Hematologic and plasma biochemical values of Spix's macaws (Cyanopsitta spixii)

The Spix's macaw (Cyanopsitta spixii) is considered the world's most endangered parrot, with the last wild bird disappearing in 2001 and only 74 birds in captivity. To establish hematologic and plasma biochemical reference ranges and to look for differences relative to sex, age, and season, we obtained blood samples from 46 captive Spix's macaws (23 male, 23 female) housed in aviaries at the Al Wabra Wildlife Preservation in the State of Qatar. No significant differences in hematologic or plasma biochemical values were found between females and males. Adult and juvenile birds differed in mean concentrations of glucose, total protein, amylase, cholesterol, and phosphorus; in percentages of heterophils and lymphocytes; and in the absolute lymphocyte count. Total protein, cholesterol, and phosphorus concentrations; hematocrit; and heterophil and lymphocyte counts differed significantly by season. Baseline hematologic and plasma biochemical ranges were established, which may be useful as reference values for clinicians working with this highly endangered species.     

A longitudinal study on avian polyomavirus-specific antibodies in captive Spix's macaws (Cyanopsitta spixii)

Avian polyomavirus (APV) causes a range of disease syndromes in psittacine birds, from acute fatal disease to subclinical infections, depending on age, species, and other unidentified risk factors. To determine the prevalence of APV-specific antibodies in a captive population of Spix's macaws (Cyanopsitta spixii) in Quatar, 54 birds were tested by blocking enzyme-linked immunosorbent assay. A prevalence of 48.1% for APV antibodies, which indicates viral exposure, was found. Of 36 Spix's macaws that were serially tested over a period of 4 years, 50.0% were consistently positive, 36.1% were consistently negative, 5.5% had permanently declining antibody levels, and 2.8% showed variable results. By using polymerase chain reaction testing on whole blood samples, an apparent viremia was detected in 1 of 44 birds (2.3%), although contamination provides a likely explanation for this isolated positive result in a hand-reared chick. The white blood cell count was significantly higher in antibody-positive birds compared with antibody-negative birds (P < .05). Because antibody-positive and antibody-negative birds were housed together without a change in their respective antibody status, transmission of APV within the adult breeding population appeared to be a rare event.     

Plasma osmolality reference values in African grey parrots (Psittacus erithacus erithacus), Hispaniolan Amazon parrots (Amazona ventralis), and red-fronted macaws (Ara rubrogenys)

Birds are routinely presented to veterinarians for dehydration. Success with these cases ultimately depends on providing replacement fluids and re-establishing fluid homeostasis. Few studies have been done to determine reference ranges for plasma osmolality in birds. The goals of this study were to determine reference values for plasma osmolality in 3 species of parrots and to provide recommendations on fluid selection for replacement therapy in these species. Blood samples were collected from 21 adult Hispaniolan Amazon parrots (Amazona ventralis), 21 Congo African grey parrots (Psittacus erithacus erithacus), and 9 red-fronted macaws (Ara rubrogenys), and were placed into lithium heparin containers. Plasma osmolality was measured in duplicate with a freezing point depression osmometer. Summary statistics were computed from the average values. Reference ranges, calculated by using the robust method, were 288-324, 308-345, and 223-369 mOsm/kg in African grey parrots, Hispaniolan Amazon parrots, and red-fronted macaws, respectively. The mean +/- SD values were 306 +/- 7, 327 +/- 7, and 304 +/- 18 mOsm/kg in African grey parrots, Hispaniolan Amazon parrots, and red-fronted macaws, respectively. Comparisons with osmolality values in mammals and values previously reported for psittacine bird species suggest that plasma osmolality is slightly higher in parrots than in mammals, species-specific differences exist, and differences between reported values occur. Overall, fluids with an osmolarity close to 300-320 mOsm/L, such as Normosol-R, Plasmalyte-R, Plasmalyte-A, and NaCl 0.9%, can be recommended in parrots for fluid replacement therapy when isotonic fluids are required.     

Radiographic evaluation of cardiac size in four Falconiform species

To establish reference values for the cardiac size during radiographic examination in 4 species of Falconiformes used for falconry, lateral and ventrodorsal radiographs were examined from healthy birds of 4 species: Harris' hawks (Parabuteo unicinctus) (n = 48), peregrine falcons (Falco peregrinus) (n = 35), saker falcons (Falco cherrug) (n = 19), and lanner falcons (Falco biarmicus) (n = 13). On the lateral view, ratios between the length of the heart from base to apex and total length of the carina were calculated. On the ventrodorsal view, ratios between the width of the heart at its widest point and the distance between the ribs at the same level and between the width of the coracoid immediately caudal to the humeral articular surface in the shoulder joint and width of the heart and the distance between the ribs were calculated. No differences were found between species in the ratio of length of the heart/length of the carina. The ratios of width of the heart/distance between ribs and width of the heart/coracoid width differed between hawks and falcons but did not differ between the 3 falcon species.     

An analysis of errors in kinematic parameters associated with in vivo functional radiographs.

A pair of functional radiographs, taken at each end of the range of motion, are used to determine spinal motions. Graphic construction and computer-assisted methods are available for the radiographic analysis. The later provides many more motion parameters. A study of lumbar spine lateral radiographs was conducted to determine errors in the motion parameters due to spinal level, radiographic quality, and errors in the two digitizing instruments. Significant differences were found in the errors due to the two digitizers when the same radiographic pair was redigitized several times. There were only minimal differences, however, between the digitizers when the radiographic films were remarked and redigitized. The error ranges (2 x SD) for the motion parameters were 1) rotation = +/- 1.25 degrees; 2) translation of the inferior posterior vertebral body corner = +/- 0.86 degrees; and 3) coordinates for the center of rotation = +/- 4.3 mm. Both the spinal level and radiographic quality affected the magnitude of errors in all motion parameters.     

Direct plain radiographic methods versus EBRA-Digital for measuring implant migration after total hip arthroplasty

We aimed to determine whether the precision and sensitivity of migration measurements after total hip arthroplasty (THA) using direct plain radiographic techniques could be made comparable to those of digital methods (EBRA-Digital; University of Innsbruck, Innsbruck, Austria) by careful control of radiographic technique and use of modern measuring tools. Precision was examined by analysis of consecutive radiographs taken after repositioning in 20 patients after hybrid THA. The precision (95% confidence interval) of measurements for cup migration using direct methods was +/-1.11 to 3.07 mm (x-axis) and +/-1.28 to 1.92 mm (y-axis). The precision of EBRA for cup measurements was +/-1.00 mm (x-axis) and +/-0.82 mm (y-axis). The precision of stem y-axis migration measurements was +/-1.12 to 6.91 mm using direct methods and +/-0.80 mm using EBRA. Migration of the stem (1.53 mm subsidence; P<.01) and the cup (0.53 mm cranial migration, P<.05) was detected using EBRA in 10 patients followed for 6 months after hybrid THA, but significant migration was not detectable using the most precise of the direct methods. Careful measures to standardize plain radiographs improve precision of direct radiographic measurements; however, their long-term sensitivity remains inferior to methods that employ quality control and measurement algorithms to measure migration from digitized radiographs.     

Computer-assisted analysis of lower limb geometry: higher intraobserver reliability compared to conventional method.

Exact radiographic evaluation of lower limb alignment, joint orientation and leg length is crucial for preoperative planning and successful treatment of deformities, fractures and osteoarthritis. Improvement of the accuracy of radiographic measurements is highly desirable. To determine the intraobserver reliability of conventional analysis of lower extremity geometry, 59 long leg radiographs were randomly analyzed 5 times by a single surgeon. The measurements revealed a standard deviation between 0.36 degrees and 1.17 degrees for the angles mLPFA, mLDFA, MPTA, LDTA, JLCA and AMA (nomenclature according to Paley), and 0.94 mm and 0.90 mm for the MAD and leg length, respectively. Computer-assisted analysis with a special software significantly reduced the standard deviation of the mLDFA, MPTA, LDTA, JLCA (each p < 0.001), AMA (p = 0.032) and MAD (p = 0.023) by 0.05-0.36 degrees and 0.14 mm, respectively. Measuring time was reduced by 44% to 6:34 +/- 0:45 min (p < 0.001). Digital calibration by the software revealed an average magnification of conventional long leg radiographs of 4.6 +/- 1.8% (range: 2.7-11.9%). Computer-assisted analysis increases the intraobserver reliability and reduces the time needed for the analysis. Another major benefit is the ease of storage and transfer of digitized images. Due to the varying magnification factors on long leg radiographs, the use of magnification markers for calibration is recommended.     

Reference intervals for intraocular pressure measured by rebound tonometry in ten raptor species and factors affecting the intraocular pressure

Intraocular pressure (IOP) was measured with the TonoVet rebound tonometer in 10 raptor species, and possible factors affecting IOP were investigated. A complete ophthalmic examination was performed, and IOP was assessed in 2 positions, upright and dorsal recumbency, in 237 birds belonging to the families Accipitridae, Falconidae, Strigidae, and Tytonidae. Mean IOP values of healthy eyes were calculated for each species, and differences between families, species, age, sex, left and right eye, as well as the 2 body positions were evaluated. Physiologic fluctuations of IOP were assessed by measuring IOP serially for 5 days at the same time of day in 15 birds of 3 species. Results showed IOP values varied by family and species, with the following mean IOP values (mm Hg +/- SD) determined: white-tailed sea eagle (Haliaeetus albicilla), 26.9 +/- 5.8; red kite (Milvus milvus), 13.0 +/- 5.5; northern goshawk (Accipiter gentilis), 18.3 +/- 3.8; Eurasian sparrowhawk (Accipiter nisus), 15.5 +/- 2.5; common buzzard (Buteo buteo), 26.9 +/- 7.0; common kestrel (Falco tinnunculus), 9.8 +/- 2.5; peregrine falcon, (Falco peregrinus), 12.7 +/- 5.8; tawny owl (Strix aluco), 9.4 +/- 4.1; long-eared owl (Asio otus), 7.8 +/- 3.2; and barn owl (Tyto alba), 10.8 +/- 3.8. No significant differences were found between sexes or between left and right eyes. In goshawks, common buzzards, and common kestrels, mean IOP was significantly lower in juvenile birds than it was in adult birds. Mean IOP differed significantly by body position in tawny owls (P = .01) and common buzzards (P = .04). By measuring IOP over several days, mean physiologic variations of +/- 2 mm Hg were detected. Differences in IOP between species and age groups should be considered when interpreting tonometric results. Physiologic fluctuations of IOP may occur and should not be misinterpreted. These results show that rebound tonometry is a useful diagnostic tool in measuring IOP in birds of prey because it provides rapid results and is well tolerated by birds.     

Radiographic assessment of adult flatfoot

BACKGROUND: The accurate measurement of flatfoot on standing radiographs allows correct diagnosis of the condition and evaluation of reconstructive procedures. METHOD: The standing radiographic measurements of patients with symptomatic, adult flatfoot were compared to controls using blinded observers. RESULTS: On the lateral radiograph, the talar-to-first metatarsal angle, the calcaneal pitch angle, and the medial cuneiform-fifth metatarsal height differed significantly between the patient group and the controls. The difference in the talar-to-first metatarsal angles on lateral radiographs was the most statistically significant (patient group 21.1 +/- 10.8 degrees and control 7.1 +/- 10.7 degrees, p < 0.0001) with good correlation between readings (intraobserver 0.75, interobserver 0.83). On the anteroposterior (AP) radiograph, the talar head uncoverage distance was the most significantly different measurement between these groups. CONCLUSIONS: These findings support the hypothesis that the talar-first metatarsal angle is an accurate radiographic identifier of patients with symptomatic, adult flatfoot.     

Blood pressure effects of thoracic gunshot wounds: the role of bullet image diameter

Differences in handgun bullet diameter, expansion, and penetration (no exit) versus perforation (with exit) may be the cause of variable blood pressure effects after thoracopulmonary injury. Forty nonlethal isolated gunshot wounds of the thorax were evaluated excluding wounds of the heart, great vessels, and spinal cord. Chest radiographs were assessed for bullet base diameter, bullet expansion, and wound length. Large bullets were defined as having radiographic base images of 9 mm or more in diameter. Systolic blood pressures were compared between penetrating large and small bullet groups and with perforating wounds. Response times and demographics were compared. Wounds caused by large bullet penetration resulted in lower initial systolic blood pressures than wounds caused by small bullet penetration (98 vs 125 mm Hg, P < 0.05). The average age, transport time, and wound length were similar among the bullet groups. We conclude that penetrating thoracopulmonary wounds caused by large bullets resulted in lower initial systolic blood pressure.     

Quantitative anatomic study of atlanto-odontoid joint and design of an artificial atlanto.odontoid joint for the orthopedic clinic

OBJECTIVE: To observe and measure morphological parameters of the Chinese atlanto-odontoid joint anatomically in order to provide an anatomic data for designing artificial atlanto-odontoid joint used for substituting the destroyed atlanto-odontoid joint in the orthopedic clinic. METHODS: The relative anatomic parameters of 32 sets of fresh Chinese adults'atlanto-odontoid joint specimens were measured with a digital caliper and a goniometer, including the width of anterior arch of atlas (AW), the thickness of atlas at the junction of anterior arch and lateral mass (AD), the thickness and height of anterior tubercle of atlas (AT and AH), the middle height, length and width of the lateral mass (MHL, L and LW), the height, transverse and anteroposterior distance of odontoid process (DH, DW and DD), the retroversion angle of odontoid process (beta degree),the facial angle of odontoid process (theta degree) and so on. The data were statistically analyzed in order to ascertain the morphological parameter ranges of artificial atlanto-odontoid joint. An artificial atlanto-odontoid joint was designed according to these data. The operations of anlanto-odontoid joint arthroplasty were conducted in 3 cases of adult cadaver specimens. RESULTS: The width of AW was (20.45+/-1.53) mm, AD (3.91+/-1.32) mm, AT and AH (9.43+/-1.93)mm and (10.23+/-1.32) mm, respectively, MHL and LW (13.68+/-1.38) mm and (12.98+/-1.52) mm, respectively, DH (15.25+/-2.11) mm, DW and DD (9.69+/-1.38) mm and (11.26+/-1.02) mm, respectively, beta degree (12.23+/-4.27) degree, theta degree (65.48+/-2.17) degree. The prosthesis was composed of atlas part, axis part and accessories. Neither the vertebral artery nor the medulla oblongata was injured. CONCLUSIONS: The design of artificial atlanto-odontoid joint is feasible according to these parameters. The artificial joint can not only rebuild the stability of atlanto-axial joint, but also reserve the rotation function between atlas and axis. Every part of the joint has their own parameter ranges in purpose to firm fixation, convenient operation and good motion without further injury. The prosthesis can be used for patients suffering from compression of medulla oblongata and resection of dens when it is required.     

Effect of radiographic quality on computer-assisted head penetration measurements

Even the most sophisticated computer-assisted radiographic techniques of measuring femoral head penetration into the polyethylene liner depend on the quality of the radiograph being evaluated, which varies greatly in clinical settings. The authors of this study sought to determine how the accuracy and reproducibility of three commercially available computer-assisted measurement systems differed when measuring optimal radiographs (with sharply defined component edges) and suboptimal radiographs (with less well defined edges). Using three computer-assisted measurement systems, the authors measured head penetration on simulated and clinical hip radiographs. All systems calculated head penetration as the movement of the head center relative to the cup center. To define the periphery of the prosthetic head and cup, one method (System One) used the human eye and a digitizing tablet, whereas the other two methods (System Two and System Three) used digital edge detection algorithms. For simulated hip radiographs, error was calculated as the absolute value of the difference between the known amount of head penetration, determined by a coordinate measuring machine, and the amount of penetration determined by the software. Three way analysis of variance showed a significant difference in absolute error among the three measurement techniques. System One had a significantly smaller absolute error (0.11 +/- 0.06 mm) than did System Two (0.25 +/- 0.25 mm) and System Three (0.19 +/- 0.13 mm). In addition, three-way analysis of variance showed that optimal radiographs were associated with a significantly lower absolute error (0.14 +/- 0.09 mm) than were suboptimal radiographs (0.23 +/- 0.22 mm). For optimal radiographs, there was no significant difference in error among the three measurement methods; all systems were accurate and reproducible. However, for suboptimal radiographs absolute error increased and varied widely, and a significant difference among the methods existed. These data show the susceptibility of head penetration measurements to radiographic technique and underscore the importance of good quality radiographs for all analyses of head penetration.     

Cellular and vascular reactions in the liver to radio-frequency thermo-ablation with wet needle applicators. Study on juvenile domestic pigs

The aim of this animal experiment was to investigate the cellular and vascular reactions in the liver of juvenile domestic pigs produced by a radio-frequency thermoablation (RFTA) applicator perfused with saline solution. METHODS: A total of 13 coagulation necroses were produced in the liver of 3 anesthetized domestic pigs using RFTA. The pigs were dissected and the coagulations examined. RESULTS: The mean macroscopical length and width of the coagulation zones with a hemorrhagic marginal zone after a 5-minute application time were 34.1 +/- 8 mm (22-46 mm) and 20.8 +/- 4 mm (12 +/- 28 mm) respectively. The sonographically determined diameters correlated significantly (r(length) = 0.741 and r(width) = 0.923). Three areas in the coagulation zones could be histologically distinguished: (1) central necrosis zone, (2) hemorrhagic marginal zone, (3) sublethal damage zone. Large vessels did not show any substantial changes after RFTA. Venous vessels less than 1 mm were completely thermally denatured or destroyed. CONCLUSIONS: Tumors in close proximity to large blood vessels can be treated by RFTA with 'wet electrodes'.     

The effects of minor hip flexion, abduction or adduction and x-ray beam angle on the radiographic joint space width of the hip

OBJECTIVE: Joint pain may cause patients to hold their limbs in mild flexion, abduction or adduction to minimize pain, regardless of the extent of articular pathology, and these positional changes may have substantial effects on the interpretation of radiographic joint space. We aimed to study the impacts of minor degrees of flexion, abduction or adduction of the hip, as well as the angle of the x-ray beam on the radiographic joint space width (JSW) of the hip joint. METHODS: In the first part of the study, 65 patients (44 males, 21 females, mean+/-SD age 49+/-17) without clinical evidence of hip osteoarthritis (OA) who underwent intravenous pyelography (IVP) were studied. The hips were differentially positioned during the sequential radiographs required for the IVP procedure. Baseline radiographs were taken at 15 degrees internal rotation of the hips [the standard position for anteroposterior (AP) pelvis radiography]; additional positions included the hips at 15 degrees and/or 30 degrees flexion, and 15 degrees adduction and/or 30 degrees abduction. Radiographic JSWs were measured at three sites using a dial caliper: superomedial, superolateral, and the point of narrowest JSW. In the second part, 15 patients without clinical evidence of hip OA who underwent supine abdominal radiography for non-rheumatological indications were evaluated by standard (AP) pelvis x-ray in the same setting and JSW measurements were made as described above. RESULTS: When the average of the three measurements of the JSW was taken for each hip, baseline JSW was 4.38+/-0.55 mm (mean+/-SD). Positioning of the hip significantly (P<0.01) affected the radiographic JSW, with apparent widening during adduction and 30 degrees flexion, (JSW 4.56+/-0.51 mm and 4.53+/-0.58 mm, mean+/-SD), respectively, but narrowing during abduction (4.17+/-0.59 mm, mean+/-SD). Fifteen degree flexion of the hip did not result in statistically significant change in JSW measurements. Upon comparison of the AP pelvis view with the supine abdominal view, neither the average JSW nor the point of narrowest JSW differed significantly, although the superolateral JSW was significantly greater on the AP pelvis view (P=0.02). CONCLUSIONS: Subtle positional changes in the hip, such as may occur during pain or in OA, may artifactually alter the measured radiographic JSW. Thus, longitudinal studies which employ hip JSW to assess disease progression may yield biased results due to changes in pain rather than structure unless care is taken to ensure constant positioning of the hip.     

Lung tissue volume estimated by simultaneous radiographic and helium dilution methods.

The pulmonary total tissue volume (blood, extravascular water, and dry tissue volume) was measured by finding the difference between the radiographic displacement volume of the thorax (RDVT) and the lung gas volume. Simultaneous determinations of RDVT and gas volume were made in 10 healthy subjects sitting upright. RDVT was determined from posteroanterior and lateral chest radiographs, a computerised modification of the Barnhard method being used; and gas volume was measured by helium dilution with each radiographic exposure. At functional residual capacity pulmonary total tissue volume was 843 +/- 110 ml (1 SD). The density of the lung (ml tissue per ml tissue and gas) was 0.19 +/- 0.03 (1 SD). This method, different in principle from indicator-dilution and acetylene rebreathing studies, provides measurements of total tissue volume.     

Evaluation of ulnar styloid length

PURPOSE: General awareness of the ulnar styloid impaction syndrome is low and often is neglected. Radiographic evaluation of the ulnar styloid length generally includes an x-ray of the posteroanterior view. This study analyzed the effect of different radiographic views to assess the length of the ulnar styloid. The ulnar styloid-capitate ratio (SCR) expresses the relative length of the ulnar styloid, and we compare this ratio with the ulnar styloid process index (USPI). METHODS: To evaluate the ulnar styloid and to analyze the effect of different radiographic views on measurement outcome, measurements were performed in 7 different radiographic positions of both wrists of 69 patients. To assess the relative size of the ulnar styloid and its impaction potential the USPI was calculated, re-evaluated, and compared with the SCR, in which the length of the ulnar styloid is divided by the length of the capitate bone. RESULTS: The mean ulnar styloid length in all standard posteroanterior radiographs is 4.4 +/- 1.2 mm. In our population the average USPI was 0.21 +/- 0.11 and the average SCR was 0.18 +/- 0.05. The SCR has a stronger correlation with the length of the ulnar styloid than the USPI. Furthermore this new ratio eliminates differences related to gender, whereas the USPI does not. CONCLUSIONS: To identify ulnar impaction potential we recommend using the USPI, but to compare ulnar styloid between patients we recommend using the SCR obtained from neutral posteroanterior radiographs. For white patients we suggest defining a long ulnar styloid as having an SCR greater than 0.18 +/- 0.05 and/or an overall styloid length greater than 6 mm.     

Measurement of hip prostheses using image analysis. The maxima hip technique

A computer-based image analysis system has been developed as a research tool in total hip replacement. The system has been programmed to take multiple measurements from coronal plane radiographs. Poor quality radiographic images can be enhanced and standardised. The measurements which can be obtained include stem subsidence, cup migration, cup wear, and stem loosening. Reproducibility and accuracy were +/- 0.01 mm and +/- 0.5 mm respectively. The present application is in retrospective research, but prospective monitoring of radiographs is planned.     

Manual versus digital radiographic measurements in acetabular dysplasia

The intraobserver and interobserver variability of common radiographic measurements associated with hip dysplasia from plain and digital radiographs was assessed. Only the interobserver reliability of measuring Hilgenreiner's distance was found to be potentially clinically significant. The average Spearman correlation coefficients between groups were 0.81 acetabular index, 0.80 medial teardrop to medial metaphysis distance, and 0.77 Hilgenreiner's distance. The average difference between digital and plain radiographs was acetabular index 0.97 +/- 0.6 degrees, medial teardrop to medial metaphysis distance 0.5 +/- 0.56 mm, and Hilgenreiner's distance 0.41 +/- 0.78 mm. These values are clinically insignificant; therefore, digital radiographs are as reliable as conventional radiographs in assessing hip dysplasia.     

Comparative Electrocardiography in Four Species of Macaws (Genera Anodorhynchus and Ara)

Electrocardiograms (ECGs) were recorded during isoflurane anaesthesia from 52 macaws of four species of the genera Anodorhynchus and Ara in order to establish electrocardiographic reference values. The birds examined were clinically healthy macaws of the following species: hyacinth macaw (HM; Anodorhynchus hyacinthinus, n = 14); green‐winged macaw (GWM; Ara chloroptera, n = 11); blue‐throated macaw (BTM; Ara glaucogularis, n = 15); and red‐fronted macaw (RFM; Ara rubrogenys, n = 12). All ECGs were recorded using a paper speed of 50 mm/s and a calibration of 10 mm = 1 mV. Significant differences were determined between species for the heart rate, duration and amplitude of the P wave, amplitude of the T wave, and amplitude of the QRS complex, specially comparing the RFM to the other macaw species. No significant differences were found between two species of similar body weight: the HM and the GWM.     

Hemodynamics of the cirrhotic patient during liver transplantation. Influence of the preservation of portal and vena cava flow

OBJECTIVE: To describe the hemodynamic pattern of patients undergoing liver transplantation with preservation of portocaval flow. PATIENTS AND METHODS: A prospective study of 20 cirrhotic patients who had not previously undergone surgery for portal hypertension or had porto-systemic bypass, both of which have hemodynamic effects in the cirrhotic patient. The patients were transplanted with preservation of inferior vena cava flow and temporary portocaval shunt. RESULTS: The decrease in cardiac output during the anhepatic phase was only 10% and mean blood pressure (77.6 +/- 11 versus 76 +/- 10 mm Hg) and supply pressures (central venous pressure 9.1 +/- 5.5 versus 8.4 +/- 5.3 mm Hg; pulmonary capillary pressure 11.4 +/- 6.1 versus 11.3 +/- 7.4 mm Hg) remained stable. Likewise, no significant increase in systemic vascular resistance (614 +/- 223 versus 676 +/- 306 dyne-sec/cm5) or heart rate (90 +/- 14 versus 97 +/- 17 beats/min). The number of units of packed red cells was 2.7 +/- 2.5 and 35% of the patients required no transfusions. Diuresis was stable throughout the procedure (total diuresis 3.6 +/- 2.4 mL/Kg/h; anhepatic phase 1.3 +/- 1.5 mL/Kg/h). CONCLUSIONS: Creation of a portocaval shunt during the anhepatic phase of liver transplantation allows hemodynamic vital signs to be held stable, decreases the need for transfusion and maintains diuresis.