Asunto(s)
Trasplante de Hígado/estadística & datos numéricos , Adulto , Niño , Supervivencia de Injerto , Hong Kong , Humanos , Trasplante de Hígado/mortalidad , Trasplante de Hígado/fisiología , Donadores Vivos , Estudios Retrospectivos , Tasa de Supervivencia , Donantes de Tejidos , Obtención de Tejidos y Órganos/organización & administraciónRESUMEN
OBJECTIVE: Two sampling techniques, simple random sampling (SRS) and systematic sampling (SS), were compared to determine whether they yield similar and accurate distributions for the following four factors: age, gender, geographic location and years in practice. METHOD: Any point estimate within 7 yr or 7 percentage points of its reference standard (SRS or the entire data set, i.e., the target population) was considered "acceptably similar" to the reference standard. The sampling frame was from the entire membership database of the Canadian Chiropractic Association. The two sampling methods were tested using eight different sample sizes of n (50, 100, 150, 200, 250, 300, 500, 800). From the profile/characteristics, summaries of four known factors [gender, average age, number (%) of chiropractors in each province and years in practice], between- and within-methods chi 2 tests and unpaired t tests were performed to determine whether any of the differences [descriptively greater than 7% or 7 yr] were also statistically significant. The strengths of the agreements between the provincial distributions were quantified by calculating the percent agreements for each (provincial pairwise-comparison methods). Any percent agreement less than 70% was judged to be unacceptable. RESULTS: Our assessments of the two sampling methods (SRS and SS) for the different sample sizes tested suggest that SRS and SS yielded acceptably similar results. Both methods started to yield "correct" sample profiles at approximately the same sample size (n > 200). CONCLUSION: SS is not only convenient, it can be recommended for sampling from large databases in which the data are listed without any inherent order biases other than alphabetical listing by surname.
Asunto(s)
Quiropráctica , Bases de Datos como Asunto , Muestreo , Factores de Edad , Canadá , Humanos , Distribución Aleatoria , Factores SexualesRESUMEN
OBJECTIVE: The authors report their experience with living donor liver transplantation (LDLT) using extended right lobe grafts for adult patients under high-urgency situations. SUMMARY BACKGROUND DATA: The efficacy of LDLT in the treatment of children has been established. The major limitation of adult-to-adult LDLT is the adequacy of the graft size. A left lobe graft from a relatively small volunteer donor will not meet the metabolic demand of a larger recipient. METHODS: From May 1996 to November 1996, seven LDLTs, using extended right lobe grafts, were performed under high-urgency situations. All recipients were in intensive care units before transplantation with five having acute renal failure, three on mechanical ventilation, and all with hepatic encephalopathy. The median body weight for the donors and recipients was 58 kg (range, 41-84 kg) and 65 kg (range, 53-90 kg), respectively. The body weights of four donors were less than those of the corresponding recipients, and the lowest donor-to-recipient body weight ratio was 0.62:1. The extended right lobe graft was chosen because the left lobe volume was <40% of the ideal liver mass of the recipient. RESULTS: Median blood loss for the donors was 900 mL (range, 700-1600 mL) and hospital stay was 19 days (range, 8-22 days). Homologous blood transfusion was not required. Two donors had complications (one incisional hernia and one bile duct stricture) requiring reoperation after discharge. All were well with normal liver function 5 to 10 months after surgery. The graft weight ranged from 490 g to 1140 g. All grafts showed immediate function with normalization of prothrombin time and recovery of conscious state of the recipients. There was no vascular complication, but six recipients required reoperation. One recipient died of systemic candidiasis 16 days after transplantation and 6 (86%) were alive with the original graft at a median follow-up of 6.5 months (range, 5-10 months). CONCLUSIONS: When performed by a team with experience in hepatectomy and transplantation, LDLT, using an extended right lobe graft, can achieve superior results. The technique extends the success of LDLT from pediatric recipients to adult recipients and opens a new donor pool for adults to receive a timely graft of adequate function.
Asunto(s)
Lesión Renal Aguda/cirugía , Trasplante de Hígado , Donadores Vivos , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Peso Corporal , Femenino , Estudios de Seguimiento , Humanos , Consentimiento Informado , Tiempo de Internación , Hígado/diagnóstico por imagen , Hígado/patología , Pruebas de Función Hepática , Trasplante de Hígado/efectos adversos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Cuidados Posoperatorios , Reoperación , UltrasonografíaRESUMEN
OBJECTIVE: To evaluate the strategy of the management of patients with fulminant hepatic failure at Queen Mary Hospital. METHODS: In the period 1994 through 1996, 30 patients with fulminant hepatic failure were managed by active supportive treatment in the Intensive Care Unit in preparation for liver transplantation. Liver transplantation was performed in 14 patients (aged 17-47), 3 of whom received liver grafts from brain-stem dead donors and 11 received live-related grafts from family members. The median duration from admission to liver transplantation was 3 days (range: 1-6 days). RESULTS: Thirteen patients (93%) survived the liver transplantation and are well after a median period of follow-up of 7 months. The only mortality was in a patient with pre-exiting renal transplantation and hepatitis B infection, who died from intra-abdominal candidiasis. CONCLUSION: The strategy of active supportive treatment and early liver transplantation using live-related liver graft is probably the key to the success of the management of fulminant hepatic failure in our series.
Asunto(s)
Encefalopatía Hepática/cirugía , Trasplante de Hígado , Adolescente , Adulto , Femenino , Hong Kong , Humanos , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Sepsis/prevención & controlRESUMEN
The feasibility of adult-to-adult living donor liver transplantation (LDLT) is restricted by the adequacy of the graft size. A left lobe graft from a relatively small donor will not meet the metabolic demand of a larger recipient. We report a successful LDLT performed on a 90-kg man using an extended right lobe graft weighing 910 g from his relatively smaller-size brother. The donor-to-recipient body weight ratio was only 0.82. No homologous blood transfusion was required for the donor, and the donor recovered uneventfully except for mild transient hyperbilirubinemia. The graft provided adequate function for the metabolic needs of the recipient despite postoperative septic complications. Both donor and recipient were well with normal liver function at 4 months after operation. LDLT using the extended right lobe liver graft can extend the limit on the size of the adult recipient and may be a viable option even when the donor is relatively small compared with the recipient.
Asunto(s)
Trasplante de Hígado , Donadores Vivos , Adulto , Azatioprina/uso terapéutico , Ciclosporina/uso terapéutico , Quimioterapia Combinada , Hepatectomía , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Hígado/inmunología , Masculino , Esteroides/uso terapéuticoRESUMEN
The major limitation of adult-to-adult living donor liver transplantation is the adequacy of the size of the graft that can be safely harvested from the donor. The present report describes a 22-year-old woman with stage 4 hepatic coma due to fulminant hepatic failure who was successfully treated using a small-for-size left lobe graft from her father. The graft weight was 0.6% of the recipient's body weight, or 25% of her ideal liver weight. Avoidance of warm ischemia, short cold ischemic time, and early treatment of rejection are important elements in optimizing small-for-size graft function. Since the left lobe represents 23-36% of the total liver volume of an adult, it is possible, in most cases, to harvest a left lobe graft of adequate size from a donor of similar size as the recipient.
Asunto(s)
Encefalopatía Hepática/cirugía , Trasplante de Hígado/métodos , Hígado/anatomía & histología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos/fisiología , Donantes de TejidosAsunto(s)
Hepatectomía/métodos , Trasplante de Hígado/métodos , Donantes de Tejidos , Adulto , Niño , Preescolar , Estudios de Seguimiento , Hong Kong , Humanos , Lactante , Trasplante de Hígado/inmunología , Trasplante de Hígado/fisiología , Persona de Mediana Edad , Núcleo Familiar , Selección de Paciente , Factores de TiempoAsunto(s)
Supervivencia de Injerto , Trasplante de Hígado/fisiología , Donantes de Tejidos , Adolescente , Adulto , Cadáver , Niño , Preescolar , Quimioterapia Combinada , Femenino , Rechazo de Injerto/epidemiología , Rechazo de Injerto/terapia , Humanos , Inmunosupresores/uso terapéutico , Lactante , Trasplante de Hígado/inmunología , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Muromonab-CD3/uso terapéutico , Núcleo Familiar , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Moderate to severe pain occurs in 75 to 100% of patients after major operations. Pain control techniques, for examples the patient controlled analgesia (PCA) and epidural analgesia, are effective in relieving postoperative pain. Routine delivery of these pain control techniques to patients undergoing operations can be provided by an anaesthesiologists-based acute pain service (APS). METHODS: This manuscript audited postoperative pain management service to 1369 ethnic Chinese patients and 74 patients of other races, over a 30 mon period in a teaching hospital in Hong Kong. The APS was prioritized to elderly patient (36.1%, aged 65 or higher), patients of poor physical condition (27.0% ASA III or IV) and those undertaken major operations. Most patients (1348, 93.4%) received either one of the four standardized analgesic regimens including PCA or epidural analgesia. RESULTS: The median verbal quantitative scale of pain (VQS) at rest/movement were 2.0/4.3 on operative day and 0/0.6 on 4th postoperative day. The morphine consumption in 665 Chinese patients (PCA intravenous morphine) was 26.1 +/- 14.3 mg/kg/h (mean +/- SD) during the first 20 postoperative hours. This decreased to 18.1 +/- 15.1 at 21th to 44th and 18.5 +/- 14.9 at 45th to 68th hours postoperatively. There was no difference in morphine consumption between Chinese patients and other races. The incidence for nausea and vomiting were 26.5% and 13.3%, respectively. Respiratory derangement occurred in 23 patients (1.9%) and almost always accompanied by somnolence. Most patients (1176, 81.5%) rated their postoperative analgesia on discharge from the care of APS. CONCLUSIONS: Effective and safe postoperative analgesia in Chinese patients can be achieved with currently available pain control techniques such as epidural and PCA. APS is a practicable approach to deliver these techniques to postoperative patients on a routine basis.
Asunto(s)
Dolor Postoperatorio/terapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morfina/efectos adversos , Morfina/uso terapéuticoRESUMEN
A human acute lymphoblastic T-cell line, MOLT-3, was fed with Roswell Park Memorial Institute Medium 1640 supplemented with 10% fetal bovine serum and antibiotics which contained increasing concentrations of methotrexate (MTX). The development of drug resistance was associated initially with progressive decrease in MTX transport. When the cells became 200-fold resistant, a rise in the dihydrofolate reductase was noted which was short-lived in the absence of the drug. A 10,000-fold increase in MTX resistance was accompanied, in addition to further decrease in MTX transport, by a 10-fold increase in the dihydrofolate reductase activity. While the purely transport-related resistant cell lines had a collateral sensitivity to lipid-soluble antifols, the sublines which had both transport- and enzyme-related MTX resistance contained a subpopulation highly resistant to these antifols. Chromosome analysis of the subline with increased dihydrofolate reductase activity showed an expanded abnormally banded region in chromosome 5.
Asunto(s)
Leucemia Linfoide/tratamiento farmacológico , Metotrexato/farmacología , Línea Celular , Supervivencia Celular/efectos de los fármacos , Aberraciones Cromosómicas , Resistencia a Medicamentos , Humanos , Leucemia Linfoide/enzimología , Leucemia Linfoide/genética , Metotrexato/metabolismo , Tetrahidrofolato Deshidrogenasa/análisis , Tetrahidrofolato Deshidrogenasa/genéticaRESUMEN
Synchronous yeast-phase cultures of Wangiella dermatitidis were induced by starvation, heat shock, and inhibition of deoxyribonucleic acid synthesis by hydroxyurea. Hydroxyurea-induced synchrony resulted in some distortion of the yeast-phase cell cycle. However, induction of synchrony by hydroxyurea is a rapid and simple technique which generates a marked degree of synchronous growth.
Asunto(s)
Hongos/citología , Ciclo Celular , División Celular/efectos de los fármacos , ADN de Hongos/biosíntesis , Hongos/efectos de los fármacos , Hongos/metabolismo , Calor , Hidroxiurea/farmacología , Factores de TiempoRESUMEN
Temperature-sensitive morphological mutants of Wangiella dermatitidis were stained with mithramycin, a fluorescent nuclear stain. Multicellular forms of the mutants each contained two or more nuclei, documenting that nuclear division accompanied the yeast-to-multicellular form conversion.