Diaphragmatic dysfunction after pediatric orthotopic liver transplantation.

BACKGROUND: Pediatric orthotopic liver transplantation (OLT) has a low mortality. Some children, however, have an adverse outcome defined as a prolonged ventilatory support requirement and protracted pediatric intensive care unit (PICU) stay. The aim of this study was to determine if that adverse outcome related to the child's condition pre-OLT and/or the development of a pleural effusion or diaphragmatic dysfunction. METHODS: The study included 210 children with a median age at transplantation of 45.5 months (range 0.2-252 months). Fourteen had undergone retransplantation. The duration of ventilatory support (intermittent positive pressure ventilation [IPPV]) and PICU admission and development of a pleural effusion and/or diaphragmatic dysfunction were documented for each child. The patients were divided into three groups according to whether they had acute liver failure (ALF), chronic liver disease at home (CHOM), or chronic liver failure sufficiently ill to be in the hospital awaiting transplantation (CHOSP). RESULTS: The 36 children with ALF were of similar age to the 138 CHOM and 36 CHOSP children but required longer IPPV (P<0.0001) and PICU stay (P<0.0001). Overall, 17 children developed diaphragmatic dysfunction and 138 pleural effusions; affected children required longer IPPV and PICU stay (P<0.01). Regression analysis demonstrated that diaphragmatic dysfunction, but not pleural effusion development, was associated with prolonged ventilation (P<0.01) and protracted PICU stay (P<0.05). Other risk factors were ALF (P<0.01), retransplantation (P<0.01), and young age (P<0.05). CONCLUSION: Diaphragmatic dysfunction adversely influences PICU morbidity after OLT. Early assessment of diaphragmatic function, and if necessary aggressive management, might improve outcome.

An investigation into the risk of air embolus during veno-venous bypass in orthotopic liver transplantation.

After observing micro-bubble activity in the venovenous bypass system during liver transplantation, an experiment was designed to investigate the origin of these bubbles and to define the conditions under which they occurred. Using a Biomedicus constrained vortex pump and a customized circuit design, microbubble activity was measured in saline and blood media during varying pre- and post-head pressures. The data show that air emboli can be generated from this pump and the rate at which they develop is directly related to the pre- and post-head pressure and hematocrit.

Automatic perimetry and visual P300: differences between upper and lower visual fields stimulation in healthy subjects.

Human visual-evoked potentials (VEPs) from upper and lower hemifield stimulation are thought to reflect the anatomical and functional differences between the hemiretinas and corresponding visual pathways. Conflicting results have, however, been reported in topographic studies on the putative cortical generators. We have estimated by automatic perimetry (Octopus 2000R, Program 32) and compared the sensitivity thresholds of lower and upper hemifields of the retina in 12 healthy subjects with no history or evidence of visual or neurological diseases. A visual P3 that is linked to cognitive function was recorded in an odd-ball paradigm with presentation of high-contrast checkerboards at two different spatial frequencies at 20 degrees eccentricity in each hemifield. VEP and P3 were recorded at O1 and O2 and at Cz according to the 10/20 international system. Lower sensitivity thresholds were found, and higher VEP and event-related potential (ERP) amplitude values were obtained when stimulating the lower, compared with the upper, visual hemifield. The results are consistent with previous findings and anatomical and physiological evidence in animals and man. Interactions between perceptive process in the visual system and higher cognitive functions are a possible explanation for this finding.

Retinal early receptor potential in retinitis pigmentosa: correlations with visual field and fluorangiography estimates.

The flash induced electroretinogram (ERG) and early receptor potential (ERP) were recorded in a population of patients with definite diagnosis of retinitis pigmentosa in the context of a study protocol including a complete diagnostic screening. ERPs were evoked by full-field 20-joule stimuli (5 stimuli at 10 min of interval in dark adaptation); recording was by skin electrodes positioned at the inferior orbital margin; amplifiers were set at 10-10,000 Hz. The flash ERG was absent or markedly abnormal in all cases, even at an early stage of development of the retinitis, while ERPs (with a normal morphology, latency of the R1 component increased and a reduced amplitude compared to normal controls) could be identified unambiguously in all cases. The amplitude reduction was highly correlated with the severity of the disease as determined by kinetic perimetry and fluorangiography.