Objective To investigate the management of donor livers in partial living liver transplantation.Methods Nine cases of partial living related donor liver transplantation in Kyoto University served as subjects.The donor liver perfusion time and method,and preparation and preservation were studied.Results The donor livers in 9 cases were successfully removed with the liver removal accounting for 20%to 29%of the total livers.The recipients were alive well.Conclusion The donor liver perfusion time and method.and preparation and preservation were the keys in partial living related donor liver transplantation.

Objective To discuss the treatment and prevention of bile duct complications after living donor liver transplantation. Methods The clinical data of 84 cases of living donor liver trans-plantation including 56 adult recipients and 28 pediatric recipients were analyzed. Amongst the 84 pa-tients, 66 had benign end-stage liver diseases and 18 hepatocellular carcinoma. Duct-to-duct biliary re-construction was performed in 50 cases. One recipient received an end-to-end and end-to-side anasto-mosis of hepatic duct of donor and hepatic duct and common bile duct of recipient and another under-went end-to-end anastomosis of hepatic duct of donor and hepatic duct and cystic duct of recipient while the other 32 cases hepaticojejunostomy. 4Fr or 6Fr stent was routinely inserted into bile duct af-ter biliary reconstruction and elicited from the anterior wall of common bile duct or lateral wall of jeju-nal caecum of recipient in all the 84 cases. Results Twenty-four cases had biliary complications and the incidence was 28.5 %. The incidence of biliary leakage was significantly different between duct-to-duct reconstruction and hepaticojejunostomy (8.3% νs 16.7%, P＜0.05). The incidence of biliary stricture was markedly different between duct-to-duct reconstruction and hepaticojejunostomy (50% νs 16.7%, P＜0.05). The biliary complication was remarkably different between single hepatic duct and multiple hepatic duct (20.8% νs 79.2, P＜0.05). Four cases of biliary leakage were cured with con-servative treatment and the other 4 need reoperation. Four cases of biliary stricture were cured by way of endoscopic dilation and nose-biliary drainage, 2 cases turned to be better. Six cases were cured by conversion of hepaticojejunostomy and 4 turned to be better by way of percutaneous transhepatic biliar-y dilation and drainage. The recipients didn't die of biliary complications. Conclusion It is necessary to decrease the biliary complications after living donor liver transplantation, to be satisfactory blood supply and anastomotic technigue and select appropriato biliary reconstruction.

OBJECTIVE:
This study aims to examine the awareness and ability of health care providers to cope with language barriers at medical facilities in Hyogo Prefecture, Japan, and to clarify the issues concerning health care for foreigners.
METHODS:
In total, 2100 copies of self-report questionnaires on issues of health care for foreigners were mailed to health care providers of 352 hospitals in Hyogo. The survey was conducted from February to March 2010.
RESULTS:
The response rate of medical facilities was 21.6% (76/352), whereas that of the health care providers was 15.2% (320/2100). Approximately 10% hospitals handled foreign patients at least once per month, and they dealt with patients using several languages, including English, Chinese, Korean, and others. The providers' main issue was communication with their foreign patients. The documents and booklets for guidance regarding some health care procedures at the hospitals were also poorly prepared. It is therefore exceedingly necessary for hospitals to provide common documents in different languages; moreover, the government or local authorities should arrange for public medical interpretation services.
DISCUSSION:
Medical facilities in Hyogo have been struggling to improve their linguistic capabilities, and it is difficult to indicate whether public organizations concerned with medical interpretation are being recognized. Efforts on the part of medical facilities and local and national governments, as well as cooperation of nonprofit organizations, are immensely essential to resolve the issue of multilingual health care. This survey suggests that to help people with diverse languages, the health care system in Japan should be improved rapidly, particularly with regard to the establishment of licensed professional medical interpreters.

Aneurysm of peripheral pulmonary artery was rarely reported. A 51-year-old man who was pointed out a coin lesion at the right hilus region on the chest X-ray film complained back chest pain. Selective pulmonary arteriography revealed the peripheral pulmonary aneurysm of saccular dilatation running into the middle lobe. Aneurysmectomy was performed successfully and the patient returned to social work. Pathologic specimen revealed partly necrosis of medial cell. Eleven surgical cases including this case were reported in Japan. A brief review of the literature was made.

The indications for living donor liver transplantation (LDLT) were successfully expanded from pediatric to adult cases last 15 years. During this process, graft type has been shifted from left side liver to right side liver. Although the introduction of right lobe graft can successfully increase the actual graft size in LDLT, problem related to "small-for-size grafts" have gradually come to light. "Small-for-size syndrome", such as poor bile production, delayed synthetic function, prolonged cholestasis, and intractable ascites, leading to septic complications and higher mortality, are neither specific nor inevitable in low-weight liver grafts. Many factors other than actual graft weight contribute to the occurrence of "small-for-size syndrome". In the clinical setting, surgical modification targeting portal hemodynamics and tissue congestion is a key to overcome "small-for-size syndrome". Until now, several therapeutic options were reported, but further elucidation of the pathogenesis in "small-for-size syndrome" will be a solution for improving the outcomes in adult-to-adult LDLT.
Humans ; Liver/*pathology/*physiopathology ; Liver Transplantation/*adverse effects ; *Living Donors ; Organ Size ; Transplants

A 51-year-old man admitted to our hospital because of an ECG abnormality pointed out by his local doctor. He had been hospitalized for scarlet fever at age 10. A coronary artery CT scan showed coronary artery aneurysm of the left main trunk (LMT), and coronary angiography showed 3-vessel disease including a chronic total occlusion of the right coronary artery (RCA). We performed conventional coronary artery bypass grafting (CABG) using an arterial graft and aneurysmectomy. The patency of the graft was confirmed by coronary angiography postoperatively. The pathological diagnosis of the coronary aneurysm was Kawasaki disease. CABG is a standard procedure for coronary artery aneurysms with Kawasaki disease. However, there are no established treatment guidelines on whether to perform aneurysmectomy. We chose CABG with aneurysmectomy because of the possibility of intra-aneurysmal thrombosis leading to peripheral occlusion, and the cause of the coronary artery aneurysm could not be determined. However, even if additional treatment by percutaneous coronary intervention (PCI) is not possible, it is important to avoid occlusion of the graft.

Cabrol's technique was performed on a patient with corrected transposition of the great arteries (SLL), complicated by annuloaortic ectasia (AAE) and aortic regurgitation (AR). The patient, a 52-year-old male, complained mainly of dyspnea on physical exertion. In 1983, he underwent implantation of a pacemaker to treat advanced atrioventricular block. In 1994, his cardiac function deteriorated to NYHA III. Cardiac catheter examinations exhibited 2nd degree Seller's aortic valve insufficiency and 2nd degree insufficient closure of the left atrioventricular valve. The patient was Cardell classification B3, with a Shaher Type 4 coronary artery. A composite graft was made using a 27mm St. Jude Medical valve and a 30mm woven Dacron graft. The left atrioventricular valve had three leaflets, accessible from the right atrium using the septal approach. Kay's method was used to suture the posterior leaflet and reduce regurgitation. The patient has made favorable progress during the two-year follow-up period.

In accordance with the advisory statement by the International Liaison Committee on Resuscitation and the Guidelines for Cardiopulmonary Resuscitation of the American Heart Association, we developed an advanced cardiac life support (ACLS) course for undergraduate medical students and assessed the effectiveness of and issues related to this program. A 2-day ACLS course with a special emphasis on MEGA code training was provided to 93 fifth-year medical students, after which evaluation testing was performed. Knowledge about airway management using airway adjuncts (correct response rate, 78.1% to 98.4%) and the treatment algorithms for ventricular fibrillation (81.3% to 95.3%) were well retained. However, knowledge about pharmacologic intervention was poorly learned. Most of the problems in the MEGA code algorithms for asystole and pulseless electrical activity were associated with drug administration. We conclude that this ACLS course for undergraduate medical students is effective but may not be sufficient for teaching certain aspects of ACLS.

This study was performed to clarify whether local anesthesia or sympathetic ganglion block abolishes the effects of electrical acupuncture (EA) on the autonomic nervous system or not.
Twelve healthy adult volunteers and 24 patients are divided into the following three experimental groups of each 12. EA was performed to the traditional acupuncture points on the meridians (H7; SHENMEN and CX4; HSIMEN). (1) In control group, only EA was performed. (2) In stellate ganglion block (SGB) group, EA was performed after unilateral SGB. (3) In local anesthesia (LA) group, EA was performed after local anesthesia on the same acupuncture points. The measured parameters on the autonomic nervous system functions were heart rates, R-R intervals in ECG, blood pressure and deep tissue temperature.
Results are as follows; Means of heart rate decreased significantly by EA in both control and SGB groups. Systolic blood pressure, diastolic blood pressure and RR-CV showed no significant changes by EA in all groups. Deep tissue temperature of the anterior forearm ipsilateral to the stimulation side decreased significantly by EA in SGB group. Deep tissure temperature of the anterior forearm contralateral to the stimuli decreased significantly by EA in both control and SGB groups. In LA group, however, all parameters were not changed by EA.
In summary, the effects of electrical acupuncture on the autonomic nervous system were not much different between control and SGB groups. It seems that one side of stellate ganglion block dose not interfere with the effects of acupuncture. On the other hand, any changes on the autonomic nervous system by electrical acupuncture were not observed in LA group. The fact showed that local anesthesia abolishes the effects of acupuncture on site. Local anesthesia blocks peripheral nerves and nerve endings. Therefore, we conclude that the effects of acupuncture on the autonomic nervous system are transmitted through the peripheral nerves, especially through the sensory nerves.