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Wagner de Castro Andrade Manoel Carlos Prieto VelhoteAli Ahman Ayoub Marcos Marques SilvaNelson Elias M. Gibelli Ana Cristina A. TannuriMaria Merces Santos Maria Lucia Pinho-ApezzatoFabio de Barros Daniel Rangel MoreiraHelena T. Miyatani Raimundo Renato PereiraUenis Tannuri 《Journal of pediatric surgery》2014
Background/Purpose
Living donor liver transplantation has become a cornerstone for the treatment of children with end-stage hepatic dysfunction, especially within populations or countries with low rates of organ utilization from deceased donors. The objective is to report our experience with 185 living donors operated on by a team pediatric surgeons in a tertiary center for pediatric liver transplantation.Methods
Retrospective analysis of medical records of donors of hepatic grafts for transplant undergoing surgery between June 1998 and March 2013.Results
Over the last 14 years, 185 liver transplants were performed in pediatric recipients of grafts from living donors. Among the donors, 166 left lateral segments (89.7%), 18 left lobes without the caudate lobe (9.7%) and 1 right lobe (0.5%) were harvested. The donor age ranged from 16 to 53 years, and the weight ranged from 47 to 106 kg. In 10 donors, an additional graft of the donor inferior mesenteric vein was harvested to substitute for a hypoplastic recipient portal vein. The transfusion of blood products was required in 15 donors (8.1%). The mean hospital stay was 5 days. No deaths occurred, but complications were identified in 23 patients (12.4%): 9 patients experienced abdominal pain and severe gastrointestinal symptoms and 3 patients required reoperations. Eight donors presented with minor bile leaks that were treated conservatively, and 3 patients developed extra-peritoneal infections (1 wound collection, 1 phlebitis and 1 pneumonia). Eight grafts (4.3%) showed primary dysfunction resulting in recipient death (3 cases of fulminant hepatitis, 1 patient with metabolic disease, 1 patient with Alagille syndrome and 3 cases of biliary atresia in infants under 1 year old). There was no relation between donor complications and primary graft dysfunction (P = 0.6).Conclusions
Living donor transplantation is safe for the donor and presents a low morbidity. The donor surgery may be performed by a team of trained pediatric surgeons. 相似文献64.
65.
荧光共振能量转移(FRET)技术广泛用于活细胞中生物大分子构象变化和分子间动态相互作用的实时研究.受体光漂白法和敏化发射测量方法是激光共聚焦显微镜研究FRET的两类常用方法,在实验中应注意FRET荧光对样品选择的要求及FRET技术的局限性等问题.FRET技术作为活细胞研究强有力的工具在生命科学领域具有广阔的应用前景. 相似文献
66.
Francesco Giallauria Carlo Vigorito Massimo F. Piepoli Andrew J. Stewart Coats 《International journal of cardiology》2014
Background
Although cardiac contractility modulation (CCM) has emerged as a promising device treatment for heart failure (HF), the effect of CCM on functional capacity and quality of life has not been the subject of an individual patient data meta-analysis to determine its effect on measures of functional capacity and life quality. This meta-analysis is aimed at systematically reviewing the latest available randomized evidence on the effectiveness of CCM on functional capacity and quality of life indexes in patients with HF.Methods
The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched in May 2013 to identify eligible randomized controlled trials comparing CCM with sham treatment or usual care. Primary outcomes of interest were peak oxygen consumption, 6-minute walk test distance and quality of life measured by Minnesota Living With Heart Failure Questionnaire. There was no sufficient information to address safety. Mean difference and 95% confidence intervals (C.I.s) were calculated for continuous data using a fixed-effects model.Results
Three studies enrolling 641 participants were identified and included. Pooled analysis showed that, compared to control, CCM significantly improved peak oxygen consumption (mean difference + 0.71, 95% C.I. 0.20 to 1.21 mL/kg/min, p = 0.006), 6-minute walk test distance (mean difference + 13.92, 95% C.I. − 0.08 to 27.91 m, p = 0.05) and quality of life measured by Minnesota Living With Heart Failure Questionnaire (mean difference − 7.17, 95% C.I. − 10.38 to − 3.96, p < 0.0001).Conclusions
Meta-analysis of individual patient data from randomized trials suggests that CCM has significant if somewhat modest benefits in improving measures of functional capacity and quality of life. 相似文献67.
目的比较手助腹腔镜活体供肾切取术(HLDN)和开放手术活体供肾切取术(ODN)的临床疗效,观察术后受者移植肾近期存活情况。方法回顾性分析中南大学湘雅三医院移植中心2004年1月至2013年11月完成的341例亲属活体肾移植供、受者资料。根据供者手术方式的不同,将其分为HLDN组(103例)和ODN组(238例)。比较两组受者手术时长、切口长度、供肾热缺血时间、肾动脉长度、肾静脉长度、术中失血量、围手术期芬太尼用量、术后非甾体抗炎药(NSAIDs)用量和术后恢复劳动天数。术后48h使用视觉模拟评分(VAS)法评估两组供者疼痛程度。术后随访供、受者恢复情况,并于术后7d、1个月复查受者肾功能。连续变量采用t检验进行比较,分类变量采用Fisher确切概率法进行比较。结果HLDN组和ODN组供者切口长度分别为(6.0±0.4)cm和(13.5±1.0)cm,术中失血量分别为(45±12)mL和(151±24)mL,差异均有统计学意义(t=73.56和42.56,P均〈0.05)。两组手术时长、供肾热缺血时间、肾动脉长度、肾静脉长度相比,差异均无统计学意义(t=1.39,1.70,0.00和1.85,P均〉0.05)。103例HLDN组供者中有102例顺利完成手术,1例主动中转开放,术后发生肺部感染1例,无术后切口感染及其他严重并发症。238例ODN组供者均成功完成手术,术后切口感染1例、脂肪液化2例,术后出血通过外科止血2例,无其他手术相关并发症。HLDN组和ODN组供者术后48hVAS分别为(2.3±0.6)分和(3.9±0.9)分,围手术期芬太尼用量分别为(1.7±0.2)mg和(1.9±0.2)mg,术后NSAIDs用量分别为(22±33)mg和(47±42)mg,术后恢复劳动天数分别为(23±10)d和(44±15)d,差异均有统计学意义(t=16.52,8.48,5.37和13.00,P均〈0.05)。两组供者术后7d、1个月血清肌酐水平相比,? 相似文献
68.
目的探讨儿童终末期肝病模型(PELD)评分系统用于预测婴幼儿活体肝移植预后的作用。方法回顾性分析2006年10月至2012年12月上海交通大学医学院附属仁济医院肝脏外科收治的101例小儿活体肝移植临床资料。患儿术前诊断均为胆道闭锁。术前对每例患儿进行PELD评分,根据PELD评分将患儿分为两组:低分组(PELD评分16分,62例)和高分组(PELD评分≥16分,39例)。比较两组患儿围手术期的基本情况及术后并发症发生率。结果两组患儿的手术年龄和体重差异均有统计学意义(均为P0.05),但两组性别、移植物(肝)重量/受体的体重、供肝冷缺血时间、术中失血量等差异均无统计学意义(均为P0.05)。PELD高分组患儿移植术后的肺部感染和胆道并发症发生率均明显高于低分组(均为P0.05)。结论术前PELD评分可用于预测婴幼儿肝移植的预后,为婴幼儿肝移植的围手术期的治疗、监护及护理措施的制定提供参考。对于术前PELD评分较高的患儿,应加强围手术期并发症的监护处理。 相似文献
69.
Karine de Lima Sírio Boclin Eduardo Faerstein Ant?nio Carlos Monteiro Ponce de Leon 《Revista de saúde pública》2014,48(2):249-257