in patients with good LCC. The clinical outcomes of the patients with complete RCN were significantly superior to the patients with partial or no RCN. Hemorrhagic transformation was observed in 4 patients (22%), but 2 patients did not affect clinical outcome. Three patients died(17%). CONCLUSION: Considering the natural outcome and quality of life of the patients with ischemic stroke in CAT, our results suggest that superselective local infusion of UK as a treatment modality for acute major ischemic stroke is a effective method, as long as adequate clinical variables are fulfilled.