Adult-to-adult living donor liver transplantation using extended right lobe grafts.

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.     

Attitudes towards mental illness: testing the contact hypothesis among Chinese student nurses in Hong Kong

This study investigated whether previous contact with mental illness affected the attitudes to mental illness (AMI) of general student nurses in Hong Kong — the contact hypothesis. We employed a quasi-experimental design. We compared the attitudes to mental illness of students who had previous contact with mental illness through having taken a psychiatric secondment with those who had not taken a psychiatric secondment. Also, we compared the AMI of: students who had taken other courses related to mental illness with those who had not; those who had a family history of mental illness with those who had not; and those who lived with a mentally ill relative with those who did not. We found that previous contact with mental illness had no significant effect on the attitudes to mental illness of the students. In other words our findings do not support the contact hypothesis. Our sample expressed positive general attitudes to mental illness when presented with general issues about mental illness. However, their attitudes were less positive when presented with specific issues about mental illness that might impinge upon their daily lives. We discuss the implications of these findings for mental health nursing practice, education and research.     

肺癌脑转移的CT研究

目的:研究分析肺癌脑转移瘤的CT特征和规律。材料与方法:回顾总结并分析经病理证实的74例肺癌脑转移病例,就其转移灶的CT特征和规律做出评价。结果:肺癌脑转移以顶、额叶为好发部位,转移灶主要表现为结节状均一强化和环状强化中心低密度,可单发或多发。瘤周水肿以腺癌和低分化癌较明显。环状强化中心低密度灶周水肿较结节均一强化灶周水肿明显。结论:CT增强扫描能清楚地显示转移灶的大小、部位、形态、边缘状况和密度变化,是肺癌脑转移的首选检查方法。     

Early antenatal sonographic diagnosis of conjoined syncephalus-craniothoraco-omphalopagus twins. Case report.

The paper describes the prenatal ultrasonographic diagnosis of conjoined syncephalus-craniothoraco-omphalopagus twins at 13 weeks' gestation. The mother, after genetic counseling, decided to interrupt the pregnancy. The fetal karyotype, the maternal serum and amniotic fluid alpha-fetoprotein levels were normal. The diagnosis was confirmed by pathologic examination of the fetus after termination of pregnancy.     

The tracheal nonadrenergic noncholinergic inhibitory system during antigen challenge

This study was undertaken to test the hypothesis that malfunction of the nonadrenergic noncholinergic inhibitory system (NANCIS) induces hyperreactive airways. Antigen sensitized guinea pigs were divided into four groups: (1) antigen challenge (n = 6), (2) 2 min oxyhemoglobin (HbO2) + antigen challenge (n = 5), (3) 27 min HbO2 + antigen challenge (n = 4), and (4) 2 min HbO2 + transmural stimulation (TS) + antigen challenge (n = 6). These animals were sensitized with ovalbumin 10 days before the study. In addition, 12 normal control animals without antigen sensitization were used for comparison. Under artificial ventilation, the anesthetized-paralyzed animals were hourly injected with atropine (0.2 mg/kg) and propranolol (1 mg/kg). Cervical segment of the trachea was converted to a closed tracheal pouch filled with Krebs solution containing also atropine (1 microM) and propranolol (3.5 microM). A change in the pouch pressure (Pp) reflected NANCIS TS- or antigen (5 micrograms) challenge-induced relaxation and/or constriction. HbO2 was used to inhibit NANCIS transmitter. There was no significant difference between normal and sensitized animals in the NANCIS TS-induced relaxation. Antigen challenge resulted in biphasic alteration in Pp, an initial increase and then a decrease after about 7 min. HbO2 pretreatment alone did not potentiate antigen-induced increase in Pp. HbO2 + TS, however, significantly abolished the late relaxation phase after antigen challenge.     

Acute pancreatitis in the aged

Forty-seven patients aged more than 75 years with acute pancreatitis were studied. The most common cause of acute pancreatitis was biliary tract stones. The clinical presentation and severity of the disease as judged by the number of poor prognostic factors were not different from the group of patients aged less than 75 years. The mortality rate in the older group was thrice that of the younger group (21.3% versus 7.24%). The higher mortality rate was explained by a higher incidence of deaths related to complications of biliary stones and coincidental diseases. Significantly more aged patients with mild disease died, indicating the limitation of predictive ability of the scoring system in acute pancreatitis of the aged.     

In vitro synthesis of antimycobacterial antibodies with different specificities in various tissues of leprosy patients

For the detection of the synthesis in vitro of anti-Mycobacterium leprae antibodies in various tissues of leprosy patients, biopsy specimens of skin lesions, nasal mucosa, larynx, lymph nodes, and bone marrow were cultured in a medium containing 14C-labeled lysine and isoleucine. The culture fluids were analyzed by crossed immunoelectrophoresis with intermediate gel and autoradiography. The results show that synthesis of anti-M. leprae antibodies occurs at the investigated sites of leprosy patients and that the specificities of the synthesized antibodies differ between sites in individual patients. It is conceivable that these antibodies play a role in the local defense against M. leprae.     

Influence of age on the mortality from acute pancreatitis

The influence of age on the mortality rate of 268 patients with acute pancreatitis was studied. The hospital mortality rate for patients aged below 50 years was 5.9 per cent. The figure increased to 21.3 per cent in patients aged over 75; the high mortality was accounted for by a higher incidence of deaths related to concomitant medical or surgical diseases in the same hospital admission rather than to complications resulting directly from the pathological process of acute pancreatitis. When only deaths due to complications of acute pancreatitis were analysed, the mortality rate was not significantly different between the young and elderly groups. Moreover, the complication rate and the proportion of patients having severe disease (judged by the number of prognostic signs) were not higher in the elderly. Thus acute pancreatitis was intrinsically not more serious were it not for the presence of concomitant diseases with advanced age.     

隆鼻硅胶假体雕刻中的四个角度

目的探讨隆鼻硅胶假体雕刻中的四个角度与隆鼻并发症的关系。方法总结了420例硅胶假体隆鼻术患者,分析并发症与假体雕刻的关系,提出假体雕刻要与鼻部解剖形态相吻合的四个角度。结果术后1周,发现3例患者假体鼻根部向一侧轻度偏斜,2例6个月后鼻根部假体固定不良。1例术后主诉头痛,取出假体后症状消失。其余未发生并发症。结论假体雕刻与鼻部解剖形态的四个角度相吻合,可以减少并发症的发生,提高美容效果。