A Case of Fulminant Hepatic Failure Secondary to Non-thrombotic Graft Infarction After Living Related Liver Transplantation / 대한이식학회지

Non-thrombotic graft infarction of the liver following orthotopic liver transplantation(OLT) occurs infrequently during an otherwise uneventful recovery 1 week after OLT. The typical clinical presentation is an uneventful initial postoperative recovery, followed by sudden deterioration of allograft function in the absence of vascular thrombosis with rapid progression to graft failure. The characteristic pathological change is massive hemorrhagic necrosis with only mild portal tract inflammation. The pathogenesis and definite etiologies were until not clear. Recently we experienced non-thrombotic graft infarction on the 8th day after liver transplantation from a 51-year-old living donor to his 17-year-old daughter.

The Preventive Effect of Pentoxifylline on the Oleic Acid-Induced Lung Injury / 대한마취과학회지

BACKGROUND: Although exact mechanism of adult respiratory distress syndorme (ARDS) is not known, many evidences suggest that inflammatory mediators such as protease and oxygen radicals may be the final common pathway to the endothelial injury. It is gradually accepted that activated neutrophils play a major role in the process. Pentoxifylline is a methylated xanthine with a wide range of actions that make it theoretically useful in the treatment of ARDS. Studies show that it decreases neutrophil phagocytosis and superoxied production. The aim of this experiment is to determine whether pentoxifylline has a preventive effect on oleic acid-induced lung injury. METHODS: Oleic acid (0.08 ml/kg) was infused in 10 mongrel dogs in order to induce acute lung injury. Pentoxifylline (20 mg/kg) was administered 40 mins before oleic acid injection. The author made a comparative studies on the effects of pentoxifylline on hemodynamics and gas exchange before oleic acid injection and at 15, 30, 45, 60, 90 mins after oleic acid injection. RESULTS: There were not significant changes in mean arterial pressure, cardiac output, systemic vascular resistence, pulmonary wedge pressure intrapulmonary shunt in both groups. There were statistical significance in arterial oxygen tension, pulmonary artery pressure, pulmonary vascular resistance between both groups (p<0.05). CONCLUSIONS: Pentoxifylline is a noteworthy drug that could be a candidate as a therapy to help prevent effect in lung injuries that share a common mechanism with oleic acid-induced lung injury.

Hemodynamic Effects of General Anesthesia during Thoracic Epidural Block / 대한마취과학회지

BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.