Long-term results for liver transplantation from non-heart-beating donors maintained with chest and abdominal compression-decompression.

INTRODUCTION: The aim of this study was to evaluate long-term results after liver transplantation from non-heart-beating donors (NHBD) using the method of chest and abdominal compression-decompression to maintain donors. METHODS: From December 1995 to November 2004, 10 NHBD were identified and maintained by means of the method of chest and abdominal compression-decompression until family and judicial permission were granted. Nine donors were Maastricht type II and one was type IV. RESULTS: The mean age of donors was 40.5 years and the mean time under cardiopulmonary resuscitation (CPR) was 80 minutes. Orthotopic liver transplantation (OLT) was performed using these 10 liver grafts after a mean cold ischemia time of 561.5 minutes. All patients developed good posttransplant function, except for one patient who presented with primary nonfunction corrected with retransplantation. This complication was directly related to a long CPR time (P < .01). After a mean follow-up of 57 months, only one patient died from a hepatitis C virus (HCV) recurrence. The rest of the patients have maintained good graft function over time. CONCLUSIONS: NHBD maintained with the method of chest and abdominal compression-decompression are a valid choice to increase the donor pool. Liver transplantation using these grafts has proven good long-term results, comparable to their heart-beating counterparts.

Portal vein thrombosis in patients undergoing orthotopic liver transplantation: intraoperative endovascular radiological procedures.

PURPOSE: To evaluate the usefulness of endovascular procedures for portal vein complications during orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Between May 1994 and November 2004, we performed 504 OLTs in 464 adults. Seventy-eight patients (16.8%) presented with portal vein thrombosis (PVT). This analysis of patients from May 2000 to September 2004 included 10 patients with PVT, who were treated with endovascular techniques due to low portal flow. We compared this group with patients who were treated surgically with attention to rethrombosis and survival rates. If portal vein problems were due to obstruction, a venoplasty and primary stent placement were performed. We also embolized with coils or surgically ligated remaining competitive portosystemic shunts. RESULTS: Perfusion problems in the allograft were solved in all cases. We placed seven stents and embolized six competitive shunts. One anastomotic dysfunction was repaired. None of the patients died or rethrombosed during surgery or follow-up. CONCLUSION: Endovascular techniques during OLT can resolve some liver graft perfusion problems due to PVT and "steal" phenomena, especially with unsatisfactory eversion thromboendovenectomy in patients with grade IV PVT. Although primary permeability of stents has been good, these results need to be confirmed.

Benefits of recombinant activated factor VII in complicated liver transplantation.

INTRODUCTION: Recombinant activated factor VII (rFVIIa, NovoSeven, NovoNordiskA/S, Bagsvaerd, Denmark) has shown benefits in hemophilic patients and recently in transplant recipients. This study presents our experiences with rFVIIa in complicated liver transplant recipients. METHODS: From May 2001 to August 2004, rFVIIa was administered to 7 patients undergoing liver transplantation. All treatments were made on emergency bases, except for 1 case with hemophilia A, who received prophylactic treatment. The drug was delivered when severe bleeding with coagulopathy persisted despite the usual treatment with blood products. The drug doses were 60-90 mug/kg; the results were evaluated clinically and analytically. RESULTS: Seven patients undergoing liver transplantation were treated with FVIIa. Mean prothrombin times before and after treatment were 17.5 and 10.9 seconds, respectively, with a mean reduction of 7.2 seconds (P = .03). Mean thromboplastin times before and after treatment were 38.1 and 29.4 seconds, respectively, with a mean reduction of 8.7 seconds (P = .034). The average dose was 83.6 mug/kg, leading to decreased consumption of blood products (P < .01). In all cases, rFVIIa allowed sufficient hemostasis to carry on definitive treatment. There was no mortality in this series. CONCLUSIONS: These results provide new evidence on the potential benefits of rFVIIa in liver transplantation, especially for rescue therapy in cases of severe bleeding.

Steroid-free immunosuppression for pancreas-after-liver transplantation.

Simultaneous pancreas-kidney transplantation is presently a well-accepted procedure for patients with type 1 diabetes mellitus and renal failure. However, experiences with combined pancreas and liver transplantation are scarce, a few data are available about the best immunosuppression for these patients. We report our experience with two patients who received a pancreas after liver transplantation for long-standing insulin-dependent diabetes mellitus, with steroid-free immunosuppression based on daclizumab, tacrolimus, and mycophenolate mofetil. Short- and long-term evolution was uneventful. Currently, both patients are insulin free with appropriate metabolic control after 12 and 6 months follow-up. Considering our preliminary results, we suggest a steroid-free immunosuppressive regimen as an option for pancreas-after-liver transplantation.

Giant hypothalamic hamartoma with cystic change: report of two cases and review of the literature.

We describe the MRI findings in two patients with giant hypothalamic hamartomas with cystic areas. Cystic change within hypothalamic hamartomas is rarely reported in the literature.

[Course of pregnancy and delivery in adolescence]. / Przebieg ciazy i porodu u mlodocianych.

An increasing number of deliveries in adolescents is a growing problem, not only obstetrical but also social in the whole world. Pregnancy is a physiological condition, although with girls under 18 needs a special care and treatment and is called as a high risk pregnancy. Especially girls with age under 16 appear to have high risk of pregnancy pathology as well as low-birthweight infants.

Multiple intracranial lipomas, hypogenetic corpus callosum and vestibular schwannoma: an unusual spectrum of MR findings in a patient.

We describe imaging findings of a patient with multiple intracranial lipomas, hypogenetic corpus callosum and a vestibular schwannoma. We did not find association of intracranial lipomas and vestibular schwannoma in English literature.

Simultaneous determination of ampicillin and tetracycline in milk by using a stopped-flow/T-format spectrofluorimeter.

A fast and simple fluorimetric method is described for the simultaneous determination of ampicillin and tetracycline in milk by combining the stopped-flow mixing technique with a T-format spectrofluorimeter. Ampicillin determination is based on its hydrolysis with penicillinase and reaction with mercuric chloride, while the intramolecular energy transfer from tetracycline to europium ions in the presence of thenoyltrifluoracetone is used for tetracycline determination. The similar excitation wavelengths of both systems and the separation between the corresponding emission wavelengths allow the direct determination of both analytes by measuring simultaneously the initial rate of the ampicillin system and the equilibrium signal of the tetracycline system. The relative standard deviations were lower than 2%. The proposed method was applied to the determination of these antibiotics in different milk samples with a recovery of 95.0-103.3% for ampicillin and 93.3-103.3% for tetracycline.

Long-wavelength stopped-flow fluorimetric determination of lysozyme.

The use of Cresyl Violet and sodium dodecyl sulphate for the kinetic fluorimetric determination of lysozyme from dynamic fluorescence measurements at a long wavelength in the range near 600 nm was explored. The high initial rate of this system allows analytical measurements to be made within ca. 2 s after the reactants are mixed, by using the stopped-flow mixing technique, which makes the method applicable to automatic routine analysis. The calibration graph is linear over the range 0.5-40 mug ml(-1) lysozyme hydrochloride and the detection limit of 0.19 mug ml(-1). The precision is less than 2% (relative standard deviation). The results obtained by applying the proposed method to the analysis of pharmaceutical samples with no pretreatment shown how readily it can be adapted for routine analyses. Analytical recoveries ranged between 94.0 and 104.0%.

Kinetic fluorimetric determination of gliadins in foods.

Kinetic methodology was applied for the first time to the determination of gliadin proteins by using a stopped-flow mixing technique. The method is based on two simultaneous processes: the reaction between gliadins and sodium dodecyl sulfate and the elimination of the quenching caused by this surfactant of the fluorescence of Cresyl Violet. Thus, the increase in fluorescence intensity with time is directly related to gliadin concentration. The use of this oxazine dye allows dynamic fluorescence measurements at long wavelengths, which avoids potential interferences from the sample matrix. The reaction rate is measured within 5 s, so the method is very suitable for the routine determination of gliadins in food samples. The dynamic range of the calibration graph was 0.5-50 micrograms ml-1 and the LOD was 0.25 microgram ml-1. The RSD was 1.6%. The method was applied to different food samples and the analytical recoveries were 88-107%.