Impact of Smoking Cessation in Donor Candidates for Living Donor Liver Transplantation.

BACKGROUND: The relationship between smoking cessation and weight gain is well recognized. Examining the link between smoking cessation and weight gain in donor candidates for living donor liver transplantation (LDLT) is an important topic because of the influence of weight gain on the liver. This study assessed body weight (BW) changes after smoking cessation in donor candidates for LDLT. METHODS: The 27 donor candidates were retrospectively analyzed. The smoking status was determined based on questionnaires administered at the initial presentation, and the candidates were divided into 2 groups: recent quitters and nonsmokers. The changes in BW were compared between the groups. RESULTS: The recent quitters group included 10 (37.0%) candidates, and the nonsmokers group included 17 (63.0%). In the nonsmokers group, 1 candidate had gained weight since the initial presentation. In contrast, in the recent quitters group, 70.0% of candidates had gained weight since the initial presentation (P < .01). The change in BW from the initial presentation was greater in recent quitters than in nonsmokers (+1.6 kg [+2.4%] vs -0.5 kg [-0.9%]; P < .01). Two candidates in the recent quitters group gained ≥ 5 kg [8%] of weight. One of these 2 candidates was judged to be in a donor-inadequate status because of the appearance of fatty liver. CONCLUSIONS: Weight gain due to smoking cessation was observed in donor candidates for LDLT. The amount of weight gain after smoking cessation is highly individualized, so everyone concerned with LDLT must be alert to its potential development.

Living-Donor Liver Transplantation With the Use of a Left-Lobe Graft From a Donor With Anomalous Biliary Anatomy in Which B4 Joins the Right Anterior Sectional Duct: A Case Report.

When there is an anatomic anomaly in the biliary tract of the donor for living-donor liver transplantation, the risk of postoperative biliary tract complications increases in both the donor and the recipient. We studied a case of living-donor liver transplantation with a left hepatic lobe graft that had anatomic anomalies, in which the medial segmental branch (B4) joined the anterior segmental branch and the posterior segmental branch formed a common trunk with the lateral segmental branch. A 40-year-old man visited our institution as a candidate organ donor for his mother, who had end-stage liver failure. An anomaly of B4 connecting the anterior segmental branch was suspected on magnetic resonance cholangiopancreatography. On intraoperative cholangiography, confluence of B4 with the anterior segmental branch and connection of the posterior and lateral segmental branches forming a common trunk were confirmed. Accordingly, individual anastomoses of the lateral segmental branch and B4 with the recipient jejunum were planned, and a left-lobe graft was excised. The postoperative recovery was smooth, and the donor was discharged with no complications. Even when an anatomic anomaly is present in the donor bile duct, in urgent cases, accurate evaluation through the use of various modalities may enable living-donor liver transplantation with the use of a graft with an anatomic anomaly.

Reinforcing effect as a function of infusion speed in intravenous self-administration of nicotine in rhesus monkeys.

The influence of infusion speed on the reinforcing effect of nicotine (NIC) 30 micrograms/kg/infusion was studied in rhesus monkeys using intravenous self-administration at infusion speeds of 5.2, 1.3, and 0.3 micrograms/s under a fixed-ratio 5 schedule with a 15-min time-out after each intake. The 24-h self-administration rate was observed in 3 periods of 8 days each for each speed, separated by saline self-administration periods of 2 weeks each. As a result, when a fixed infusion speed of 5.2 micrograms/s was used throughout the 3 periods, the average rates of NIC were not significantly different each other, but when the infusion speed was changed from 5.2 to 1.3, and then to 0.3 micrograms/s, the average rates significantly decreased. The plasma level following a single-dose infusion of NIC 30 micrograms/kg positively correlated with the infusion speeds. These results indicate that the reinforcing effect of NIC is a function of the infusion speed, most likely through elevation of the peak level of NIC in the plasma.

[Withdrawal characteristics following frequent intravenous administration of several opioids in rats].

Characteristics of withdrawal signs of several opioids were compared in rats after short-term frequent intravenous infusions. Male Sprague-Dawley rats with catheters implanted in the jugular veins were infused with a fixed dose of a drug hourly for 72 hrs. Thirty min after the final infusion, naloxone 4 mg/kg, s.c. was administered and withdrawal signs were observed for 1 hr and the severity of the withdrawal signs was scored, classified into a behavioral sign score, autonomic sign score, and body weight loss score. As a result, total withdrawal scores of morphine, methadone, d-propoxyphene, loperamide, tramadol, and pentazocine were significantly higher than that of saline, with the highest score being observed for 4 mg/kg or more of morphine. The total score of ethylketocyclazocine was slightly but significantly higher than that of saline. Buprenorphine and thebaine produced no observable withdrawal signs. The behavioral sign score tended to be higher than the other 2 scores in the drugs showing relatively low but significant total scores such as tramadol, pentazocine, and ethylketocyclazocine, while the score of autonomic signs or the body weight loss tended to be higher in drugs showing high total scores. Thus, in the case of opioids, it is considered that the severity of withdrawal signs was mainly derived from the autonomic signs including diarrhea which may result in body weight loss.

[Studies on reinforcing effects of methylephedrine, caffeine and their mixture with intravenous-self administration in rhesus monkeys].

The reinforcing effects of methylephedrine hydrochloride (ME), anhydrous caffeine (CA) and their mixture (ME+CA) were studied by the intravenous cross self-administration experiment and by the progressive ratio experiment in four male rhesus monkeys each. In the intravenous cross self-administration experiment, ME, CA and ME+CA were found to have reinforcing effects. Self-administration rates above the level of cocaine, a typical reinforcing drug, were not observed in ME or CA alone, but observed in their mixture (120 + 126 micrograms/kg/inj.: M dose or 480 + 504 micrograms/kg/inj.: H dose). The minimum reinforcing doses were 120 micrograms/kg/inj. (M dose) for ME, 126 micrograms/kg/inj.: (M dose) for CA, and ME 30 micrograms+CA 32 micrograms/kg/inj. (L dose) for the mixture. Vomiting was observed during the session in monkeys which showed higher self-administration rates of ME and the mixture, and decreases in the rates were observed in these animals on the next day. One animal at H dose of the mixture, which showed a high self-administration rate on both the 1st and 2nd days, died after the end of the session on the 2nd day. In the progressive ratio experiment, the final ratios at 120 micrograms/kg/inj. of ME, 126 micrograms/kg/inj. of CA and the mixture of ME 120 micrograms/CA 126 micrograms/kg/inj. were almost equal to or less than that of saline (negative control). Thus, these drugs didn't show reinforcing effects at the above levels. However, a reinforcing effect was observed in three out of four monkeys administered 1920 micrograms/kg/inj. of ME, 2016 micrograms/kg/inj. of CA, and the mixture of ME 1920 and CA 2016 micrograms/kg/inj.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between minimum reinforcing doses and injection speed in cocaine and pentobarbital self-administration in crab-eating monkeys.

The relationship between minimum reinforcing doses and injection speed was investigated by using 2 levels of speeds in experiments on self-administration of cocaine or pentobarbital in 2 crab-eating monkeys each. The experiments were conducted under a fixed ratio (FR) 1 schedule with 30-min time-out after each drug injection, wherein the drugs and saline were made available for alternate 5-day periods. The minimum reinforcing doses at each injection speed were determined by the titration procedure in which the presence or absence of reinforcing effect at a particular drug dose was judged based on comparison of the self-administration rate at that dose with the rate in the preceding saline period. The results showed that the minimum reinforcing doses of cocaine and pentobarbital tended to be higher in inverse proportion to the injection speed of the drugs.

[Clinical evaluation of cardiac function test using scintiview (author's transl)].

Cardiac function was studied with Scintiview in 107 cases, 24 normal and 83 affected cases, and the following results were obtained. 1. Better data were obtained with converging collimeter than with parallel collimeter in cardiac study. (2) Red blood cells were sufficiently labeled with 99mTc using stannous chloride as reductant, and it was proven to be applicable to measurement of circulation blood volume. (3) Pulmonary circulation time and the systemic circulation time calculated from time activity curve, greater than 9.0 seconds and greater than 25 seconds, respectively, were considered abnormal prolongation. (4) Cardiac output index (cardiac output/circulation blood volume), less than 1.10 was considered decreased cardiac output. (5) Stroke volume index ((stroke volume/circulation blood volume)x 100, less than 1.70 was considered decreased stroke volume. (6) Ejection fraction, less than 60% was considered decreased left ventricular wall motion. (7) Cardiac function index (cardiac output index X ejection fraction), less than 80 was considered decreased cardiac performance.

Drug dependence potential of viloxazine hydrochloride tested in rhesus monkeys.

The drug dependence potential of viloxazine was tested in 5 experiments on rhesus monkeys. In gross behavioral observation of normal monkeys the acute CNS effects of the drug were found to be very weak. Decrement of spontaneous motor activity and occasional eye-closing were observed with single doses higher than 16 mg/kg IV, IM and 128 mg/kg PO, while convulsions and death occured at 64 mg/kg IV and IM. Viloxazine did not suppress the morphine and barbital withdrawal signs in monkeys that had been made physically dependent on these drugs and withdrawal. In the test for physical dependence by repeated administration of the drug at 16 mg/kg IM twice daily for 31 days in normal monkeys, no observable withdrawal sign was developed in the naloxone precipitation and natural withdrawal tests. In intravenous self-administration experiments, a weak reinforcing effect was demonstrated in some monkeys, but the effect was extremely weak. Thus, viloxazine was found to be physical dependence-free and its overall dependence potential was regarded as very low.