Background Adult living donor liver transplantation (LDLT) has become a routine treatment option for patients waiting for liver transplantation.
In European and North American countries, LDLT for adult recipients is mainly performed with right lobe grafts. Indications,
when compared to deceased donor liver transplantation, are controversial.
Materials and methods In our institution, patients suffering from hepatocellular carcinoma in cirrhosis, non-resectable hilar cholangiocarcinoma,
viral hepatitis associated cirrhosis, as well as cholestatic liver and biliary disease are considered good candidates for
LDLT.
Results In this overview, donor evaluation, graft selection, and the donor operation with special regard to operative techniques and
strategies are discussed. For visualization, a 5-min video sequence of the standard donor operation as performed in our institution
is attached.
Conclusion Given the ongoing shortage of donor organs, adult LDLT has become a routine treatment option for patients waiting for liver
transplantation. The associated inevitable risk for the healthy donor, however, remains ethically controversial.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
This audit has been conducted in order to provide an evidence base that clarifies the strengths and weaknesses of acute pain management at a UK hospital. Consequently, it sets the strategic direction for service improvement. Awarding up to three stars has identified the quality of each component that constitutes the acute pain service. Six different components were audited and star ratings have been awarded as shown below:
• Pain tool (including patient and staff understanding): no stars.
• Pain team (including education and clinical support): two stars.
• Intermittent opioid analgesia (sub-cut and oral morphine): two stars.
• Epidural patient controlled analgesia (EPCA): two stars.
• Intravenous patient controlled analgesia (IVPCA): two stars.
• Single-dose intrathecal opioid analgesia: three stars.
These star ratings were pulled together in order to award the acute pain service an overall rating. Consequently, the acute pain service was awarded two stars. The findings of this audit identify that this acute pain service provides a safe way to deliver hi-tech pain relief at ward level and can be relied upon to provide good quality pain management. However, too many patients are likely to miss out on the full benefits of the service due to the weaknesses as identified. The quality of the pain relief is impeded across the hospital due to low patient expectation and poor patient education, and also due to a lack of relevant knowledge amongst nursing staff. Developments in the role of the acute pain nurse, staff training and education programs, and a reduction in the variety of pain management pumps are combining to facilitate the opportunities required to address the weaknesses and to build on the strengths of the acute pain service. 相似文献
The purpose of this study was to evaluate an instrument for assessment of physical disability, mainly intended for clinical settings, the Disability Rating Index (DRI). Healthy persons (n = 1092), both white and blue collar workers, and patients (n = 366) with different levels of physical capacity, were assessed. Most of the patients (n = 303) underwent rehabilitation programmes for neck/shoulder/low-back pain but some (n = 47) were arthritis patients waiting for hip or knee replacement surgery, or wheelchair patients with multiple sclerosis (n = 16). The reliability was investigated by test-retest studies, intra- and inter-rater and internal consistency studies. Five construct validity tests were carried out: a discrimination study; a converging validity test; a test for sensitivity to small alterations in health status; and two correlational validity tests. Correlation of the self-reported DRI to the actual performance in similar activities was carried out. Responsiveness was tested by correlation of the DRI before/after replacement surgery for arthritis. The test-retest correlations were 0.83–0.95 in the studies, including correlation of different versions. The intra- and inter-rater reproducibility was 0.98 and 0.99 respectively. The Kruskal-Wallis test in the discrimination study yielded p < 0.0001. More than 90% of the respondents completed the questionnaire correctly. Correlation of the DRI to the Functional Status Questionnaire was 0.46. The responsiveness was excellent, p = 0.0001. The DRI proved to be a robust, practical clinical and research instrument with good responsiveness and acceptability for assessment of disability caused by impairment of common motor functions. 相似文献
.A sedation regimen using sequential oral trinepazine, intravenous Pethco (pethidine, chlorpromazine and promethazine) and
diazemuls was evaluated in children having native kidney (n = 17) and transplant kidney (n = 17) biopsies. Biopsy was successful in all cases, with no serious side effects. A self-reported scale of memory recall
and pain perception showed the optimal time for biopsy to be between 30 and 90 min after the intravenous Pethco. The child’s
level of distress was measured by a self-reported scale, a parent-reported scale and an observational scale for doctors and
nurses; 45% of children rated themselves highly distressed prior to the procedure, their parents being the best assessors
of this distress. Younger children and those undergoing native kidney biopsy had less understanding of the procedure. Children’s
worries could be clearly categorised into procedural and outcome issues: those undergoing transplant biopsy were more worried
about outcome, whereas those undergoing native kidney biopsy were more worried about the procedure.
Received April 3, 1995; received in revised form and accepted April 17, 1996 相似文献
The study objectives were to compare in vitro transportability and physical properties of respiratory mucus, obtained invasively by direct collection (DC) right after endotracheal intubation and non-invasively by sputum induction with 3% hypertonic saline solution inhalation (SI) 24 h before the anesthesia. Twenty-two patients with no pulmonary disease scheduled for elective abdominal surgical procedures were studied. The parameters analyzed and the main results are as follows. (1) Transportability by cilia (MCT), SI was higher than DC (0.94+/-0.25 and 0.62+/-0.25; P<0.001). There was a significant correlation between the two methods and DC could be estimated by: DC=0.21+(0.44 SI) (r=0.44; P<0.001). (2) Transportability by cough (CC), SI was higher than DC (68.23+/-32.1 and 33.58+/-19.04 mm; P=0.002). (3) Contact angle (CA), SI was lower than DC (10+/-3 degrees and 22+/-14 degrees ; P=0.025). (4) Rheological properties (no significant difference obtained between SI and DC). These results indicated that SI changes mucus physical properties and transportability in non-expectorators. 相似文献