Outcomes of Donor Evaluations for Adult-to-Adult Right Hepatic Lobe Living Donor Liver Transplantation

The purpose of this study is to determine the role of liver biopsy and outcome of patients undergoing donor evaluation for adult-to-adult right hepatic lobe living donor liver transplantation (LDLT). Records of patients presenting for a comprehensive donor evaluation between 1997 and February 2005 were reviewed. Liver biopsy was performed only in patients with risk factors for abnormal histology. Two hundred and sixty patients underwent a comprehensive donor evaluation and 116 of 260 (45%) were suitable for donation, 14 of 260 (5.4%) did not complete evaluation and 130 of 260 (50%) were rejected. Four patients underwent unsuccessful hepatectomy surgery due to discovery of intraoperative abnormalities. Between 1997 and 2001, the acceptance rate of donor candidates (63%) was higher than 2002-2005 (36%), p < 0.0001. Sixty-six of the 150 eligible patients (44%) fulfilled criteria for liver biopsy and 28 of 66 (42%) had an abnormal finding. Less than half of the patients undergoing donor evaluation were suitable donors and the donor acceptance rate has declined over time. A large proportion of the patients undergoing liver biopsy have abnormal findings. Our evaluation process failed to identify 4 of 103 who had aborted donor surgeries.     

代孕技术中的伦理道德及法律问题

新近发展的代孕技术给众多不孕夫妇带来为人父母的喜悦之时,也对人们传统的生殖伦理观念形成冲击并挑战现存法律制度.人们不仅要肯定代孕技术的合理性,也要警惕其所产生的潜在的破坏性影响.合理利用该技术和制定相应的法规是避免出现伦理和社会混乱的有效途径.     

Pulsatile Perfusion Reduces the Incidence of Delayed Graft Function in Expanded Criteria Donor Kidney Transplantation

The use of expanded criteria donors (ECD) has been proposed to help combat the discrepancy between organ availability and need. ECD kidneys are associated with delayed graft function (DGF) and worse long-term survival. The aim of this study is to evaluate the impact of pulsatile perfusion (PP) on DGF and graft survival in transplanted ECD kidneys. From January 2000 to December 2003, 4618 ECD kidney-alone transplants were reported to the United Network for Organ Sharing. PP was performed on 912 renal allografts. The prognostic factors of DGF were analyzed using multivariate logistic regression analysis. Risk factors for reduced allograft viability were greater in donors and recipients of PP kidneys. Three-year graft survival of ECD kidneys preserved with PP was similar to cold storage (CS) kidneys. The incidence of DGF in PP kidneys was significantly lower than CS kidneys (26% vs. 36%, p < 0.001). Despite having a greater number of risk factors for reduced graft viability, the ECD-PP kidneys had similar graft survival compared to ECD-CS kidneys. The use of PP, by decreasing the incidence of DGF, may possibly lead to lower overall costs and increased utilization of donor kidneys.     

心理干预对行体外受精病人的影响

体外受精(IVF)治疗对不育夫妇既是一种生理负担又是一种心理负担,在IVF各个时期均表现出心理应激,其中胚胎移植后至妊娠试验前和IVF失败后应激最强,出现负性心理反应,以焦虑、抑郁多见。研究表明,通过心理干预能有效缓解患者的负性心理,并可能提高妊娠率和降低治疗中断率。     

Mycophenolate Mofetil Use Is Associated with Decreased Risk of Late Acute Rejection in Adult Liver Transplant Recipients

Mycophenolate mofetil (MMF) used in a triple-drug regimen has been shown to decrease acute rejection rates, compared to a double-drug regimen. The impact of MMF on late acute rejection (LAR) episodes has not been well described. To investigate the risk of LAR (rejection > or = 6 months post-transplantation) data from the Scientific Registry of Transplant Recipients (SRTR) were used. We studied adult primary liver transplant recipients transplanted between June 1, 1995, and April 30, 2004, with hepatitis C virus (HCV) (n = 3356), hepatitis B virus (HBV) (n = 550) or a nonviral (n = 5740) primary cause of liver disease who were recorded as receiving continuous 3-(MMF + Tacro + steroids) versus 2-drug (Tacro + steroids) therapy for at least 6 months immediately post transplantation. Kaplan-Meier analysis showed significantly lower LAR rates 4 years post-transplant in 3- versus 2-drug HCV, HBV and nonviral disease patients. Multivariate regression confirmed 3- versus 2-drug therapy to be associated with a decreased risk of LAR. Late graft survival was significantly lower at 4 years post-transplant for patients with LAR 6-12 months post-transplantation versus patients with early rejection (78.0% vs. 87.0%, p < 0.001) and no rejection (88.1%, p < 0.001). Three-drug versus 2-drug therapy for a minimum of 6 months may offer a better treatment strategy to avoid the consequences and expense of LAR episodes.     

妊娠与柯兴氏综合征--附1例病案分析

目的 :提高妊娠合并柯兴氏综合征的诊治水平。方法 :结合国内外文献 16例 ,分析讨论妊娠与柯兴氏综合征的相互影响所导致的各种临床结局。结果 :肾上腺皮质腺瘤位于妊娠合并柯兴氏综合征的病因首位 ,而高肾上腺皮质激素刺激征和特征性腹部、大腿宽大紫纹 ,结合B超、CT可以诊断妊娠合并柯兴氏综合征 ;严重的并发症威胁母婴安全 ,积极进行手术治疗和并发症的处理可以降低母婴死亡率、延长孕周。结论 :妊娠合并柯兴氏综合征是极度的高危妊娠 ,妊娠期的早期诊断、早期治疗能改善妊娠质量。     

Physiologic mechanism and preoperative prediction of new-onset dysphagia after laparoscopic Nissen fundoplication

The aim of this study was to determine whether preoperative physiologic factors can account for and be used to predict the development of postoperative dysphagia after laparoscopic Nissen fundoplication. One hundred sixty-three patients with gastroesophageal reflux disease underwent laparoscopic Nissen fundoplication with a median follow-up of 14 months (range 6 to 81 months). Preoperative dysphagia was present in 37% (60 of 163) and was relieved in all but five patients (92%). Female sex (P = 0.01) and the presence of a stricture (P = 0.02) were the only preoperative variables associated with the presence of preoperative dysphagia. Eight percent (8 of 103) of patients without preoperative dysphagia developed new-onset dysphagia, and of these 63% (5 of 8) had a normal lower esophageal sphincter (LES) (pressure >6 mm Hg; length >2 cm; abdominal length >1 cm). New-onset dysphagia was significantly more common in patients with a normal LES (22% [5 of 23] vs. 4% [3 of 80], P = 001). Patients with a normal LES had almost a sixfold increase in the risk of developing dysphagia as those with an abnormal LES (relative risk = 5.8). Only a preoperative normal LES (P = 0.02) or mean LES pressures (P = 0.04) were positively associated with the development of postoperative dysphagia. The severity of this dysphagia also showed a strong positive trend of increasing with mean preoperative LES pressures (P = 0.07). Finally, preoperative LES pressure significantly correlated with postoperative LES pressure (r = 0.48, P = 0.01) and with mean residual LES (nadir) pressure (r = 0.33, P = 0.05) offering insight into the mechanism of this dysphagia. In conclusion, preoperative LES parameters play a role in the development of dysphagia after laparoscopic Nissen fundoplication. Patients with a normal LES or high mean LES pressures are at increased risk for developing this complication and should be informed of this before laparoscopic Nissen fundoplication. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Ga., May 20–23, 2001.     

输卵管妊娠病因分析368例

目的探讨输卵管妊娠的发病原因,以便减少输卵管妊娠的发生。方法对近6年的368例输卵管妊娠进行回顾性分析,从慢性盆腔炎、剖宫产、盆腔肿瘤、妊娠次数与计划生育措施行等因素分两个时间段对比分析,确定主要发病因素。结果慢性盆腔炎(慢性输卵管炎)、剖宫产、人工流产引起输卵管妊娠发病率明显增高(P<0.05)。初次妊娠为输卵管妊娠的发病率明显低于2次以上妊娠(P<0.05),而盆腔肿瘤、宫内节育器、避孕药、输卵管结扎术致输卵管妊娠发病比率无明显差异(P>0.05)。结论慢性盆腔炎(慢性输卵管炎)、多胎次妊娠、反复人工流产、剖宫产是导致输卵管妊娠的四大主要病因。采取避孕措施,减少多胎次妊娠,减少流产术,降低剖宫产率,加强输卵管疾病及盆腔炎的防治,以预防输卵管妊娠的发生。