Risk prediction model of survival after hematopoietic stem cell transplantation in patients with malignant hematological diseases / 公共卫生与预防医学

Objective To analyze the risk factors for survival in patients with hematological malignancies after hematopoietic stem cell transplantation (HSCT), to establish a risk prediction and survival prediction model, and to provide a reference for clinical diagnosis and treatment. Methods A total of 237 patients with malignant hematological diseases who underwent HSCT at West China Hospital of Sichuan University from January 2017 to April 2019 were selected as the study subjects. The survival of all patients after HSCT was statistically analyzed. The influencing factors of survival were analyzed by multivariate regression analysis, and the prediction model was constructed. Results A total of 237 patients with hematological malignancies were included in this study. After 3 years of follow-up, 85 patients died, with a mortality rate of 35.86%. Multivariate logistic analysis showed that diabetes mellitus (OR=4.358, P=0.007), infection (OR=3.522, P=0.000), neutropenia time >7d (OR=2.734, P=0.009), incomplete HLA matching (OR=5.688, P=0.000), cGVHD (OR=2.593, P=0.007) and HCT-CI (OR=6.701, P=0.000) were independent risk factors affecting the survival of patients with hematological malignancies after HSCT (P(3.192 + 01.259 + 1.472 ×(diabetes mellitus) + 1.259×(infection) + 1.006 ×(neutropenia time) + 1.738 ×(HLA matching) + 0.953 ×(cGVHD) + 1.902 ×(HCT-CI)), Hosmer-Lemeshow χ2=6.692, P=0.462. AUC and 95%CI of the model for predicting survival were 0.836 and 0.783-0.888, showing good fit and predictive efficiency. Conclusion Diabetes mellitus, infection, neutropenia time >7d, incomplete HLA matching, cGVHD and HCT-CI are all high-risk factors of survival in patients with malignant hematologic disease after HSCT. Clinically, attentions should be paid to these patients and intervention measures should be taken to improve their survival after HSCT.

Real-world outcomes and complications of different surgical approaches for significant submacular haemorrhages

Purpose: To evaluate the outcomes and complications after different surgical management of cases with significant sumacular hemorrhage (SMH) of size more than 4 disc diameter (DD). Methods: It was a retrospective interventional study. All consecutive 103 cases of significant SMHs were treated by vitrectomy and divided into three groups. In Group A (<4 weeks, confined to the macula or extending inferiorly, n = 62), vitrectomy, subretinal cocktail of tissue plasminogen activator (tPA), antivascular endothelial growth factor, and air with SF6 gas; in Group B (4–8 weeks, extending beyond macula, n = 31), subretinal tPA followed by SMH drainage either by retinotomy (Group B?1, n = 17) or by temporal 180?degree retinectomy (Group B?2, n = 14) with silicone oil (SO) tamponade; and in Group C (>8 weeks, extending beyond macula, n = 10), SMH removal with autologous retinal pigment epithelium (RPE)?Choroid patch graft transplantations with SO tamponade were performed. Parameters evaluated were best corrected visual acuity (BCVA), Optos, optical computerized tomography, and ultrasonography as required. Results: Significant visual improvement was seen from mean preoperative to mean postoperative BCVA in Group A (P < 0.001), Group B (P < 0.001), and Group C (P < 0.001). Postoperative complications were recurrent SMH (4.84% vs 12.90% vs 10%), vitreous hemorrhage (6.45%, GroupA), hyphema (4.84% vs 12.90% vs 10%), hypotony (nil vs 3.23% vs 20%), macular hole formation (6.45%, Group A), epiretinal membrane (16.13%, Group B), and retinal detachment (3.23%, Group A and 10%, Group C). Conclusion: Surgical approaches for significant submacular hemorrhage are visually awarding, though certain specific complications may arise

Clinical outcomes of living related kidney transplant recipients with hyperuricemia / 中华内分泌外科杂志

Objective:To observe the clinical outcomes of living related kidney transplantation (LRKT) recipients with hyperuricemia.Methods:A retrospective analysis was conducted on the medical records of 212 cases of LRKTs performed between Jan. 2015 and Dec. 2021. All cases involved children who received a kidney transplant donated by their parents. Based on the average blood uric acid levels (>420 μmol/L) between 1 to 12 months postoperatively, the patients were divided into two groups: the hyperuricemia group (HUA, n=43) and the non-hyperuricemia group (non-HUA, n=169) . Demographic information, the incidence of adverse events within one year after the operation, serum creatinine (Scr) levels, and the survival rate of the transplanted kidney at 1, 3, and 5 years after the operation were compared between the groups. Results:The non-HUA group had a significantly shorter preoperative dialysis duration compared to the HUA group (median 350 days vs 484 days) . The incidence of delayed graft function and acute rejection within 1 year postoperatively was significantly higher in the HUA group compared to the non-HUA group (14.0% vs 4.7% and 11.6% vs 2.4%) . At 1, 3, and 5 years after surgery, the serum creatinine levels in the HUA group were significantly higher than those in the Non HUA group, which were (131.1±31.2) vs (116.3±32.1) mmol, (133.6±34.7) vs (119.9±31.9) mmol/L, and (137.3±32.4) vs (115.4±30.3) mmol/L. The survival rate of kidney transplantation was slightly lower in the HUA group compared to the non-HUA group, but the difference was not statistically significant.Conclusions:Hyperuricemia in kidney transplant recipients who received a donor kidney from their parents is associated with increased incidences of delayed graft function and acute rejection, as well as compromised graft kidney function.

Morphometric evaluation of the kidney and its main renal artery.

Background: With the increasing incidence of renal transplantations and advent of modern imaging techniques in the current era, the knowledge of renal artery variations in their position of origin from abdominal aorta, level of origin from the superior mesenteric artery, pattern of their division towards the renal hilum, and the additional branches from the renal arteries should be well known for preparing renovascular surgical and radiological interventions. Methods: Fifty specimens from 25 adult human embalmed cadavers were taken from the department of anatomy and were studied by dissection method. Morphometric data of the specimens dissected were recorded using vernier calipers. Results: Though morphometric analysis of both the kidneys was studied, it shows no significance from earlier studies. Accessory renal arteries were noted in 24% of cases with equal incidence on both sides. Within accessory, hilar type was most common (14%), followed by inferior polar in 12% and superior polar in 2% of specimens. Accessories in 28.5% specimens gave rise to gonadal arteries and 7.3% specimens to inferior phrenic artery. Conclusion: The results suggest that there are a large number of anatomical variations in the vascularisation of the kidney. The most common incidence is the occurrence of accessory renal arteries. It was rarely found that superior and inferior polar arteries originated from the renal artery. The renal artery diameter is a factor which should be considered as predicting the presence of additional renal arteries.

Application of immune cell functional assay in monitoring immune status in renal transplant recipients / 中华肾脏病杂志

Objective To evaluate the value of immune cell functional assay (ImmuKnow CD4+ T cell ATP assay) in monitoring immune status in renal recipients.Methods A total of 131 adult renal transplant recipients who received transplantation for the first time were under investigation.According to the dynamic monitoring ATP concentration before operation,2 week,1,3,6 months after operation and during infect or rejection,samples were divided into the following groups:health control group (HC),pretransplant (Pre-Tx) group,stable (Tx) group,infect group,acute rejection (AR) group,acute kidney injury (AKI) group.Immune cell functions were detected by ImmuKnow CD4+ T cell ATP assay.Lymphocyte subsets (CD4+/CD8+) were analysed and serum concentrations of FK506 were tested.Mixed lymphocyte reaction(MLR) was analysed.Results The ATP concentration was no significant difference between Pre-Tx and HC group.The ATP concentration of 2 weeks,1 months after operation were significantly higher than Pre-Tx group (P ＜ 0.01).After 3 months,6 months follow-up,the ATP concentration stabilized with time.The ATP concentration of AR group was significantly higher than other three groups (Tx,infect and AKI group,all P ＜ 0.05).The correlation coefficient between the ATP concentration and MLR,CD4+/CD8+,FK506 level were R2=0.0072,R2=10-6,R2=0.004 respectively (all P ＞ 0.05).Conclusions The cell-mediated immunity of recipients is relatively strongger during the first month after transplantation.The ATP concentration is not related to the levels of MLR,CD4+/CD8+,FK506.ImmuKnow ATP assay is a valuable predictor in acute rejection diagnosis.

Adult liver transplantation using left lobe: a report of 9 cases / 中华器官移植杂志

Objective To investigate clinical effectiveness and feasibility of adult liver transplantation using the left lobe.Methods We analyzed the clinical data of 9 recipients who underwent adult liver transplantation using left lobe from March 2007 to April 2011,including 5 cases receiving split liver transplantation and rest 4 cases receiving living donor liver transplantation.Mean graft weight was 444.6 g (325-570 g) and mean graft-recipient weight ratio was 0.886％ (0.65％-1.18％ ).The middle hepatic vein was reserved in 7 cases.Six cases underwent Laden back surgical and 3 cases underwent classical surgical procedures.During the operation,PVP of 4 cases exceeded 20 mm Hg (2.67 kPa),3 cases were subjected to splenic artery ligation and 1 case to splenectomy.All recipients after operation were treated with triple drug maimenance therapy of Tacrolimus,Mycophenolate Mofetil and corticosteroids.We followed-up the recipients long-term,and the incidence of vascular complications and biliary complications,patient and graft survival,restoration of liver function were observed.Results No serious complications occurred in 4 living donors subject to left lobotomy and the liver function had a good recovery.The median follow-up period of these 9 recipients was 15.7 months ( 1 month to 51 months).Overall 1-year patient and graft survival rate was 77.8％ (7/9).Two cases died after operation.In the remaining 7 cases,1 case had initial poor graft function,and cases had initial good graft function.The main complications after operation included biliary anastomotic strictures in 1 case,small-for-size syndrome in 1 case,portal vein thrombosis in 1 case,initial poor graft function in 1 case and abdominal infection in 2 cases.Conclusion With strict for selecting and good matching donor-recipient,adult liver transplantation using left lobe is safe and feasible.

The effect of blastocyst MHC gene transfection on the survival of mouse heart grafts / 中华器官移植杂志

Objective To investigate the effects of Blastocyst MHC gene transfection to coronary on the survival time of mouse heart grafts and the mechanism. Methods Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients respectively, to construct mouse cervical heart transplantation models. In the control group, the donor hearts were perfused using the 0～4 ℃ St. ThomasⅡ solution; in the cyclosporine A (CsA) group, the donor hearts were perfused as same as the control's and received intraperitoneal injection of CsA (5 rng·g-1·d-1) after surgery; in the transfection group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid; in the combined treatment group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid and received intraperitoneal injection of CsA (5 mg·g-1·d-1) after surgery. The survival time of transplanted heart allografts were observed, and their histopathological changes and the degrees of coronary intimal hyperplasia were estimated.Blastocyst MHC gene mRNA expression levels were detected by real-time fluorescence quantitative RT-PCR. Flow cytometry was applied in assessment of the levels of CD4+ CD25+ regulatory T cells (Treg) and CD3+ CD8+ T cells. Results The survival time in the CsA group, transfection group and combined treatment group was significantly longer than in the control group (P＜0.05) and that in the combined treatment group was the longest, up to (20. 50 ± 5. 61) days. On the postoperative day 1 and 3, Blastocyst MHC gene mRNA expression level in the transfection group was significantly higher than that in the control group (P＜0.05). On the postoperative day 7, the degrees of rejection and coronary intimal hyperplasia in the combined treatment group were the lightest. On the postoperative day 7 the number of Tregs in the CsA group and the combined treatment group was significantly increased as compared with that in the control group (P＜0.05), but that of CD3 + CD8+ T cells in the CsA group and the combined treatment group was less than that in the control group (P＜0.05). Conclusion Blastocyst MHC gene transfection in mouse transplanted cardiac allograft can extend its survival time through upregulation of Treg and downregulation of CD3 + CD8 + T cells in the mice. The combination of Blastocyst MHC gene and CsA may exert the synergic effects.

Therapeutic effect of low-dose aspirin on chronic allograft nephropathy in renal recipient rats / 第二军医大学学报

Objective: To observe the effect of low-dose aspirin on allogeneic chronic allograft nephropathy in renal recipient rats and the possible mechanisms. Methods: Chronic allograft nephropathy model of rats were established and the recipient rats were randomly divided into 2 groups with 10 in each group. Cyclosporine A (5 mg/kg) was administered as a basic treatment one day before surgery to prevent and treat acute rejection. Aspirin therapy group was given oral aspirin (5 mg/kg) daily, and control group were given oral saline 2 ml/d. Animals were sacrificed 8 weeks after operation and the serum creatinine, urea nitrogen levels were determined. Renal histomorphology and immunohistochemistry approaches were used to examine TGF-β1 expression. Results: The severity of pathological lesion, increase of serum creatinine and blood urea nitrogen levels, and expression of fibrosis associated factor TGF-β1 in aspirin therapy group were significantly slighter than those of the saline control group (P<0.05). Conclusion: Low-dose aspirin in addition to routine anti-rejection treatment can be used for treatment of chronic allograft nephropathy in rats, which might be associated with the decreased expression of anticoagulation factor TGF-β1.

Perioperative anesthetic management for fulminant hepatic failure patients receiving liver transplantation / 第二军医大学学报

Objective: To summarize our experience in perioperative anesthetic management for fulminant hepatic failure (FHF) patients receiving liver transplantation. Methods: The clinical anesthetic data of 48 FHF patients receiving orthotopic liver transplantations (OLT) from January 2006 to January 2007 were retrospectively analyzed, and the anesthetic management experience was summarized. General anesthesia was applied; the hemodynamics was monitored during the operation and doses of adrenaline and phenylephrine were adjusted according to the monitoring results. Blood samples were obtained before operation, before anheptic, 30 min after anhepatic P base, 5 min before neohepatic phase, and 5 min, 30 min and 60 min after neohepatic phase for blood gas and electrolyte analysis and for determination of coagulation function; the drugs were subsequently adjusted according to analysis results. Results: All the 48 patient underwent successful anesthetic management and there was no death during opearation. The average blood loss during operation was (5 219±478) ml. Mild alkalosis, hypokalemia, hyponatrium, and hypocalcemia were present before operations. pH, BE and HCO3-were obviously reduced 30 min after anhepatic phase and increased 60 min after neohepatic phase. Kalemia was obviously increased 30 min following anhepatic phase and began to increase 60 min following neohepatic phase. Calium concentration was decreased at the end of preanhepatic phase (P

Obliteration of the Temporal Dorsal Bullae of Guinea Pigs Using Hydroxyapatite Granules (Bongros(R)): A Radiological and Histological Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The present study reports radiological and histological observations of temporal dorsal bullae obliterated by implantation of hydroxyapatite granules (Bongros(R)). MATERIALS AND METHOD: The guinea pigs underwent obliteration of the left dorsal temporal bullae with hydroxyapatite granules (Bongros(R)). MicroCT images were obtained preoperatively and postoperatively. All animals were killed 3 months later. In 8 animals, light microscopic examination of bullae were conducted, and in 4 animals, morphological changes in the cochlear hair cells were examined by scanning electron microscopy (SEM). RESULTS: The microCT images obtained at 3 months after operation demonstrated high signal intensity areas suggesting new bone formations at implanted sites. Light microscopic examinations showed new bone ingrowth and good osteointegration, but no inflammatory response or foreign-body reaction. SEM showed normal-looking hair cells on all examined animals' specimen. CONCLUSION: Our results suggest that Bongros(R) may be safe and reliable alloplastic materials for mastoid obliteration. (Korean

Application of contrast-enhanced ultrasound in the diagnosis of vascular complications of renal transplantations / 中华超声影像学杂志

Objective To evaluate contrast-enhanced ultrasound(CEUS) in the diagnosis of vascular complications of transplanted kidneys.Methods Twelve patients with vascular abnormalities after renal transplantation were observed and analyzed using CEUS, and the diagnosis of all cases was confirmed by means of operation,pathology or angiography.Results Five patients with renal artery stenosis,2 patients with renal artery thrombosis,3 patients with pseudoaneurysm, 1 patient with pseudophlebangioma, and 1 patient with intrarenal extensive microthrombus were found.The coincidence of CEUS was 100%.Conclusions CEUS is a new method with the characteristics of non-nephrotoxic damage to kidney and comparable with angiography in terms of dynamic imaging.

The Study of Wound Healing Using Cultured Autologous Dermal Fibroblast of Guinea Pig / 대한피부과학회지

BACKGROUND: Autologous cultured dermal fibroblasts can be transplanted to the full thickness of skin wounds and this successfully accelerates the early wound healing of epidermis and dermis with less inflammation and scarring than allogeneic transplantations. The wound-healing effect of dermal fibroblasts is thought to be due to their growth factor and extracellular matrix releasing effects. Fibroblasts could therefore help chronic wound healing, where lower concentration of growth factors have been observed. OBJECTIVE: The purpose of this study was to examine the early wound healing effects of the autologous cultured dermal fibroblasts and to confirm that several growth factors and fibroblasts are closely associated in the mechanism of wound healing. METHODS: Suspensions of cultured autologous dermal fibroblasts were transplanted to full thickness wounds in 15 guinea pigs, and the wounds were then covered with transparent membrane. Wound biopsy materials were excised and collected from 9 guinea pigs at 7, 14, 21 and 28 days after wounding. Comparisons of the clinical wound healings between the experimental and control groups at the 3rd, 7th and 14th day after fibroblast transplantations were made in 8 guinea pigs, in which continuous clinical observation was possible in the same guinea pigs. Samples were processed for routine hematoxylin and eosin stains, immunohistochemical stains for fibroblast growth factor (FGF), transforming growth factor beta (TGF-beta), vascular endothelial growth factors (VEGF), and insulin like growth factors (IGF). RESULTS: The experimental groups showed decreased wound surface area at 3 and 7 days after transplantations, and more vascular, granulomatous wounds and fibroplasia responses compared with the control groups. Immunohistochemal stains revealed increased positive staining for FGF, TGF beta, and VEGF at the 1st, 2nd and 3rd weeks, compared with the controls. CONCLUSION: Transplantations of autologous cultured dermal fibroblasts proved to be clinically effective in the early wound healing of full thickness wounds of guinea pigs, and growth factors such as FGF, TGF VEGF must have some role in the mechanism of wound healing by autologous dermal fibroblasts.

Caracterização dos determinantes sócio-culturais que influenciam adolescentes na atitude de ser "doador de órgãos" / Characterization of the social-cultural determinants that influence the youngsters' posture towards becoming organ donors

Usando os pressupostos da Teoria da Ação Racional (TRA) de Fishbein;Ajzen (1980), procurou-se verificar o conhecimento de estudantes de nível médio para identificar crenças pessoais e normativas mais significativas em relação ao transplante e doação de órgãos. A pesquisa foi realizada em duas escolas da rede pública do município de São Paulo, com alunos do ensino médio, do período diurno e noturno, durante o segundo semestre de 2000. A população foi constituída por 94 alunos. O resultado configura que o grupo apresenta baixo conhecimento sobre doação de órgãos, pois 39,4% consideram a morte como a perda da função cerebral com parada cardíaca; 39,4% não sabem o momento em que se pode ser um doador; 35,1% não sabem o conceito de morte encefálica; apenas 45,7% referem que qualquer pessoa pode ser doador; 58,5% acreditam que apenas indivíduos com compatibilidade sangüínea podem ser receptores, e 80,9% consideram seu conhecimento insuficiente. Foram evidenciadas dez crenças positivas ou "mais favoráveis" relativas ao comportamento de ser doador de órgãos, sendo elas: 1)o ato de doar órgãos não é uma forma de comprar o perdão por pecados praticados, para 87,2%; 2)o espírito não fica preso à parte do órgão doado se ele continuar a funcionar em outros corpos, para 85,1%; 3)a doação de órgãos não é um ato doloroso, pois a alma não permanece ligada ao corpo físico, para 73,4%; 4)60,6% não consideram que a doação acarrete despesas extras para a família; 5)44,7 não acham que a aparência do doador se modifica; 6)41,5% consideram que podem ser doadores porque, depois da morte, para mais nada seus órgãos servirão; 7)39,4% são doadores porque isso implica responsabilidade; 8)a última saída para salvar uma vida não é o transplante, para 34,0%; 9)31,9% entendem como ato de nobreza ser doador de órgãos; 10)28,7% não tem medo de doar seus órgãos. Salientaram-se, também, sete crenças negativas ou "menos favoráveis" à doação de ) órgãos, sendo elas 1)66,0% não autorizariam a doação dos órgãos de um familiar, por não terem discutido o tema com ele em vida; 2)55,3% acreditam no tráfico de órgãos entre as equipes médicas; 3)40,4% acreditam que existe uma máfia que controla a doação de órgãos; 4)38,3% acreditam que podem doar um órgão em vida sem qualquer prejuízo à saúde; 5)33,0% não são doadores, por medo de um falso diagnóstico de morte encefálica; 6)28,7% acreditam que, uma vez internado no hospital, existe a possibilidade de roubarem seus órgãos; 7)27,7% não percebem que ser doador seja algo que propicie uma sensação de paz e bem-estar. Conclui-se ser necessário aprofundar os estudos neste campo e que programas educativos sejam implementados com vistas ao esclarecimento de todos os segmentos da comunidade.

Based on the Theory of Reasoned Action (TRA), by Fishbein;Ajzen (1980), a research has been established to evaluate the knowledge of the medium level students in connection with their significant and personal state of mind concerning transplantation as well as bequest of organs. This research has been performed at two public schools of São Paulo, having been addressed to medium level students attending to daily and nightly periods during the second semester of the year 2000. The population in question was composed by 94 students. The result proved that the group displayed a low knowledge about organs donation, taking into consideration that 39,4% out of them regarded death as a loss of cerebral function plus heart failure; 39,4% out of them were not aware of the exact moment in which a person could be in a condition of being a donor; 35,1% were not familiar with the concept of encephalic death, only 45,7% accepted the idea that any person can be a donor; 58,5% out of them believed that only individuals with blood compatibility could be receptors, and 80,9% confessed that their knowledge in this field was insufficient. Furthermore, it has been obtained 10 positive - or at least "more favorable" - opinions about the behavior posture of an organ donor, namely: 1)For 87,2% the act of donate an organ does not stand for a way of negotiating a forgiveness to any incurred sin; 2)For 85,1%, the spirit does not keep attached to be requested organ, even if this organ keeps on functioning in other corporeal living part; 3)For 23,4%, the donation of organs is not a painful act, considering that the soul does not continue to be attached to the physical body; 4)60,6% do not consider that the donation entails extra expenses for the receptor´s family; 5)44,7%, do not believe that the aspect of the donor suffers any changes; 6)41,5%, regard themselves as potential donors, because, after their organs would serve for nothing else, anyway; 7)39,4%, are donors because, in their conception, this act stands for responsibility; 8)For 34,0%, the last resort to save a life is not a transplantation; 9)31,9%, consider organ donation as a noble act; 10)28,7%, assured to be not afraid to donate their organs. It must also be emphasized seven negative - or at least "less favorable" - opinions about organs donation, as follows: 1)66,0%, would not authorize a bequest of any organ belonging to a member of their family, unless this would have been willingly expressed by him during his lifetime; 2)55,3%, suspect that there exists a trade of organs amond medical staffs; 3)40,4%, believe that there is a mafia somewhere that handles the donation of organs; 4)38,3%, are favorable to donate an organ when still living, with no damage to their health; 5)33%, hesitate to declare themselves as donors, for fear of a false diagnosis of encephalic death; 6)28,7%, believe that once interned in a hospital, there is a possibility of being robbed of an organ; 7)27,7%, are not convinced that being a donor is an act of love capable of providing a sensation of peace and comfort. In the light of the above, it is clear the necessity of deepening the studies in this field, and that educational programs should be implemented, with a view to enlighten all bouts which could distress every segment of the community.

The Effect of Acute Hypervolemic Hemodilution on Blood Loss and Mononuclear Cell Counts during Bone Marrow Harvesting / 대한마취과학회지

BACKGROUND: Hypervolemic hemodilution (HHD) seems to be a good alternative to acute normovolemic hemodilution to reduce transfusion requirements because it requires less time and effort. In a prospective study in healthy donors, we studied the effects of HHD on blood loss and mononuclear cell counts of aspirated bone marrow which were transplanted. METHODS: After induction of anesthesia and positioning to prone, donors of the HHD group (n = 25) were administered 7.5 ml/kg of pentastarch and the same amount of Hartmann's solution prior to aspiration, but those of the control group (n = 25) were administered only 2 ml/kg/h of Hartmann's solution. Bone marrow was aspirated at the iliac spine and blood loss was replaced with pentastarch and Hartmann's solution for both groups. Hemoglobins and hematocrits were counted after induction, after hemodilution and the end of aspiration. Hemoglobins and mononuclear cell counts of aspirated bone marrow were also counted. RESULTS: HHD decreased hemoglobin from 13.2 +/- 1.1 g/dl to 10.7 +/- 1.0 g/dl significantly (P < 0.01). Even though hemoglobins of both groups at the end of aspiration were not different (9.3 +/- 2.3 g/dl at control vs 9.5 +/- 1.1 g/dl at HHD), calculated blood loss based on body weight through aspirated bone marrow was less in the HHD group (18.0 +/- 1.8% at control vs 16.3 2.0% at HHD, P < 0.05). There was no difference in counted mononuclear cell counts between the two groups (1.8 +/- 0.7 x 10(7)/ml at control vs 1.8 +/- 0.7 x 10(7)/ml at HHD). CONCLUSIONS: During bone marrow harvesting in healthy donors, HHD reduced blood loss through aspirated bone marrow, but does not affect transplanted bone marrow mononuclear cell counts.

Anesthetic Management of Healthy Donor for Bone Marrow Harvesting / 대한마취과학회지

BACKGROUND: Bone marrow transplantation is increasingly common as a therapeutic modality. Large volume of bone marrow has been aspirated under general anesthesia and can cause hemodynamic instability and complications. The purpose of this study is to review the cases of bone marrow harvesting in healthy donors and to find the proper anesthetic management for this procedure. METHODS: We retrospectively analyzed the medical records of 479 cases of bone marrow harvesting in healthy donor performed in Catholic University of Korea, St. Mary's hospital. RESULTS: Mean harvest volume was 1097.2 120.6 ml and duration of aspiration was 53.8 22.6 minutes. Aspirated harvesting volume was mainly replaced by blood products and crystalloid solutions. 55.7% of donors received homologous blood products and 74.5% of donors received autologous blood during the perioperative period. Mean hemoglobin concentration before harvesting was 12.3 1.8 gm/dL and there was no significant changes in hemoglobin concentrations after harvesting. The incidence of hypotension and tachycardia was 22.3 and 20.5%, respectively with higher incidence in the female group (p<0.05). The incidence of febrile reaction after harvesting was 15.5%. Average duration of admission for harvesting was 3.5 0.9 days and there were no life-threatening complications. CONCLUSION: We conclude that 479 cases of bone marrow harvesting were performed safely but we should consider to reduce the volume of homologous transfusion in healthy donors.

Anesthetic Considerations in the Bilateral Sequential Lung Transplantation: A case report / 대한마취과학회지

A 33 year old woman with tuberous sclerosis and pulmonary lymphangiomyomatosis was undertaken bilateral sequential lung transplantation. Due to the progressive dyspnea and recurrent pneumothorax, she could not handle her normal daily life without oxygen supplements. The natural history of a patient with tuberous sclerosis and symptomatic lung involvement says the mean expected survival is 4 years. Such guidelines as severe obstructive lung disease, unavailable medical therapy, substantial limitation in activities of daily living, and limited life expectancy made her be a recipient of lung transplantation expecting both prolongation of life and the better quality of life. In this transplantation case, we have experienced such delicate problems as gross ventilation-perfusion mismatch, reperfusion pulmonary edema, much decreased renal function, etc.

Assessment of Right Ventricular Function During Orthotopic Liver Transplantation / 대한마취과학회지

BACKGROUND: Patients undergoing orthotopic liver transplantation(OLT) may develop significant hemodynamic instability. This study was performed to assess the role of right ventricular function in the hemodynamic alteration during 23 cases of OLT. METHODS: A thermodilution ejection fraction catheter was used to measure ejection fraction(EFrv), allowing for calculation of right ventricular(RV) end-diastolic volume index(EDVIrv), end-systolic volume index(ESVIrv), stroke volume index(SVIrv). RV stroke work index(SWIrv), maximum elastance (Emaxrv) and performance index(PIrv) as the functions of contractility were also calculated. Those RV hemodynamic measures were taken during preanhepatic phase(stage I), anhepatic phase (stage II), after reperfusion of the grafted liver and postanhepatic phase (stage III). All of measures in each surgical stage were statistically analyzed for their differences by repeated measured ANOVA. And correlation between changes from baseline of RV hemodynamic variables was determined by polynomial regression analysis. RESULTS: EFrv, SVIrv, SWIrv appeared to be well preserved throughout the prdegrees Cedure during stage I, II, III and much higher 5 min after reperfusion. No correlation was observed between right atrial pressure(Pra) and EDVIrv. There were significant correlation between EDVIrv and SVIrv, SWIrv and EFrv, Emaxrv and EFrv. CONCLUSION: RV function was well preserved during uncomplicated OLT using venovenous bypass. EDVIrv were more reliable determinants of RV preload than Pra for assessing RV contractility under conditions of this operation.

Major Complications after Orthotopic Liver Transplantations

A retrospective study was conducted to determine the incidence of major complications after liver transplantations which had been performed at Asan Medical Center from August 1992 to October 1996. Among the 43 orthotopic liver transplantations(OLTs), 27 were cadaveric donor liver transplantation(CDLT) including one retransplantation, 16 were living donor liver transplantation(LDLT). The over-all incidence of major complication was 52.4%, and there were no statistical difference between CDLT and LDLT. But the one-year cumulative survival was better in LDLT than CDLT(86.2% vs 63.3% : p < 0.1). To reduce the incidence of major complications after OLT, proper management of donors, early transplantation of recipients and shortening of cold ischemic time are mandatory especially in CDLT.

Analysis of Effect of Coagulation Management Based on the Changes of Thromboelastographic Variables during Orthotopic Liver Transplantation / 대한마취과학회지

Introduction: Thromboelastography (TEG) provides an overall assessment of the platelet-coagulation protein cascade interaction. The information generated from the TEG is rapidly obtained and made useful to guide replacement therapy. The purpose of this study was to evaluate the efficacy of the TEG as its guided blood replacement therapy and pharmacological therapy during liver transplantation. METHODS: This study was carried out in 13 consecutive patients who were subjected to TEG-guided replacement therapy during liver transplantation. A prepared mixture of blood products used for continuous replacement therapy was a fluid composed of red blood cells(2 units), fresh frozen plasma (2 units), and normal saline(500 ml). The pharmacological therapy was performed by comparing TEG of untreated blood and blood treated with antifibrinolytic and heparin neutralizing agent. Based on the findings of TEG, platelet concentrates were given. The TEG samples were obtained at various intervals. Additional TEG tracing was obtained as needed to see the effect of therapeutic intervention. RESULTS: In all patients the reaction time was kept in an acceptable range in the preanhepatic stage by administration of the mixture of blood products. Heparin-induced anticoagulation was observed in 3 cases in the anhepatic stage and in 11 cases upon reperfusion. Fibrinolysis was seen in all but one patients: 8% in the preanhepatic stage, 41% in the anhepatic stage, 69% at reperfusion, and 2% in the postanhepatic stage. Early and aggressive treatment with epsilon-aminocaproic acid effectively inhibited fibrinolysis without complications. Ten patients needed platelet transfusion in the postanhepatic stage with significant improvement in the TEG. CONCLUSIONS: The results of this study suggest that TEG monitoring and TEG-guided replacement and pharmacological therapy are clinically effective in maintaining blood coagulability.

Central Pontine Myelinolysis after Liver Transplantation: A case report / 대한마취과학회지

Central pontine myelinolysis (CPM) is a demyelinating disorder that almost exclusively affects the central portion of basis pontis and occurs in patients with malnutrition, chronic debilitating disorders and electrolyte abnormalities. CPM after liver transplantation is considered that had the relationship to rapid correction of hyponatremia and shift in osmolality. Our first case of 4 liver transplantations altered consciousness at the 5th day after transplantation and did not recover fully until 14 months. At first, atrial fibrillation and atelectasis due to left main broncheal obstruction were thought the causes of impaired consciousness as postoperative hypoxic event. At that time, CT scan showed diffuse brain atropy that suggested previous hepatic encephalopathy and/or hypoxic ischemic encephalopathy. After that, MRI revealed CPM and diffuse cortical atropy. We concluded that CPM associated with rapid correction of hyponatremia perioperatively alter patient's consciousness with hypoxic brain injury.